Wednesday, October 9, 2013

More Talk on Health Care

My wife and I had the chance to hear from one of the prominent experts in the health care field last night.

Arthur Garson is the former dean of the University of Virginia (UVA) medical school.  He remains active in the field as an advisor to a number of global health care initiatives, including the World Bank.  Dr. Garson has also co-authored a book on health care in the U.S. titled "Health Care Half Truths: Too Many Myths Not Enough Reality".

Dr. Garson was speaking at an event here in Boston sponsored by the UVA Club of Boston.  My daughter is a second year student at UVA.

I can't do justice to all of the remarks that Dr. Garson made over the course of his hour-long presentation, but I thought he made a number of points that you might find interesting:
  • On Obamacare:  the costs of the new program are clear but the savings are not.  Dr. Garson believes that the program does not address some of the fundamental issues in our health care system, and so is skeptical of its longer-term success.
  • On Our Health-Care System:  any way you measure it, our system does not stack up well versus a number of other health care systems throughout the world. We need to make fundamental changes;
  • On Medical vs. Health Care:  Dr. Garson believes it is important to make the distinction.  The quality of medical treatment varies widely across the U.S.  Boston hospitals are among the finest in the world, according to Dr. Garson, but other areas come up short (including New York City, surprisingly).  Health care - which encompasses the quality of life - is poor by a number of measures, including teenage pregnancy rates; teen suicide rates; infant mortality; and fatalities due to gun violence;
  • On Waste in Our Health Care System:  Most agree that hundreds of billions are wasted each year, yet the solutions are not easy.  Physicians often perform too many tests, but the reasons can vary (fear of lawsuits is one commonly-cited reason, but often it is just the doctor's style);
  •  Medicare:  Dr. Garson noted that no single factor has contributed more to the growth in medical spending than Medicare.  As an example, he noted that a patient with back pain is six times as likely to have spinal surgery in Miami (with a large elderly population) than Seattle.  While medicare reimbursement rates are often the subject of complaints, the volumes often make up for lower margins;
  • Doctor payments:  our medical system encourages doctors to do more procedures since they are paid by the number of procedures.  Paying doctors on a salary rather than a fee-for-service would be a much better way to contain costs;
  • End of Life Care:  Most cite the fact that 40% of a typical patient's health care spending occurs in the last year of their life.  Problem is, since there is no way of knowing your final date.  Dr. Garson cited the example of his two parents who were both diagnosed with lung cancer within weeks of each other. One died within three months, while the other died three years later.
Dr. Garson said that he and his co-author were working on a new version of his book, which should be coming out soon.  If you are at all interested this complex topic, it might be worth a read.