Garson champions health care reform
Proposing new category of coverage for those
By Kathleen D. Valenzi
Arthur Tim Garson Jr., dean of the U.Va. Medical
School, has a long-standing interest in health policy reform
and its personal.
the late 1980s, while serving as chief of pediatric cardiology
at Baylor College of Medicine in Texas, Garson received devastating
news. One of his long-term patients, a young woman with chronic
heart-rhythm problems whom he had begun treating when she was
only 5 and had watched grow up, had died a preventable death shortly
after her 20th birthday.
the time she was 20, her Medicaid benefits had run out,
Garson said. She never filled a prescription for the drugs
she needed in order to control her heart rhythm.
Garson, a proponent of every citizens right to affordable,
accessible health care, the death of this young woman was the
final straw. He could no longer simply talk among his colleagues
about the need for health care reform. He needed to and
has become one of reforms public champions, writing
national policy reports and White House briefing papers, drafting
state legislation related to health policy, and serving on a variety
of opinion-swaying boards such as the National Advisory Council
of the Agency for Healthcare Research and Quality.
with a presidential election little more than a year away, Garson
is paying close attention to the platforms that contenders for
the White House are beginning to articulate. One common element
he has observed is a laudable desire to make sure that every citizen
has health care coverage.
Arthur Garson Jr., M.D., M.P.H.
Vice President and Dean of the
School of Medicine
James Carroll Flippin Professor in
Garson assumed the position of Dean of the School of Medicine
and Vice President of the University of Virginia in June
2002. He graduated from Princeton University in 1970 and
received his M.D. from Duke University in 1974, remaining
there for his pediatric residency. In 1979, he completed
a pediatric cardiology fellowship at Baylor College of Medicine
and joined its faculty in 1985. He was named chief of pediatric
cardiology in 1988.
1992, he received a masters degree in public health,
specializing in health policy and health care finance, from
the University of Texas in Houston, and he was recruited
to Duke to be associate vice chancellor of health affairs.
While there, much of his work focused on health policy.
Three years later he returned to Houston and became senior
vice president and dean for academic operations at Baylor
and vice president of Texas Childrens Hospital.
Garson has an extensive history of national and international
service to the field of pediatric cardiology, specifically
in the area of sudden death in children and adolescents.
He was president of the American College of Cardiology from
2000-2001, and he continues to serve on its Board of Trustees
and on several of its committees, including Government Relations
and Quality of Care.
serves on the Agency for Healthcare Research and Quality
National Advisory Council. In 2001, he was appointed a member
of a White House Advisory Panel on Health System Improvement.
Dr. Garson helps strengthen and guide medical education
through his service to the Association of American Medical
Colleges, the University Hospitals Consortium and the Association
of Academic Health Centers.
July 2, 2002
said, 41 million Americans do not have coverage. That number
represents more people than the combined populations of Canada
and Australia. Further, because people are constantly losing
or changing jobs, the number of uninsured Americans can and does
routinely spike up to as high as 70 million during the course
of a given year.
17 percent of the nations uninsured are in families without
jobs, Garson said. The rest work for small businesses that cant
afford to provide health benefits, or they are self-employed.
their sizable numbers collectively, the uninsured as a group still
reflect only 15 percent of the total U.S. population a
number small enough to be ignored by many legislators. Fifteen
percent is a small number to those counting votes, but 40 million
people is a huge problem, he said.
has observed that recent health reform proposals do not attempt
to revamp the current system entirely. Its appropriate,
he said, that in almost all of them, three elements of the system
remain the same: Medicare for those age 65 and older, the Veterans
Health Administration for individuals meeting certain criteria
(for example, veterans with service-related disabilities) and
group plans offered by large companies to their employees.
leaves two questions for consideration, Garson said. How
will we handle the poor? and How will we handle those
who earn above a certain poverty level but who do not work for
present, children and the elderly with low incomes have access
to health care through Medicaid, a joint state and federal health
program, while children in families slightly more well-off are
served by fill-in programs, like the State Childrens Health
Insurance Program. But still, there is no safety net
in most states for anyone between 19 and 64 years of age.
Garson would prefer to see and has proposed is a
new category of coverage. It would take people who are under 150
percent of the federal poverty level, or less than 65 years old
who are not eligible for any other program, and pool them into
a health plan that would be administered by the state and paid
for with matching federal funds, like the Medicaid and SCHIP programs.
other group to be served includes people who make more than 150
percent of the poverty level but cannot afford health insurance.
Most work for small businesses. They need to have a mechanism
for pooling their risk and making their premiums similar to those
who work for large employers, Garson said. Such a pooling would
give states the ability to negotiate the best rates for a particular
set of benefits in a similar way as the Federal Employee Health
the problem is complex, it is unlikely to be solved anytime soon.
of us believe it will take some worsening crisis to jump-start
real reform, Garson said. In my mind, the catalyst will
be related to cost. Despite all the efforts to reduce waste, costs
are going to continue to skyrocket because of new technologies
and because of the growing numbers of patients with chronic diseases.
costs will eventually prompt big businesses to lobby for reform.
Spiraling costs will also increase the number of uninsured, and
when this group becomes large enough, legislators will finally
listen to them, Garson said. Thats what its
going to take.