Comments on: Taking Another Look at McAllen

By: Peter Orszag’s Bad Idea | John Goodman | NCPA

Peter Orszag’s Bad Idea | John Goodman | NCPA — Wed, 29 Jul 2009 15:31:11 +0000

[...] country of unjustifiably high Medicare spending. Yet as Greg Scandlen has previously pointed out at this blog, McAllen is a poor city with many health problems and very little private insurance. So Medicare is [...]

By: TW

TW — Mon, 27 Jul 2009 15:02:05 +0000

Atul Gawande has replied to this criticism. It's hard to look at his chart comparing McAllen with El Paso (6th poorest place in the US) and conclude that the 2:1 ratio of medical costs is because McAllen is so much poorer & sicker!

By: vicente juan

vicente juan — Thu, 16 Jul 2009 22:02:37 +0000

Has anyone noticed that these places with “low medical cost” usually are associated with institutions where interns and residents are abound (cheap slave labor). Tha amount of care these providers dish out in El Paso(UT system) or in Rochester (Mayo Clinic) is paramount to a defacto subsidy to the cost of the care delivered. McAllen does not have this scape valve. Do not be fooled, Medicare has exact figures where the money goes, what billing patterns are aberrant, and who is profiting the most in this “parallel universe”. Let’s see the figures, Show us the money

By: vicente juan

vicente juan — Thu, 16 Jul 2009 22:01:30 +0000

Has anyone noticed that these places with “low medical cost” usually are associated with institutions where interns and residents are abound (cheap slave labor). Tha amount of care these providers dish out in El Paso(UT system) or in Rochester (Mayo Clinic) is paramount to a defacto subsidy to the cost of the care delivered. McAllen does not have this scape valve. Do not be fooled Medicare has exact figures where the money goes, what billing patterns are aberrant, and who is profiting the most in this “parallel universe”. Let’s see the figures,

By: Mike

Mike — Thu, 16 Jul 2009 18:30:10 +0000

I suggest everyone read the link to Gawande’s follow-up article in Laura’s post above.

More importantly, I wonder why the Texas Medical Association and many members of the medical community are preoccupied with questioning Gawande’s numbers or reasoning instead of simply looking in the mirror and asking “How am I part of the problem?” The American public needs to do the same.

By: adrienne

adrienne — Thu, 16 Jul 2009 16:19:31 +0000

What about the costs associated with defensive medicine in McAllen? Isn’t Hidalgo County statistically one of the counties in Texas with exceptionally high damage awards in injury and malpractice suits based on their jury pool composition?

By: James

James — Wed, 15 Jul 2009 22:14:41 +0000

Gawande’s article suffers from statistical selectivism. He freely compares McAllen (the city) to El Paso. McAllen is the wealthiest part of Hidalgo County (the real service area for McAllen hospitals and physicians) and it is home to only 15% of the county inhabitants. El Paso is both a city and a county where the city is home to 85% of the county population. The true socioeconomic and disease incidence differences can only be appreciated by comparing county to county, or by comparing McAllen to the wealthiest 15% of El Paso County.

By: John R. Graham

John R. Graham — Wed, 15 Jul 2009 20:00:38 +0000

Dr. Gawande blames the old bugbear: physician-driven supply, which I suppose is why the Texas Medical Association felt the need to respond. However, in the post to which Laura links, Dr. Gawande asserts that McAllen experienced a surge in physician-owned imaging capacity and other facilities since the mid-1990s, but El Paso did not.

This brings us full circle: The doctors in El Paso must be astonishingly inattentive to their business prospects if they were not able to observe and replicate their neighbors’ opportunities. This is really not credible.

Gawande doesn’t tell us whether the proportion of residents on Medicare is higher in McAllen than El Paso but if this is the case it would support Cooper’s suggestion that physician-induced demand is more characteristic of Medicare than private payers. Furthermore, I see from Dr. Gawande’s 2nd post that he reports cancer incidence in McAllen of 516.6/100,000 versus only 420.1/100,000 in El Paso – 23% higher. So, the population is definitely a lot sicker, despite similar socioeconomic profile.

By: Laura

Laura — Wed, 15 Jul 2009 12:13:07 +0000

True, Mark, but John’s right. In the article, Gawande mentions that McAllen and El Paso not only have similar geography, but also similar demographics. What’s more, Gawande addresses to the rest of your concerns here: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html

By: Mark

Mark — Wed, 15 Jul 2009 05:04:14 +0000

Actually, John, the town of El Paso is mentioned in the linked article. The Texas Medical Association points out that contrary to the xenophobic beliefs espoused in the Gawande article, a mere shared proximity to the Mexican border does not imply that two cities are otherwise identical.