McAllen, Texas: health-care spending capital of the world
I only got around to reading Atul Gawande's remarkable New Yorker piece on disparities in health-care costs within the United States -- and even between different parts of Texas -- last week. I deserves all the buzz it's received.
I've heard the health-care expert Uwe Reinhardt, of Princeton, say that the phenomenon Gawande explores is the single most important fact to get one's head around in the health-care debate. What is Rochester, Minnesota doing right and towns like McAllen, Texas, where Gawande sets part of his story, doing wrong? (At the time, I jotted down the phrase "story idea" next to my notation of Reinhardt's observation. I guess I can cross that one off the "possibles" list, given that Gawande has produced a National Magazine Award contender.)
Gawande floats some speculative but persuasive theories about why some cities have particularly "expensive" cultures when it comes to health care, and how to change those cultures: he thinks doctors should work in problem-solving teams, for example, possibly under set salaries, and not as independent entrepreneurs.
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I'm surprised you don't include a link to the Globe's Spotlight Series on Partners Healthcare. The series makes the argument that Partners' business practices have been a major factor in pushing Boston towards the McAllen model of healthcare. In many ways it serves as a reportorial counterpart to Gawande's speculative theories, even though it was published late last year.
The irony is that Partners is Gawande's employer. He could have written his New Yorker piece by staying home.
The Mayo clinic basically has no competition in Rochester. That is one difference. Are the patients in Rochester just doing what the doctors say, or are they as litiginous as they are in McAllen? Yes, McAllen spends more but in the end, over spending there also has a lot to do with the patients and the medico-legal climate. How about insurance companies CEOs? If anyone asking them to make less? Doctors' fees in the US have been basically frozen since 1997 or so. It is easy to ask for doing away with private medicine, the entrepeneurial spirit of physicians, ask doctors to work more for less, etc, if your livelihood does not come from seeing patients like the author of this report, and certainly Uwe Reinhardt. Make things difficult enough for current and future doctors, and you will end up with mediocre practitioners, maybe just nurses. Then, try to find a good doctor, a vanishing breed as we speak. Of course, who would be crazy enough to go into medicine then?