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Exposing the Twenty Medical Myths: Why Everything You Know about Health Care Is Wrong and How to Make It Right
Despite intense political focus and debate for the past 10 years, Americans remain deeply worried about the availability and affordability of health care for themselves and their families. In clear and accessible prose, journalist Ryan Holeywell and medical doctor and health policy expert Arthur Garson provide Americans with the tools we need to have an honest, unbiased view of the state of health care policy in America. By fact checking 20 enduring health care myths they move the debate beyond Obamacare v. repeal and replace and give citizens the tools they need to evaluate the major policy issues confronting our health care system.
- GenresHealth
272 pages, Hardcover
Published October 22, 2019
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December 3, 2019
Exposing the 20 medical myths, Arthur Garson & Ryan Holeywell, 2019, 257pp.
ISBN 9781538131183
Dewey 362.10973
Library-of-Congress RA425
The "Affordable Care Act" (Obamacare) insured 20 million more Americans, but did not reduce costs. p. x. Thirty million remain uninsured. p. 9.
1 US care is best.
No.
2. US care is cheaper.
No. US MRI $3,000+; Australia $215. [Are those the total amounts the hospital bills the patient + the insurance company + the government?] p. 11
3. US wastes 10%.
No. 33%. Over half of that is administrative waste and overcharges. Others are overtreatment & mistreatment. p. 27. [How does that relate to the immense price difference between US procedures & same procedures in other countries, as on p. 11? For those procedures, isn't it over 90% waste due to overcharges?]
4. Most spending is in last 6 months of life.
No. Medicare spends 25% on patients who die that calendar year. [which on a rough average would be those who will die in the next 6 months.] Medicare spends 4 times as much on patients who died as on all others combined. [That means Medicare spends 80% on patients who die, 20% on all others: 4 to 1. Which is it?]
5. US care is consistently good.
No.
6. Patients decide best.
No.
7. Prevention saves money.
No.
8. US won't ration care.
No.
9. US has too few MDs.
No.
10. Malpractice suits protect patients.
No.
11. US has a safety net.
No.
12. Workers can afford care.
No.
13. Emergency room suffices for uninsured.
No.
14. The market can fix it.
No.
15. Providers should be paid by the task.
No.
16. US can't ever reduce medical costs.
No.
17. Americans are like everyone else.
No. [Trots out supposed unique American traits like individualism. What's /really/ unique here is how far concentrated wealth has gone toward capturing government policy. Obama, Labor Day 2009: "The insurance industry should be free to make a profit." http://worleydervish.blogspot.com/200... more: http://worleydervish.blogspot.com/sea...
US never got national medical insurance thanks to the American Medical Association, which wants no government controls on what physicians can charge ("thanks for the government-funded medical education, go away now"). And, whites were afraid universal medical coverage would treat blacks in white hospitals.]
18. Previous reform attempts have taught us little.
No.
19. Americans can't agree on goals.
No.
20. Nothing will work for US.
No.
The book is dedicated to Uwe Reinhardt (1937-2017), who clearly explained medical-care-payment issues. https://www.goodreads.com/author/list...
Carolyn Englehard's 2007 book, /Healthcare Half-Truths/, inspired this one. p. x. "The questions are the same now, but the answers are different."
[A terrific book is T.R. Reid, /The Healing of America/. Positive, insightful.]
ISBN 9781538131183
Dewey 362.10973
Library-of-Congress RA425
The "Affordable Care Act" (Obamacare) insured 20 million more Americans, but did not reduce costs. p. x. Thirty million remain uninsured. p. 9.
1 US care is best.
No.
2. US care is cheaper.
No. US MRI $3,000+; Australia $215. [Are those the total amounts the hospital bills the patient + the insurance company + the government?] p. 11
3. US wastes 10%.
No. 33%. Over half of that is administrative waste and overcharges. Others are overtreatment & mistreatment. p. 27. [How does that relate to the immense price difference between US procedures & same procedures in other countries, as on p. 11? For those procedures, isn't it over 90% waste due to overcharges?]
4. Most spending is in last 6 months of life.
No. Medicare spends 25% on patients who die that calendar year. [which on a rough average would be those who will die in the next 6 months.] Medicare spends 4 times as much on patients who died as on all others combined. [That means Medicare spends 80% on patients who die, 20% on all others: 4 to 1. Which is it?]
