“I have doubts about the study from another perspective, albeit anecdotal, from a Texan who travels widely across the state.

McAllen is a winter mecca for thousands of retirees from the mid-west. Winter Texans, as they are called, form a huge caravan of travel trailers from September through early November, becoming sem-permanent residents for several months, while still claiming actual resident status back in Minnesota or Michigan or Ohio. Having been in McAllen/Harlingen and needing to see a Dr. for a minor injury the waiting room was full of retired, older folks, many of whom, I’d suspect of being on Medicare. I’d expect the distortions caused by the influx of an older, semi-resident population would be significant and I’ve not seen any comments in the studies that take this demographic into account.

McAllen is hardly equivalent to El Paso, much less Grand Junction.

Posted by: gdb in central Texas | June 29, 2009 at 10:37 AM”

This anecdote mirrors what I have asserted previously–that McAllen is a “healthcare destination” and the Dartmouth data fails to capture this phenomenon since it relies upon provider claims data presumably without extracting McAllen residents’ data from Medicare recipients receiving treatment in McAllen who do not live in McAllen.