Why Medicare Costs in Mcallen Texas Are so High

Atul Gawande leads with the thought that healthcare that costs more isn't necessarily better care at all. And Gawande lets the reader know that the town of McAllen, Texas, is able to provide some meaningful lessons to others on healthcare. This paper provides a review / summary of the article by Gawande.

To begin with, as background, McAllen is a border town that has the lowest family income in the United States but interestingly, has low unemployment because of the fact that it is in a foreign trade zone. Medicare is in full use in McAllen, because enrollees in Medicare receive $15,000 in healthcare benefits, about twice the national average. Speaking of healthcare, Gawande notes that the U.S. is the "most expensive in the world" and because of that the "global competitiveness of American businesses" has been damaged and President Obama is quoted by Gawande saying the greatest threat to America's balance sheet is "the skyrocketing cost of health care."

Meanwhile, while observing Dr. Lester Dyke, and checking into the health problems of people in McAllen, Gawande (38% of the people are obese) wonders in the article why heart-related diseases were so low. Was it a matter of great healthcare services? And if heart-related health problems were so rare, why were Medicare expenditures so high? Was it a matter that doctors were " ... racking up charges with extra tests, services and procedures? (Gawande). For example, by operating on a person with gallstone disease (rather than trying to coax the patient into changing lifestyle patterns) a doctor can make " ... an extra seven hundred dollars" (Gawande).

The article begins zeroing in specifically on the overuse of procedures on the 4th and 5th pages; for example, a patient comes in with chest pain and fifteen years ago the doctor might have given her an EKG and sent her home. But in 2009, when the article was published, she would likely be given a "stress test, an echocardiogram, a mobile Holter monitor" and possibly a cardiac catheterization. There seems to be no doubt in Gawande's mind that overuse of medical technology has led to the huge Medicare payments. The McAllen area Medicare patients received about 50% more visits from specialists than Medicare patients in the El Paso area; and Gawande runs down the list of tests and procedures (knee replacements, breast biopsies, ultra sounds and many more) that are far more prevalent in McAllen than in El Paso.

How does Gawande explain this contrast in the use of Medicare funds? Even Rochester, Minnesota (where the Mayo Clinic is located), has far lower Medicare spending than McAllen, Texas. The way the author addressed this issue -- after doing the math by comparing Medicare costs in other regions to McAllen -- was to visit with the heads of the hospitals to interview them and try to figure out why Medicare costs in McAllen were so sky-high compared to other locations. He met with Gilda Romero, COO of McAllen Heart Hospital, who seemed pretty down to earth and worked in a plain office with no fancy or expensive furnishings.

Romero seemed taken aback by the data presented by Gawande. She asserted that her physicians did not perform surgeries that were not necessary. She suggested the ballooning costs to Medicare in McAllen must be coming from Doctors Hospital at Renaissance, a physician-owned hospital that rakes in huge profits and gives doctors not only healthy fees, but doctors get a percentage of the profits. When Gawande visited the Renaissance facility, he was greeted nervously by the CEO (though other board members in the garish-sized board room seemed to pretend to be happy to see him); and he was given a lot of cliches and platitudes about government waste, poor management of Medicare at the federal level. And the doctors said they don't order more surgery and scans than are needed albeit they claimed they were not aware of the overuse of testing and technologies.

Gawande's last few pages zero in on money, the driving force behind perhaps too many healthcare decisions by doctors. "No one teaches you to think about money in medical school," Gawande explains. But as soon as a doctor is in practice, he or she is thinking about money, and on that subject, Gawande notes that healthcare leaders in McAllen, years ago, decided to treat patients like mortgage lenders and hence they were all about profit rather than good healthcare for their patients. Gawande spends the final few pages of this article (which is more like a treatise) praising the Mayo Clinic for its ethics, and pointing to the crux of the issue: "someone has to be accountable for the totality of care," and in McAllen, that is not happening.

The author posits that giving the duty of managing the "full complexity of medical care" to insurers is a mistake, since they have not shown the ability to do it. And he supports the idea of local medical communities coming together to resolve the problems.