Where Should Americans Look for Health Care?
Mensan's new PBS doc suggests looking outside the country -- for better models and care itself
Mensan Suzanne Garber knows health care inside and out, both from an eight-year career in the international health care industry but also from her own experiences — a bout with ovarian cancer and a rare heart defect causing two aorta and taking nearly 40 years of misdiagnoses to identify.
She’s seen around the world health care work and, at times, not work, from her time in international medical assistance and also from maladies she suffered over many years living abroad — appendicitis in Spain, bronchitis in Greece, malaria in Mexico, leptospirosis in the Dominican Republic. Now, she’s primed to share her global view of health care.
In a new documentary set to air next month on PBS, Garber lays bare some of the frustrating intricacies of the U.S. health care system in light of how other countries operate and how their citizens engage in their own health. Gauze: Unraveling Global Healthcare, a short, 26-minute film, is Garber’s first. She’s not a professional filmmaker. Not yet, at least. In the spring of 2014, in between a non-compete from her previous job and her next, she plowed through her contact list and set out to tell the story of health care abroad.
On her first trip, she visited China, Hong Kong, Vietnam, Thailand, and Singapore. Other sojourns followed, and by the last interview, in May of 2015, Garber and her production crew of four — “who all have day jobs” — had compiled more than 70 hours of interview footage and another 30 in b-roll while logging stops in 24 countries on four continents.
“People get afraid and confused about what’s available internationally,” Garber recently told the Bulletin. “[The film is] meant to spur conversation, which is what is lacking in the national scene.”
Surprisingly and perhaps refreshingly, Garber avoids hitting the same notes that cause much of the current political discord over U.S. health care. Viewers needn’t have a specific take on the Affordable Care Act, for example, to appreciate Gauze. “It’s funny, when I started this three years ago I could not have imagined the political climate that we’re in now,” Garber said. Rather than delivering a political message, the film simply asks viewers to widen their options.
“Originally my intent was to show health care facilities outside the United States, what the systems are like, and not to be afraid when you do get sick overseas,” she said, referring to a group of some 100 million people affected annually.
“Most Americans when they are traveling will just stick it out and wait until they get home,” Garber said. “My point was to show people that it’s not all bad. And the U.S. ranks 37th on the World Health Organization’s ranking of global health systems [the only WHO list of its kind, created in 2000]. You’re likely to get better care in 36 other countries. Ironically, Cuba is ranked 39th. I’ve actually done a medical mission to Cuba where I witnessed them using fishing wire as a suture. So if we’re only two spots ahead of Cuba, and they’re doing that, that doesn’t really say a whole lot about our system.”
Garber was able to secure Gauze a slot on WPBT-TV, a southwest Florida PBS affiliate, airing in November, thanks in part to her keen networking abilities. (In 2015 she published a book on the subject, Safety Network: A Tale of Ten Truths of Executive Networking (reviewed in the September 2016 Bulletin). After connecting through the International Women’s Forum, Garber impressed the PBS CEO with a screening. A national airing could follow, and the film is also being shown at private events and conferences.
Garber used the experience to start a company, also called Gauze, which she said is the world’s largest and most comprehensive database of hospitals outside the U.S. The goal is to inform and connect the 1.2 billion annual international travelers who might find themselves sick abroad.
In the run-up to the PBS debut of Gauze, Garber talked at length with the Bulletin about the state of health care in the U.S. and elsewhere.
Mensa Bulletin: The U.S. health care system is often touted as the world’s best. You don’t agree?
Suzanne Garber: There was an interview that didn’t make the final cut of the film. We interviewed the head of benefits for the AFL-CIO, which is the single largest purchaser of employee health care in the U.S. When I asked him, “Do you think the United States has the best health care system in the world?” his response was, “How can it when a third of its population doesn’t have access to it?” Which is why access is so important to health care rankings.
MB: But if you have insurance, and health care is accessible and affordable, the U.S. health care system is tops, no?
