Welcome to McAllen, Texas. They call themselves the square dancing capital of the world and they are part of America’s poorest county. They also, aside from Miami, spend the the most on health care per person. Medicare spends $3000 dollars more per enrollee than the per capita income (which is a dismal $12K).
When it comes to the health care cost explosion, if we can solve it there, we can solve it anywhere.
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.
So what is happening in McAllen. It can’t be the square dancing. Are they sicker there? Fatter? Hypochondriacs? According to Atul Gawande’s piece in the New Yorker, “the primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.”
More is not better. But our whole medical system is geared to give you the next test, the next treatement and to send you to the next specialist. As a doctor I know said to me recently, “We don’t get paid to do nothing. It’s in the culture.”
If we’re going to fix health care costs in America, we may want to start where it costs the most. So brush up on your do-si-do and let’s go to McAllen, Texas.
