Conversations about health care reform are heard everywhere these days. Our Government officials debate it regularly, the media discusses every different version of it, and the American public wonders if it will ever actually happen. With all these different ideas on how to reform the health care system, it’s easy to get confused and overwhelmed. And, frankly, it all starts to sound a little stale after a while. But, every once in a while, you come across an intriguing and thought-provoking article that really makes sense, like this one. We just happened to stumble across this article written by Atul Gawande of The New Yorker, and honestly believe it’s one of the best articles we’ve ever read on controlling health care costs and health care reform.
“The Cost Conundrum” is a long and detailed article, but it’s extremely interesting. Instead of writing a dry, humorless critique of the health care system, the author instead provides us with fascinating statistics, real-life examples, and even a bit of humor. Yet, through it all, Gawande makes his point clear: “we took a wrong turn when doctors stopped being doctors and became businessmen.”
To start, the article comments on how high our nation’s health care costs have become. Our country’s health care is by far the most expensive in the world. Money spent on doctors, hospitals, drugs, and other medical costs now accounts for more than one of every six dollars we earn. Health care costs have caused millions of families to file bankruptcy, and it has hurt our country’s global competitiveness. In fact, President Obama even acknowledged its effects in a March speech: “The greatest threat to America’s fiscal health is not Social Security. It’s not 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 costs of health care. It’s not even close.”
The article introduces the little town of McAllen, Texas. McAllen is located in Hidalgo Country, which has the lowest household income in the country. Yet surprisingly, McAllen is one of the most expensive health care markets in the country. Miami is the only other city that spends more per person on health care than McAllen – and Miami has much higher labor and living costs. In 2006, Medicare spent $15,000 per enrollee in McAllen – that’s almost twice the national average!
What’s the reason for these high health care costs? Unfortunately, it’s hard to say for sure. El Paso County is about 800 miles up the border from McAllen. Both have essentially the same demographics, a population of roughly 700,000, and similar public health statistics. The treatments and technologies offered in McAllen were comparable to those offered in El Paso. Public statistics show no drastic difference in the supply of doctors. But health care costs in El Paso are much lower than those in McAllen. In 2006, Medicare only spent $7,504 per enrollee in El Paso – that’s half as much as they spent in McAllen!
So, you would assume that the quality of health care must be the big difference between the two cities, right? If everything else is the same, yet McAllen has such high health costs, the quality of care offered there must be better. Right? Not according to statistics! Medicare ranks hospitals on 25 metrics of care. On all but 2 of these, McAllen’s five largest hospitals performed worse, on average, that the hospitals in El Paso. So, if it’s not quality of care they’re paying for, what exactly is it?
To put it simply, it seems that the doctors in McAllen are more revenue-focused than most other doctors. They find ways to increase their high-margin work and decrease their low-margin work. They order expensive tests and rely on surgery even when it’s not necessary. In fact, one hospital executive in McAllen accounts several cases of outright fraud: “I’ve had doctors here come up to me and say, ‘You want me to admit patients to your hospital, you’re going to have to pay me.’” He said they always requested over $100,000 per year – and sometimes as much as $500,000 per year. And although he stressed that this was only a few doctors, he also acknowledged that he had never been asked for a kickback until he came to McAllen.
On the other end of the spectrum is the Mayo Clinic, one of the highest-quality, lowest-cost health care systems in our country. The basic view of the Mayo Clinic is: “The needs of the patients come first” – not the convenience of the doctors or the revenues. A few decades ago, the Mayo Clinic decided to work on eliminating as many financial barriers as possible. They pooled all the money the doctors and hospital system received, and they started paying everyone a salary. This way, the doctors wouldn’t focus on trying to make more money by ordering unnecessary tests and medical procedures. Instead, they simply focus on what is medically best for the patient.
When you contrast and compare these different hospital systems: McAllen, El Paso, and the Mayo Clinic, it’s easy to see why our nation’s health care system has become so uncontrolled. Health care reform is absolutely vital for the financial stability of our country and the overall well-being of our people. If you get a chance, read through Gawande’s article in The New Yorker. It’s absolutely astounding, riveting, and inspiring.
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 don’t, McAllen won’t be an outlier. It will be our future.
- Atul Gawande
via Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker.