5. US care is consistently good.
No.
6. Patients decide best.
No.
7. Prevention saves money.
No.
8. US won't ration care.
No.
9. US has too few MDs.
No.
10. Malpractice suits protect patients.
No.
11. US has a safety net.
No.
12. Workers can afford care.
No.
13. Emergency room suffices for uninsured.
No.
14. The market can fix it.
No.
15. Providers should be paid by the task.
No.
16. US can't ever reduce medical costs.
No.
17. Americans are like everyone else.
No. [Trots out supposed unique American traits like individualism. What's /really/ unique here is how far concentrated wealth has gone toward capturing government policy. Obama, Labor Day 2009: "The insurance industry should be free to make a profit." http://worleydervish.blogspot.com/200... more: http://worleydervish.blogspot.com/sea...
US never got national medical insurance thanks to the American Medical Association, which wants no government controls on what physicians can charge ("thanks for the government-funded medical education, go away now"). And, whites were afraid universal medical coverage would treat blacks in white hospitals.]
18. Previous reform attempts have taught us little.
No.
19. Americans can't agree on goals.
No.
20. Nothing will work for US.
No.
The book is dedicated to Uwe Reinhardt (1937-2017), who clearly explained medical-care-payment issues. https://www.goodreads.com/author/list...
Carolyn Englehard's 2007 book, /Healthcare Half-Truths/, inspired this one. p. x. "The questions are the same now, but the answers are different."
[A terrific book is T.R. Reid, /The Healing of America/. Positive, insightful.]
July 8, 2019
The American healthcare system, or nonsystem as Dr. Arthur Garson Jr. and Ryan Holeywell call it in Exposing The Twenty Medical Myths, is not only bad (life expectancy is 43rd in the world), it is framed in myths and falsehoods. The book shows in no uncertain terms how and why the stories we read are generally wrong, the complaints misguided, and the situation even worse than we think we know.
This is the 36th book on healthcare that I have reviewed, and I can quickly and easily say Exposing The Twenty Medical Myths is the most important book on American healthcare yet. It is focused, clear, organized, cogent, helpful and fair to all. It is carefully written at a lowest common denominator level, with no five dollar words, no hyphenated Latin and no attempt to hide the diagnosis from the patient.
Dr. Garson began as a pediatric cardiologist. He helped a little girl stabilize and survive, and watched her grow to adulthood, becoming personally close with the entire family. One day he took a call from the girl’s mother. The girl had dropped dead after running out of meds. She was 19, and Medicaid had cut her off because – she turned 19. This incident changed his outlook and Dr. Garson moved into the policy and management arenas.
We all think we know about waste in American healthcare, but Garson and Holeywell break out the sickening numbers. Of the one trillion dollars a year that are wasted, $192 billion go to overtreatment (unnecessary tests, procedures and treatments). They say doctors demonstrate an “entrepreneurial spirit”, piling up charges wherever possible. They are encouraged in this by the system, where doctors are self-employed contractors, paid by the piece (“fee for service”). It can also be defensive, as in avoiding malpractice suits and the accompanying insane insurance premiums. When doctors are salaried, overtreatment drops 9-33%. Remarkably, doctors want to get off this hamster wheel too. 69% would prefer a salary plus bonus for positive outcomes. The top hospitals use this adult system, but not insurers or government.
There are calls we aren’t making. Health issues from high cholesterol levels cost $10.8 billion a year to remedy. These costs could be greatly reduced if all people with heart disease took statins daily as prescribed. However, the statins would cost more than $28 billion a year, two and a half times as much. Similarly, the cost of regulating high blood pressure in the entire population is three or four times the cost of treating those adversely affected by it. The authors examine the tradeoffs and point out where not only the system, but we ourselves have been wrong in our arguments. Prevention is not automatically better.
There is incredible bureaucracy. With all the coding necessary to appease insurance companies and government programs for payment, 25% of expenditures go to administration, not care. The book points to Duke University Hospital, where the 900-bed facility employs 1300 full time bill coding specialists. With a single payer system, there would be an instant massive reduction in expenditures and pricing.
