McAllen, Texas and the High Cost of Health Care _ the New Yorker

7/29/2019 McAllen, Texas and the High Cost of Health Care _ the New Yorker

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Costlier care is often worse care.

Photograph by Phillip Toledano.

ANNALS OF MEDICINE

What a Texas town can teach us about health care.

by Atul Gawande

J UNE 1, 2009

t 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 its 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 marketsin the country. Only Miamiwhich has much higher labor and living costsspends 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 anespecially intense form. Our countrys 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. Its also devouring our government. The greatest threat to Americas fiscal health is not SocialSecurity, President Barack Obama said in a March speech at the White House. Its not the investments that weve made to rescue

McAllen, Texas and the high cost of health care : The New Yorker http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=tru

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McAllen, Texas and the high cost of health care : The New Yorker http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=tru


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revenue by shifting his operations for well-insured patients to a specialty hospital that he partially owned while keeping his poor and

uninsured patients at a nonprofit hospital in town. Even in Grand Junction, Michael Pramenko told me, some of the doctors are

beginning to complain about leaving money on the table.

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than

whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a

mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to

build a new generation of Mayos and Grand Junctions. If we dont, McAllen wont be an outlier. It will be our future.

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McAllen, Texas and the High Cost of Health Care _ the New Yorker

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