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| |  THE COST CONUNDRUM What a Texas town can teach us about health care.
It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers....
Full article here: http://www.newyorker.com/reporting/2...a_fact_gawande
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| | Advertisement Sponsored Links | | | | No. 1 | 
Sep 28, 2009, 11:52 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
I love Atul Gawande's writing - it's lucid, accessible, always relevant and interesting.
| | No. 2 |
Sep 29, 2009, 01:22 AM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
I'm also a big fan of Atul Gawande. I though this article was horrifying. It's the free market, taken to the extreme.
| | No. 3 |
Sep 29, 2009, 09:48 AM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
Excellent article, thank you for that.
| | No. 4 |
Sep 29, 2009, 03:14 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
well written article by Gawande. One of the highlights of the article was when he likened providing healthcare to building a house. Great analogy. Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check. | | No. 5 |
Sep 29, 2009, 03:35 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
Not disagreeing with the author that healthcare costs are out of control.
However; one needs to understand McAllen, TX. It's a border town with Mexico, and as is not that unusual; it has very low income. It also has a HUGE population of older Americans who have retired there. It's a kind of Texas version of Miami/Fort Lauderdale. So not a big shock there is a high consumption of healthcare dollars.
Just understand in the environment. But, I still agree with the author that costs of American healthcare are out of control.
| | No. 6 |
Sep 29, 2009, 03:49 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care. Originally Posted by Not_A_Hat_Person  I'm also a big fan of Atul Gawande. I though this article was horrifying. It's the free market, taken to the extreme.
Our health care market is not a free market. Government pays 45 percent of all medical claims in the United States. The vast majority of patients have their medical bills paid by a third party payer, Medicare, Medicaid, or private insurance. Costs will be high in a third party payer system, because the consumer is disconnected from the cost. Do you call your auto insurance company if you have a flat tire or need an oil change? No, you do not. Insurance is supposed to be for a major problem, not for every nickel and dime cost. In addition, government mandates and regulations make the cost of private health insurance unaffordable. In fact, there are close to 2,000 mandates on insurers within a state. In other words, they must pay for prostate exams and many other things demanded by the government, so politicians can get re-elected, imagine that. If we eliminate these regulations and cut taxes, even diabetics could afford to purchase health insurance. In most states, one insurer has a monopoly, no wonder costs are so high. Obama talks about competition. Yet, he is opposed to letting insurers compete across state lines. Can you imagine not being able to buy an auto insurance policy in a neighboring state? The same people who have come up with this screwy system are going to fix it, give me a break!
| | No. 7 |
Sep 29, 2009, 04:31 PM
Updated
Sep 29, 2009 at 04:39 PM by Jbrock718
| | No. 8 |
Sep 29, 2009, 05:27 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care.
I don't have any stats. I am surprised their median age is higher than those other cities. All I know is from visiting McAllen (where I have relatives that live there in their retirement) and seeing city-sized communities of trailer parks (all retirees).
Once more, I'm not debating the author of the article, I agree with him. I'm just trying to understand why this one city has particular disparities in income vs. cost of medical care.
| | No. 9 |
Sep 29, 2009, 05:48 PM
Re: THE COST CONUNDRUM What a Texas town can teach us about health care. Originally Posted by TiffyRN Not disagreeing with the author that healthcare costs are out of control.
However; one needs to understand McAllen, TX. It's a border town with Mexico, and as is not that unusual; it has very low income. It also has a HUGE population of older Americans who have retired there. It's a kind of Texas version of Miami/Fort Lauderdale. So not a big shock there is a high consumption of healthcare dollars.
Just understand in the environment. But, I still agree with the author that costs of American healthcare are out of control.
The point of the article isn't really that the McAllen area spends more on healthcare overall, total than other areas -- it is that the McAllen area spends more per Medicare recipient than many other areas, without having better outcomes. So it doesn't really matter that there are more older people living there -- the "per person" figure is what counts.
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