Gawande’s New Yorker article has become required reading. But is McAllen a microcosm of American health care? Or is it a curiosity. I’m afraid it’s the latter. McAllen is unique. Read what McAllen’s physicians have to say about it. It’s at the most southern tip of Texas in a county with 725,000 people, 90% of whom are Hispanic – one of the poorest counties in the nation. But because of NAFTA, McAllen is the fastest growing community in the nation. People and money are pouring in from the north and across the border, and there’s also a great deal of cross border activity – working in one place, living in the other and shopping in McAllen on the way back. The in-pouring of wealth has fostered high-tech medical facilities – cancer centers, heart institutes, psych units, rehab units – big city medicine in the middle of nowhere. Entrepreneurism abounds, in retail, real estate and medical care. Yet 36% of the population is below the poverty line, including almost 25% of the Medicare population, whose outcomes are poor, not just in McAllen but everywhere. So, there a collision of abundant health care resources related to burgeoning wealth and massive utilization related to profound poverty — an extreme example of the affluence-poverty nexus. A Monty Python version US health care.
Possibly unaware of the connection, Gawande described the poverty effect in a previous New Yorker article, about the “Checklist.” That project took him to Detroit’s Sinal Grace Hospital, which the Dartmouth group had criticized as a hotbed of waste and inefficiency due to an overuse of supply-sensitive services. What Gawande stumbled into was quite different: “Occupying a campus of red brick buildings amid abandoned houses, check-cashing stores and wig shops on the city’s West Side, Sinai-Grace is a classic urban hospital. It has eight hundred physicians, seven hundred nurses and two thousand other medical personnel to care for a population with the lowest median income of any city in the country.” It is little wonder that its patients consume more resources, but such consumption is unlikely to result from “the overuse of supply-sensitive services.” Indeed, what the suppliers desire most is fewer demands on their already overworked lives. As in Chicago, poverty matters.
One last word, and it’s for the President. Health care reform is on a failure course because ideologues are twisting anecdotes into policy. I want you to succeed. I want the nation to succeed. Making McAllen required reading is not the way to do it.
I came across this today at: http://justoneminute.typepad.com/main/2009/06/forcing-prices-down-does-not-normally-increase-supply.html
“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.
I wonder how much of the Northeast Medicare treatment is actually expended in Miami and South Florida in the winter. Lots of snow birds there.