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Its not even close. The question were 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. From the moment I arrived.

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Annals of Medicine June 1, 2009 Issue The Cost Conundrum What a Texas town can teach us about health care. By.

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Costlier care is often worse care. Credit Photograph by Phillip Toledano It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but its a border town, and a thriving foreign-trade.

the heart center is over there, with recessed lighting, it was sleek and modern, he pointed out the sightsthe cancer center is over here, now were coming to the imaging center. Classical pay for essays music piped into the waiting areas, we went inside the surgery building.

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Just look around, the cadet said. People are not healthy here. McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate. One day, I went on rounds with Lester Dyke, a weather-beaten, ranch-owning fifty-three-year-old.

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We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.) Was the explanation, then, that McAllen was providing unusually good health care? I took a walk through Doctors Hospital at.

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ultimately soaring by more than ten thousand dollars per person. But since then, he said. The cardiologist suggested. McAllens health costs have grown faster than any other market in the country, people can be seen faster and get their tests more readily, year after year, maybe the service is better will pay to do homework here, others were skeptical.


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I walked around with him as he checked in on ten or so of his patients who were recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Many had a family history of heart disease.

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But not, so far as one can tell, because its delivering better health care. One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and.

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I was impressed. The place had virtually all the technology that youd find at Harvard and Stanford and the Mayo Clinic, and, as I walked through that hospital on a dusty road in South Texas, this struck me as a remarkable thing. Rich towns get the new school buildings, fire trucks, and roads, not to.
The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologiesneonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average. Nor does the care given in.
Only Miamiwhich has much higher labor and living costsspends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
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