Product Description Health Care Half-Truths shows the ways in which American health care is tarnished and ways in which it shines, explaining that if we are going to make our health care system work, we must begin with the truth. In this book, Dr. Arthur Garson identifies twenty myths about the U.S. health care system and uses his extensive knowledge and keen insights to blow them apart.
Customer Reviews:
The book misses the major expense in health care. October 9, 2008
The changes outlined in the book are desperately needed so that we can delivery quality health care to the US population at a good value.
However, the book misses the 800 pound gorilla in the room; doctor's extraordinary incomes.
A good friend of mine is a lawyer who negotiates doctor's salaries as a business. We were discussing the situation with the cost of health care last week. He acknowledged that the problem of costly health care is never going to be solved unless this situation is brought under control.
Some little-known facts: The average MD income is close to $400K/year. Starting salaries for top-tier specialists (fresh out of residency) are typically in the range of $680K/year. After a few years, these same specialists expect an income in the range of $1.4M/year.
Based on the number of doctors in the US, and their average income, and the US GDP, approximately $1 in $20 spent in the US goes into a doctor's pocket.
If the American public, and business, learns about this situation, (and they will due to my lobbying and publicity efforts), something will be done to take care of the problem. A single-payer US health plan is long overdue, as are programs to increase the supply of doctors.
Health Care Half Truths Misses Some Big Issues June 28, 2008 1 out of 1 found this review helpful
This book does provide some good background into a lot of the various issues involved in our broken, health care system in the USA. For someone new to this field, Garson and Engelhard give some valuable insight into many of the complexities that have developed over the past 20 - 30 years. It does point out that there is a difference between medical care and health care. Obviously the medical care definition reflects a restricted scope and the rather obvious bias of a medical doctor. The authors contend that our USA medical care (the physician and patient relationship only)is about the best in the world; witness all the people who come to this country for surgery and complex medical care. However, the book is weak in identifying the shortcomings and errors in hospital service and doctor malpractice. A new emphasis on transparency in service and costs is not developed nearly as strongly as it should be.
Another subject that has not been investigated at all is the make-up of the uninsured 45 million residents in our country. Chapter 15, "Myth:People Who Work Can Afford Insurance" includes this one key sentence, "However, there are 11 million people -twenty five percent of the uninsured-who probably CAN afford health inssurance coverage, with family incomes over $50,000 (after all, the same family plan in the individual market used for our low income family would amount to less than ten percent of income)." That is all that is said in the entire book about this gross inequity between who pays and who doesn't. When Governor of MA, Mitt Romney's bi-partisan commission examined the uninsured in his state, it found that over 50% of those claiming uninsured status could afford a health insurance plan. In addition, the authors do not even examine the millions of federal, state, county and city public employees who have "first dollar" complete medical coverage as employees (and retires)for which they pay small (or zero) premiums, deductibles or co-pays. Local tax-payers subsidize these very inequitable medical expense plans that far exceed what the average worker in this country receives or can afford.
Unfortunately, this helpful book side steps the huge inequities in coverage and employee cost that present major distortions at the personal level in our health or medical care systems.
Another excellent book on the USA healthcare system May 31, 2008 3 out of 3 found this review helpful
Dr. Arthur Garson and Carolyn Engelhard both of the University of Virginia Medical School (at least according to the book jacket) have written a clear, intelligent, factually-based analysis of the healthcare system in the USA. The book is similar to A Second Opinion by another physician/academician/administrator, Dr. Arnold Relman, whose background seems to be similar to that of Dr. Garson. Both have experience and knowledge that permit them to accurately analyze and comment on the full range of issues from the science and practice of medicine to healthcare policy.
The tack that Dr. Garson and Ms. Engelhard have taken is to identify half truths in various segments of the healthcare system, then discuss what is the true half and what is the false half of each half truth.
The introduction to the book lists 20 myths (aka half truths) that are later treated in detail in each chapter. The first myth listed is "American medical care is second-rate compared with other countries", myth three is "American wastes one-half of its medical care dollars", "America will not ration medical care".
The authors briefly discuss each myth after stating it in the introduction. For that reason a busy policy-maker or other interested party could simply read the introduction to gain an excellent understanding of the current system and to understand which issues are the most salient and why. The introduction debunks virtually all of the unsubstantiated assertions that physicians, politicians and average patients/taxpayers assume to be true simply because they are constantly repeated.
As an example, in the first chapter after the introduction, the authors make the important distinction between the medical care/medical care costs and healthcare/healthcare costs. Almost universally, people make assertions about healthcare and healthcare costs when in fact they are discussing medical care and the costs of medical care.
Health outcomes are the key measures of the efficacy of the healthcare system in total of a given country or region as opposed to measures of the efficacy of the medical care system alone. The medical care system has a strong influence on health outcomes, but it is not the sole influence by long measure. Health outcomes are a function of many factors. The authors cite several. They include the per capita income of a country and its distribution, level of education, geography, genetics, social standing, personal behavior (i.e. use of harmful substances such as alcohol and tobacco), governmental public health policy and others.