So-called corporate wellness programs not only don’t save companies money, they lose money on them. Pointless tests, misinterpreted results and the simple fact that young people won’t feel the bad effects of their abusive lifestyles until much later, mean the whole effort is a loss for the employer. Not to mention employee resentment at the intrusiveness of questionnaires and wristband personal trackers. Surveillance is not healthcare. And the accompanying threats are not welcomed.
Back on the Medicaid front, most recipients already work, but their employers offer no health insurance. So changing the laws to force Medicaid recipients to work in order to receive coverage is largely meaningless. 75% of the uninsured have at least one full time employed person in the family (but the employer offers no insurance). People 19-64 without health insurance die 40% more than those with health insurance.
The best way I can describe what’s going on in Exposing The Twenty Medical Myths is to simply list the chapters, something I have never done before in a review. But the titles are so descriptive and enticing they speak volumes by themselves:
1 Myth: US Health Care Is the Best in the World
2 Myth: In Many Ways, US Health Care Is Cheaper than Other Countries’
3 Myth: The United States Wastes One in Every Ten Medical-Care Dollars
4 Myth: Most Medical-Care Dollars Are Spent in the Last Six Months of Life
5 Myth: The United States Consistently Provides High-Quality Medical Care
6 Myth: Consumers Make the Best Decisions about Their Medical Care
7 Myth: Preventive Care Saves Money
8 Myth: The United States Will Not Ration Medical Care
9 Myth: The United States Faces a Dangerous Shortage of Doctors
10 Myth: The Current Malpractice System Protects Patients
11 Myth: In the United States There Is a Safety Net of Government Health Programs for the Poor
12 Myth: People Who Work Can Afford Health Insurance
13 Myth: The Uninsured Get Adequate Care in the Emergency Department
14 Myth: The Market Can Fix Health Care
15 Myth: Doctors and Hospitals Should Be Paid Separately for Each Service They Perform
16 Myth: The United States Will Never Be Able to Reduce the Cost of Medical Care
17 Myth: When It Comes Right Down to It, Americans Are Like Everyone Else
18 Myth: Previous Attempts at Health-Care Reform Have Taught Us Very Little
19 Myth: Americans Are So Divided That We Can’t Even Agree on Goals for Our Health Care
20 Myth: There Is No Health-Care System That Will Work for the United States
One of the core facts behind America’s spending is a misconception about what medical care can achieve. The authors say 40% of life expectancy comes down to personal behavior. Only 10% of life expectancy can be attributed to medical care. Between self-destructive tendencies and waste in the system, America pointlessly spends trillions annually.
There is a terrific, intelligent discussion of the medical food chain. As the doctor shortage worsens (and doctors collect in big cities), primary care doctors will take on more of the responsibilities of specialists. Nurse-practitioners will take on more of the functions of primary doctors, and technicians will perform more of the routine tests. This “task shifting” should make appointments easier to get and cheaper to perform. Patients themselves will take on more responsibilities through phone and computer apps and home versions of test equipment. Telemedicine will help make up for the lack of rural doctors. Artificial intelligence will help make more accurate decisions right over the phone with a consulting nurse. Finally, leaps into gene modification might begin to lessen the need for constant checkups and monitoring chronic diseases.
As for value received, value is defined as quality divided by cost. If the cost increases without improvements in care, the value decreases as the system heads into volume-based care instead of value-based. This brings up the only obvious omission I could find: shopping. Hospitals will not tell patients what a procedure costs. The truth is they make it up afterwards, jacking it as high as possible, knowing the insurers will knock it down. There is zero transparency for the patient, and looking for value is impossible in the USA.
Exposing The Twenty Medical Myths is a remarkable achievement. In just 210 pages, it captures the essence of the situation and explains it rationally and fairly, backed by facts, figures and direct experience managing the system. It is a sane analysis of an insane nonsystem where the quality of patients’ healthcare varies directly with the quality of their jobs. This is unique in the world and in no way desirable, fair or workable, but the edifice is so huge and convoluted, it pretty much has to continue. Insurers want to profit, government wants out, and patients are caught in the middle, paying more than 30% of their income for coverage at average figures. It’s all just wrong, and the stats show it definitely isn’t working.
But now you will at least know why.
David Wineberg
This is the 36th book on healthcare that I have reviewed, and I can quickly and easily say Exposing The Twenty Medical Myths is the most important book on American healthcare yet. It is focused, clear, organized, cogent, helpful and fair to all. It is carefully written at a lowest common denominator level, with no five dollar words, no hyphenated Latin and no attempt to hide the diagnosis from the patient.