SG: I believe that doctors, nurses, and everyone involved in the clinical aspect of care perform their jobs to the best of their abilities and have the patients’ best interests at heart. I don’t think people go into medicine for non-altruistic reasons.
Having said that, I agree with Beth Benta, featured in the film, who is a holistic and integrated wellness coach — she basically does functional medicine. I agree with what she said in that we are awesome with emergency and critical care. We do that exceptionally well. If there’s a problem, we can react to it in an instant. However, when you start looking at preventive care, we hardly pay any attention to that. I think there might be a change in tides, particularly with insurance companies offering smoking cessation programs or weight loss programs. But I would challenge readers to think about that themselves: How often do they go to the doctor for preventive health checkups? How often are they going to the gym? How often are they evaluating their diets?
And look at what they’re doing in Europe from a preventive standpoint and giving employees a month off — and they do that in Latin America — because they know it’s for the benefit of the employees and ultimately the benefit of their companies. It recharges the people.
MB: What are the other big knocks against the U.S. health care system?
SG: I will point to Dr. [Martin] Makary. He had published a report in May 2016 in BMJ [British Medical Journal] how the number-three leading cause of death — and this is not reported anywhere, except in his article — the number-three leading cause of death in the United States is medical error.
It was interesting because no American publication would publish his findings. What he did over a period of nearly a decade was study the death records of millions of patients. And in this investigative reporting, he looked at not just the immediate cause of death. The immediate cause might have been pneumonia or infection, but the procuring cause of death might have been an operation that went awry or an infection that they picked up in the hospital.
So if there’s 300,000 deaths a year in the U.S. as a result of medical error, I think it certainly does speak for the need for transparency in our system. Dr. Makary is a huge advocate for cameras in operating rooms, which of course the American Medical Association is completely against. And I understand, we’re a very litigious society; many doctors are going out of business because of their insurance premiums for liability. It’s very unfortunate, this system we’ve created.
MB: What should you do when you have a health care event, assuming it’s not an emergency?
SG: Health care is one of those things we’re conditioned to react to. I’m not going to look for a cardiologist if I don’t need to. I’m not going to look for an auto mechanic until I need one. It’s that reactive state that we’ve been conditioned to work in, whereas we should really take it and turn it around.
The first thing I tell everyone is you need to assume responsibility for your health care. And that means making choices for yourself that keep you healthy. Number two, have a champion on your side or an advocate. When I got cancer, as I mentioned in the film, I couldn’t think properly. I just couldn’t. I advocate not to go to the doctor alone. You’re not going to hear certain things. And don’t bring somebody who’s going to be overly emotionally invested because they’re not going to hear some things either. Bring somebody who can take notes, or ask to tape the conversation — because you want to be able to look back at what was actually said.
I spoke this week with a woman who is CEO of RN Cancer Guide. Her company provides a nurse advocate for you to attend and participate in meetings with the doctor. Even though they’re not a family member, it’s probably best they’re not because they’re not emotionally invested. Yes, a number of insurance companies provide case managers. They’re really there to help contain costs. Yes, they’re there for you, and they are nice to have. But they are also looking at the containment of costs for the insurance company.
Number three, be educated. And that goes along with taking control of your own health and looking for different resources that are objective. The difference in cost is so disparate, if not by hundreds even thousands of percentage points, and that’s even within the same city.
MB: And consider getting treatment outside the U.S.?
SG: There are great options outside the United States for elective procedures. What we’re seeing now, especially from an employer standpoint, is a number of employers who are offering their employees the option to get elective procedures performed outside the United States that would cost a fraction of what they would here. In doing so, they’re sometimes bringing their entire families over; they’re giving them a financial incentive; they’re doing a lot of things to contain costs but also to ensure employers have the best access to care.
Because even here in the U.S., I’ve done a couple of experiments where I’ve called specialists or subspecialists or tertiary care to get appointments, and they’re eight to 10 weeks out. If I had something that’s not critical but very concerning, do I want to wait eight to 10 weeks for an appointment? And there are a number of places, whether it’s Colombia, Thailand, Hong Kong, Poland, that will pretty much set up an appointment for you immediately.