Checking In With Dr. Arthur Garson On ‘Health Care Half Truths’

Even before the health reform debate became a bitter partisan fight, Dr. Arthur Garson, Jr., kept a close eye on health care sound bites and myths. He co-wrote a book debunking the top twenty myths on cost, coverage and quality issues: “Health Care Half Truths: Too Many Myths, Not Enough Reality.” He says that the massive amount of confusion plaguing reform efforts confirms just how pervasive such myths continue to be.

As the executive vice president and provost of the University of Virginia, Garson pushes for better understanding of the health care system by the public, policy makers and industry professionals. He began his medical career as a pediatric cardiologist and was president of the American College of Cardiology.

KHN’s Jessica Marcy recently spoke to Garson, here are edited excerpts of the interview:

Were there any specific myths that emerged that you found particularly common or damaging in the health care debate?

There is a myth that there is a government safety net for everybody.

Medicaid largely only covers people under 19 and over 65. The U.S. has not covered these people for 50 years. Now, all of a sudden, about 60 percent of them will be covered and everybody’s saying, ‘My goodness, look at how expensive that is.’ Well, yes, they’ve been that expensive for a long time. But, it seems to me it’s the right thing to do.

There’s another myth that says people who work can afford health care. About 80 percent of uninsured people work, but people who are working fulltime in low wage jobs can’t afford insurance. That’s the reason there’s a subsidy. But, again people seem to have forgotten that.

The final myth is that money is available in the system and we don’t need any more. We waste about a third of our health care dollars – about $700 billion – which is an awful lot of money. The people who created this legislation were thinking that since there is that much waste in the system, we ought to be able to get that out. The real question is can they find it and actually use it to cover the uninsured. That’s proving to be difficult.

How does the difference between medical care and Americans’ health play into myths about reforming our national health care system?

There’s a myth that American medical care is terrible and it’s not. American medical care – the things that doctors and nurses do – is moderately good, but American health care is terrible. We’re like 45th in the two major indexes of health care: life expectancy and infant mortality.

So how does that play out in the [health law]? The two major things that we can do something about are lifestyle and access. People will live longer if they don’t smoke, if they’re not 300 pounds, if they don’t do drugs and if they don’t kill each other. People will also live longer if they can get to see the appropriate health care provider at the appropriate time. But you can’t just fix medical care and expect health to get better.

With so much misinformation and confusion, how can people wade through it all to find accurate, balanced information?

There are three things that might help to put things into perspective. One, the public has a right to a single, seamless government safety net. Every other country in the world has one. But, people ought to pay for it to the extent they can and should not expect it to be cheap. We probably also can’t expect them to do it voluntarily.

Two, there’s a lot of waste in the system, but it’s going to take a multi-factorial way to find that money that comes in drips and drabs, and apply it to the uninsured.

Third, we have to change the delivery system and start to consider the patient as a part of the [medical] workforce. They can take part in their own health care and should have higher insurance premiums if they are persistent in smoking and weighing 300 pounds. We should change the scope of practice for what nurses can do, as the Institute of Medicine recommended but we should do it carefully and based on evidence. Finally, we want to think about the use of non professionals to do what they can be trained to do. That is my whole Grand-Aides program, which uses well-trained and supervised laypeople [to work as bridges between patients and health care workers]. 

If you had to write an addendum to your book following the passage of the health law, what might you add?

In the book, we did point out that the states are different and that some reform may wind up through the states. I find it very interesting that the current act really gives a lot of responsibility to states in how they’re going to deal with insurance exchanges and delivery systems, especially whether they’ll be private or public and whether the states will want to opt in or opt out. The states are really different laboratories. State innovation is alive and well and I think we’ll see a lot more of that.