Sunday, June 21, 2009

On health care in McAllen...

It is supposedly "required reading" in the Obama White House - and many of the blogs I read point to it as "the" source for answers on the health care crisis in America.

It's Atul Gawande's story on the "cost conundrum" of providing medical treatment in McAllen Texas, which appeared in the June edition of The New Yorker magazine.

Tonight, I finally had the chance to read the story. And it left me with more questions than answers.

Gawande points to McAllen as what’s wrong with American medicine today, but takes pains to point out that McAllen is actually the second most expensive health care market in America – coming in behind Miami.

So why is McAllen – the “outlier” – actually proof of what is wrong? It is an extreme example of the problem, not necessarily a reflection of the ordinary, every day “average” world of the garden variety medical practitioner.

Gawande compares McAllen to El Paso – in that they have similar demographics (poverty level, obesity rates, etc.) and though El Paso’s health care costs are half that of McAllen’s – the story focuses on McAllen, as if that is the “norm.”

What I want to know after reading this story is how much El Paso’s costs have gone up in the last few years. (My health insurance rates – despite no change in family health – went up 25 percent this year – and I’m no where near McAllen.) El Paso seems to have a handle on controlling excessive tests – but how much have their actual costs risen in the last decade? Are higher costs only associated with the "overuse" of tests?

In comparing McAllen to Mayo, I wanted to know what the obesity and poverty rates were for the patient pool at Mayo. Are we comparing apples to apples? The health care issues for the obese are a terrible problem. Is Mayo dealing with the same issues or are they more focused on cancer treatment – or knee replacement surgery – or heart surgery in thin, pre-retired people?

As McAllen goes, so goes the rest of the health care industry in the US? Seems a stretch – but perhaps Gawande is right to assume this. Would like to see the facts to back up the assumption, though.

Why is Medicare – the government program for retirees – the best source of pricing information for health care? If that is truly so – then we are negotiating health care reform from a position of ignorance. Truly. And that needs to change immediately.

To point to McAllen’s “overuse of medicine” in the second most expensive health care market in the country – within a community with a significantly high obesity rate and a per capita income of $12,000 a year – as THE example of the problems of health care in America is like looking at the Super Size me guy (the one who ate at McDonalds every meal for way too long for his documentary) as the poster child for the American diet. Great PR – but not necessarily providing the right icon for the issue.

I’d frankly like to know more about El Paso’s story….

2 comments:

David said...

I don't think the New Yorker article investigates so much as draws conclusions. There is no way we are comparing apples to apples as you so right put it.

Are we really to believe that McAllen's doctors are the greediest in the country and thats the problem with health care? Isn't it possible there are other factors that have not been considered? McAllen is a wonderful place to live and is prospering when not many places are. Just look at this google search , its loaded with praise! It seems unfair to single them out for a health care system that is probably failing many people across the country.

Anonymous said...

That "google search" goes to the McAllen Chamber of Commerce. They have a financial incentive to load McAllen with praise. Sound familiar?