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News/Commentary
McAllen, Texas—-not New York City or Washington, D.C., Baltimore, Md. or Boston, all home to major teaching institutions—-is the “most expensive town in the most expensive country for health care in the world.”
Why?
Because McAllen is the kind of town any of us can understand, this article has gotten a great deal of attention in Washington as health care reform is or is not, depending on your point of view, going forward. It has been read carefully all over Health Policy Wonk City.
The article is written by a physician-author, Atul Gawande, M.D., who tells the story about McAllen’s health care costs.
The weekly magazine summarizes the author’s credentials: ” Atul Gawande became a staff writer at The New Yorker in 1998. Also a surgeon, he completed his surgical residency at Brigham and Women’s Hospital, Boston, in 2003, and joined the faculty as a general and endocrine surgeon. He is also an associate professor of surgery at Harvard Medical School, an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health, and the associate director of the B.W.H. Center for Surgery and Public Health.”
“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.”
Source: The New Yorker, June 1, 2009