Dr. Garson began as a pediatric cardiologist. He helped a little girl stabilize and survive, and watched her grow to adulthood, becoming personally close with the entire family. One day he took a call from the girl’s mother. The girl had dropped dead after running out of meds. She was 19, and Medicaid had cut her off because – she turned 19. This incident changed his outlook and Dr. Garson moved into the policy and management arenas.
We all think we know about waste in American healthcare, but Garson and Holeywell break out the sickening numbers. Of the one trillion dollars a year that are wasted, $192 billion go to overtreatment (unnecessary tests, procedures and treatments). They say doctors demonstrate an “entrepreneurial spirit”, piling up charges wherever possible. They are encouraged in this by the system, where doctors are self-employed contractors, paid by the piece (“fee for service”). It can also be defensive, as in avoiding malpractice suits and the accompanying insane insurance premiums. When doctors are salaried, overtreatment drops 9-33%. Remarkably, doctors want to get off this hamster wheel too. 69% would prefer a salary plus bonus for positive outcomes. The top hospitals use this adult system, but not insurers or government.
There are calls we aren’t making. Health issues from high cholesterol levels cost $10.8 billion a year to remedy. These costs could be greatly reduced if all people with heart disease took statins daily as prescribed. However, the statins would cost more than $28 billion a year, two and a half times as much. Similarly, the cost of regulating high blood pressure in the entire population is three or four times the cost of treating those adversely affected by it. The authors examine the tradeoffs and point out where not only the system, but we ourselves have been wrong in our arguments. Prevention is not automatically better.
There is incredible bureaucracy. With all the coding necessary to appease insurance companies and government programs for payment, 25% of expenditures go to administration, not care. The book points to Duke University Hospital, where the 900-bed facility employs 1300 full time bill coding specialists. With a single payer system, there would be an instant massive reduction in expenditures and pricing.
So-called corporate wellness programs not only don’t save companies money, they lose money on them. Pointless tests, misinterpreted results and the simple fact that young people won’t feel the bad effects of their abusive lifestyles until much later, mean the whole effort is a loss for the employer. Not to mention employee resentment at the intrusiveness of questionnaires and wristband personal trackers. Surveillance is not healthcare. And the accompanying threats are not welcomed.
Back on the Medicaid front, most recipients already work, but their employers offer no health insurance. So changing the laws to force Medicaid recipients to work in order to receive coverage is largely meaningless. 75% of the uninsured have at least one full time employed person in the family (but the employer offers no insurance). People 19-64 without health insurance die 40% more than those with health insurance.
The best way I can describe what’s going on in Exposing The Twenty Medical Myths is to simply list the chapters, something I have never done before in a review. But the titles are so descriptive and enticing they speak volumes by themselves:
1 Myth: US Health Care Is the Best in the World
2 Myth: In Many Ways, US Health Care Is Cheaper than Other Countries’
3 Myth: The United States Wastes One in Every Ten Medical-Care Dollars
4 Myth: Most Medical-Care Dollars Are Spent in the Last Six Months of Life
5 Myth: The United States Consistently Provides High-Quality Medical Care
6 Myth: Consumers Make the Best Decisions about Their Medical Care
7 Myth: Preventive Care Saves Money
8 Myth: The United States Will Not Ration Medical Care
9 Myth: The United States Faces a Dangerous Shortage of Doctors
10 Myth: The Current Malpractice System Protects Patients
11 Myth: In the United States There Is a Safety Net of Government Health Programs for the Poor
12 Myth: People Who Work Can Afford Health Insurance
13 Myth: The Uninsured Get Adequate Care in the Emergency Department
14 Myth: The Market Can Fix Health Care
15 Myth: Doctors and Hospitals Should Be Paid Separately for Each Service They Perform
16 Myth: The United States Will Never Be Able to Reduce the Cost of Medical Care
17 Myth: When It Comes Right Down to It, Americans Are Like Everyone Else
18 Myth: Previous Attempts at Health-Care Reform Have Taught Us Very Little
19 Myth: Americans Are So Divided That We Can’t Even Agree on Goals for Our Health Care
20 Myth: There Is No Health-Care System That Will Work for the United States
One of the core facts behind America’s spending is a misconception about what medical care can achieve. The authors say 40% of life expectancy comes down to personal behavior. Only 10% of life expectancy can be attributed to medical care. Between self-destructive tendencies and waste in the system, America pointlessly spends trillions annually.
