The New Yorker profiles health care in McAllen, Texas, in a story for its June 1 issue. The article notes that McAllen receives twice the amount of money per capita for Medicare patients than El Paso, Texas. The underlining complaint about care in McAllen is that medicine has become a business and is no longer focused on quality, patient-centered care. Some physicians apparently lack information and guidelines when ordering tests. One physician says costs are higher because they order tests out of fear that they could later be sued.
I found this paragraph in the 7,775-word essay thought-provoking:
The real puzzle of American health care, I realized on the airplane home, is not why McAllen is different from El Paso. It's why El Paso isn't like McAllen. Every incentive in the system is an invitation to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than ratchet them up.
Does this mean if health care moves from traditional fee-for-service to pay-for-performance that there will still be areas of the country that will be inefficient and costly? Payment mechanisms aren't necessarily the problem?
The New Yorker has also posted a podcast interview with the article's author, Atul Gawande MD, a surgeon in Boston.