Garson champions health care reform
Proposing new category of coverage for those in need

By Kathleen D. Valenzi

Dr. Arthur “Tim” Garson Jr., dean of the U.Va. Medical School, has a long-standing interest in health policy reform — and it’s personal.

In 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.

“By 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.”

For Garson, a proponent of every citizen’s 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 reform’s 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.

Now, 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.

Garson 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.

Only 17 percent of the nation’s uninsured are in families without jobs, Garson said. The rest work for small businesses that can’t afford to provide health benefits, or they are self-employed.

Despite 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.

Garson has observed that recent health reform proposals do not attempt to revamp the current system entirely. It’s 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.

“This 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 large employers?’”

At 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 Children’s Health Insurance Program. But still, there is no “safety net” in most states for anyone between 19 and 64 years of age.

What 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.

The 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 Benefits Plan.

Because the problem is complex, it is unlikely to be solved anytime soon.

“Many 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.

“Spiraling 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. “That’s what it’s going to take.”