Arthur “Tim” Garson Jr., M.D., MPH, who leads the Texas Medical Center Health Policy Institute, is co-author of the book Health Care Half-Truths: Too Many Myths, Not Enough Reality. A physician and former medical school dean, Garson challenges commonly-held notions about the U.S. health care system. He spoke with Pulse about health care “myths.” This interview has been edited for clarity.
PULSE | Does the U.S. really have the best health care in the world?
TG | When you ask people whether the U.S. has the best health care in the world, the vast majority say “yes,” but when you ask how you measure that, you get blank stares. Two major measures are infant mortality and life expectancy. Depending upon the year, the U.S. ranks about 50th in each, which shocks people.
Medical care, on the other hand, is what doctors and nurses and patients do together. How many breast cancer screenings do we perform? What’s the mortality rate for coronary bypass? We are good at a few things—for example the U.S. ranks first in breast cancer mortality. But in the overall index of the rate of preventable deaths, we’re at the bottom of wealthy countries, ranked 18 out of 18.
There’s a frequently cited paper that says 10 percent of life expectancy is due to medical care, and 90 percent is the other things, including 40 percent that is due to people’s own behavior. If we want to improve health care, we can do a lot more by helping people quit smoking, overeating, doing drugs and committing murders.
PULSE | We hear all the time about how preventive care can save money, but you argue that’s not really the case. Could you elaborate?
TG | Let’s be really clear: prevention is important and must be done. But it rarely saves money. There are a lot of things that we do that are good for all kinds of reasons but don’t save money. In the case of prevention, saving money isn’t the point. The point is to keep people healthy.
For example, do immunizations save money? Measles immunizations do, because measles can result in a person becoming brain damaged, living a long time and requiring lots of expensive care. Preventing measles saves money. Some of the other immunizations are important to keeping people healthy, but they just don’t save money.
Here’s a real paradox: In a really well-done study, it was shown that over a very long time frame, smoking actually saves money. Why? If you smoke, you die earlier, and you don’t spend money over the course of a longer life.
PULSE | One of the things we’ve heard during the debates about health reform is that people can get insurance if they just go to work. Should we believe that?
TG | No. Uninsured people work. Data show that more than 70 percent of uninsured people come from working families. The real problem is that many of these people work for employers who aren’t offering insurance to their workers. Fewer than half of small businesses offer health insurance to their workers, according to the Kaiser Family Foundation.
As we discuss and debate the future of health care in this country, it’s important to understand that today, having a job doesn’t necessarily equate to having insurance.
PULSE | You published your book 10 years ago. How have your attitudes about the health care system changed?
TG | I’m more pessimistic now. In 2017, we were just one vote away from taking health insurance away from 20 million people, instead of giving health insurance to more people. I hope that’s a short-term aberration, rather than a view from our leaders who’ve decided the best thing we can do as a country is take health care away from 20 million people.
I was more optimistic in 2007. The last chapter of the book predicted that we would get a better health care system, but it would take a major disaster of some sort. I was wrong. We had the financial collapse in 2008, and despite the Affordable Care Act, there was no fundamental change to health policy. At some point, we’ll have a real safety net system, like just about every other country. We’re the only outlier. What I don’t know is what it will take for us to get there. But we have to keep trying.
Want to learn about more health care myths? Attend the TMC Health Policy Institute’s event: “True or False? A discussion challenging everything you think you know about health care.” 5:30–7 p.m. on Jan. 9, 2018, at the TMC Health Policy Institute, 6550 Bertner Ave., 6th floor. Free; registration required.
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Today’s #VeteranOfTheDay is Army Veteran Bernard Horowitz. Bernard served during World War II from 1943 to 1945.Bernard Horowitz was drafted into the Army in 1943. He had wanted to enlist earlier, but since his other brother was already serving his mom did not want him to serve as well so she would not give him permission. He went to Camp Grant in Illinois where he first did some clerical training. Bernard was then trained to be a medic and learned how to bandage people and care for them on the battlefield. He was then assigned to the battalion headquarters as a battalion clerk. It was his job to be in charge of the rations for all four companies at Camp Grant. Bernard made sure they got all the necessary food and that at the end of training there would be enough food to throw a party for the soldiers. Next, Bernard was transferred to a base in Wisconsin where he was responsible for discharging soldiers. While he was there, he fired a gun for the first time with no training and ended up with a swollen lip from the kick of the gun.Bernard was later assigned to the 553rd Military Police Escort Guard and sent over to Europe. He stopped in England then landed in France a few days after D-Day. One of his jobs was to guard prisoners and take them to bury dead cattle. Bernard also did traffic control when the Allies cut off the Cherbourg Peninsula. At one point, Bernard was on his way to Versailles to watch over prisoners there when he passed by a howitzer company and saw one of his cousins. During his free time, Bernard liked to listen to the radio that his whole squad had chipped in and bought to share. After the war was over, he went to Frankfurt, Germany for occupation duty and was discharged on December 7, 1945, exactly 4 years after the United States had entered the war. When Bernard got home, he attended design school and joined an organization for Jewish Veterans.Thank you for your service, Bernard!
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