Two statistics that the authors discuss in the first chapter are usually used as a proxy for the health status of a population: infant mortality and life expectancy. The USA scores poorly on both measures relative to other countries. The authors state that the USA's position is 23rd in the world in regard to life expectancy at birth. That depends on the report and year. The usual ranking puts the USA at close to 40th in that category and in infant mortality. Unacceptable situation by any measure, but abysmal when measured against medical care spending which on a per capita basis is more than 2 times the average of other OECD countries (the 30 largest industrialized countries by GNP). A mindboggling outlier status when one considers that almost all other OECD countries on a per capita basis, particularly when adjusted for per capita income, are quite close together around the mean. So much for health outcomes being second rate - they are.
On the other hand, the quality of medical care itself is generally excellent, although there is substantial variation in quality and in cost.
The book is an easy read, well-written and well-documented. The second half of the book is devoted to reviewing sources for each of the 20 chapters. The sources are good and fairly comprehensive. Each source is discussed briefly by the authors.
The book makes assessments of likely reforms to the healthcare system that will occur in coming decades. The analysis is thorough and intelligent. The last page of the next-to-last chapter (Chapter 19) lists characteristics of the American system that the authors feel have to be considered in order for any reform to be effectuated. Reform must be:
1. Consistent with the desires of lobbyists 2. Agreeable to private insurance companies 3. Accommodating to for-profit businesses and professions 4. Allowing of patient choice of provider 5. Without rationing, no to little waiting 6. Without mandates 7. Allowing of continuing employer payment of premiums 8. Without centralization in the federal government 9. Without incremental taxation 10. Granting at least a limited right to care for everyone
Personally I believe that the authors are too pessimistic regarding the potential for eliminating private insurance to be replaced with a single payer/insurer system. The current insurance/payment system is hugely wasteful in regard to resources - to the tune of hundreds of billions of dollars a year. There is a confluence of interests among businesses in their entirety, providers of all types and the general patient/taxpaying population towards realizing a single insurer/payer system. Resistance from the general public would dissipate with adequate explanation of the benefits to it of such a system. A united alliance of business as a whole and provider groups would overwhelm the lobbying of private insurers and likely pharmaceutical manufacturers/distributors on Congress that heretofore has been sufficient to foil any material change in policy.
In any case the analysis and recommendations that the authors provide are excellent, making this one more highly commendable book for interested readers.
Very clear, quick intro to US health care system in 2007 November 27, 2007 7 out of 7 found this review helpful
This book is an excellent, up-to-date overview of how the health care system works as of today. It assumes little prior knowledge, although you might have deeper understanding if you have some (they talk about the Clinton health care reform plan of 1994 but spend little time explaining what it would have done). The book is phrased as a series of "myths," but that seems to me just a gimmick that they fit around whatever they want to talk about. Who knew that a common myth was "People Who Work Can Afford Health Insurance?" It seems to me that the fact that they can't is rather well-known.
The authors' stated goal is to give factual information about the American health care system, and as such, the last half of the book is simply a references/further reading section. So the book is much shorter than it appears (but I think this is a strength, see below).
But there is some excellent stuff in here.
* They point out the leaps in some flawed arguments, like "The quality of care in the U.S. is bad because we have low life expectancy and high infant mortality." * They do puncture some real myths, like "half of all medical spending occurs in the last year of life." * They challenge some important story lines used by reformers, like "Preventive care saves money." (Sometimes it does, but many times it costs money. And the same for the opposite -- smoking usually saves money.) Another is "No Additional Money Is Needed To Cover The Uninsured" (a candidate favorite).
There are a few running themes throughout. Uninsured and underinsured people are bad for the system, and the system is bad for them. There are process and technology improvements that would be helpful in more efficiently providing medical care. Best practices don't spread throughout the medical professions as quickly as they could.
One thing this book does well is that it's scrupulously even-handed. You don't even have to open it to get a sense of this -- it has cover quotes from an aide to the new Democratic governor of Virginia, Newt Gingrich, the Brookings Institution, and the Heritage Foundation. There's stuff a single-payer advocate would love in here, but plenty of stuff to challenge the single-payer model as well.
But I think this book's greatest strength is that it provides a clear overview of where the system stands now, and does so in a read that can be done in a few hours. Absent the massive references section, we are talking about 156 pages, not particularly packed with words, and using prose that is mostly clear and not dense. I think the health-care debate last reached mass consciousness when the Clintons tried to pass their health-care reform in 1994. A lot has happened since then -- a lot of things of which I was not aware, or which I didn't understand very well. After reading, I have a much clearer picture of what the current laws are, who is covered by insurance, who usually isn't, what happens when people get sick, what the effects of some of the reform experiments of the last decade have been, what happened to the HMOs of the 1990s, and so forth.
I'd strongly recommend it for anyone interested in the system and thinking more deeply about how it should work. I would have limited my recommendation to laypeople like me, but the authors (both physicians) have convinced me that even practitioners aren't always aware of what's going on outside their immediate surroundings, so they might benefit by reading it too.
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