There is a terrific, intelligent discussion of the medical food chain. As the doctor shortage worsens (and doctors collect in big cities), primary care doctors will take on more of the responsibilities of specialists. Nurse-practitioners will take on more of the functions of primary doctors, and technicians will perform more of the routine tests. This “task shifting” should make appointments easier to get and cheaper to perform. Patients themselves will take on more responsibilities through phone and computer apps and home versions of test equipment. Telemedicine will help make up for the lack of rural doctors. Artificial intelligence will help make more accurate decisions right over the phone with a consulting nurse. Finally, leaps into gene modification might begin to lessen the need for constant checkups and monitoring chronic diseases.
As for value received, value is defined as quality divided by cost. If the cost increases without improvements in care, the value decreases as the system heads into volume-based care instead of value-based. This brings up the only obvious omission I could find: shopping. Hospitals will not tell patients what a procedure costs. The truth is they make it up afterwards, jacking it as high as possible, knowing the insurers will knock it down. There is zero transparency for the patient, and looking for value is impossible in the USA.
Exposing The Twenty Medical Myths is a remarkable achievement. In just 210 pages, it captures the essence of the situation and explains it rationally and fairly, backed by facts, figures and direct experience managing the system. It is a sane analysis of an insane nonsystem where the quality of patients’ healthcare varies directly with the quality of their jobs. This is unique in the world and in no way desirable, fair or workable, but the edifice is so huge and convoluted, it pretty much has to continue. Insurers want to profit, government wants out, and patients are caught in the middle, paying more than 30% of their income for coverage at average figures. It’s all just wrong, and the stats show it definitely isn’t working.
But now you will at least know why.
David Wineberg
August 2, 2019
I received this ARC in exchange for an honest review through NetGalley.
I’m a healthcare nut — I study healthcare, work in healthcare, and live in the industry. So when I picked this up I was looking for an interesting read on the industry, but found myself quickly skipping through pages.
I found this to be a really dry read. It feels like it’s meant for clinical staff, mainly physicians, to understand the state of the healthcare industry in the United States. There’s a lot of explaining of terminology that I already knew working back end but that someone in the clinical realm often doesn’t know.
While I think this might be a good educational read for someone with little exposure to healthcare, I quickly found myself bored with the content.
I’m a healthcare nut — I study healthcare, work in healthcare, and live in the industry. So when I picked this up I was looking for an interesting read on the industry, but found myself quickly skipping through pages.
I found this to be a really dry read. It feels like it’s meant for clinical staff, mainly physicians, to understand the state of the healthcare industry in the United States. There’s a lot of explaining of terminology that I already knew working back end but that someone in the clinical realm often doesn’t know.
While I think this might be a good educational read for someone with little exposure to healthcare, I quickly found myself bored with the content.
July 11, 2019
I really learned alot from this book. From how much does medical care really help a person's life expectancy, spoiler...10%, to how to better streamline the health care system for better savings.
I really enjoyed the knowledge and simple way in which the authors convey the complicated reality of the American Health care.
I learned a ton and will try to incorporate as much information into my own medical decisions as possible.
One small criticism is that by Myth number 16, I felt that the author were just rehashing what they had already covered.
I suppose they felt they needed to carry onto 20. Nice round number.
I really enjoyed the knowledge and simple way in which the authors convey the complicated reality of the American Health care.
I learned a ton and will try to incorporate as much information into my own medical decisions as possible.
One small criticism is that by Myth number 16, I felt that the author were just rehashing what they had already covered.
I suppose they felt they needed to carry onto 20. Nice round number.
April 14, 2020
Certainly a book with a lot of statistics and some studies to debunk some myths. However, the author has some wrong concepts on economics and law (understandable), which somehow puts into question some conclussions that are drawn.
July 9, 2019
Exposing the Twenty Medical Myths is a interesting and informative book. The has have done their research. Well written and everyone should read it.
September 22, 2019
The author's painstaking research and attention to detail is obvious in the writing of this book. There were many facts that I only discovered after reading this!
Displaying 1 - 7 of 7 reviews