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The small town of McAllen, Texas lies right across the border from Mexico. It’s also a relatively poor town, with a per capita income of $12,000. However, besides holding the title for “square-dancing capital of the country”, McAllen also happens to hold the top spot for the nation’s most expensive heath-care market. In fact, in 2006 alone, Medicare spent $15,000 per enrollee. To put it in another way, that’s $3,000 more than what most people in McAllen make in a year.

What makes McAllen so unique? It’s neighbor, El Paso, doesn’t have the same astronomical health care expenditures. Surely it’s the poor standard of living—including bad diets and heavy drinking—but no, that doesn’t happen to be the reason either. Indeed, El Paso, just eight miles up the border, has similar public-health statistics. In a similar vein of thought, most people want to blame the “excessive medical liability suits” in McAllen. However, tort reform doesn’t happen to serve as a very good scapegoat, either. Actually, Texas passed a tough malpractice reform law just a few years ago that capped pain-and-suffering awards at $250,000. The reality is that doctors in McAllen like to rack up charges on extra procedures, services, and tests.

In analyzing Medicare payment data from two private firms, D2Hawkeye and Ingenix, it was revealed that McAllen patients received more diagnostic testing, more hospital treatment, more surgery, and more health care than their neighbors in El Paso and across the country. Specifically:

The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Simply stated: most Americans want to believe that the rising cost of healthcare is due to irresonspible lawsuits and/or the general poor health of the population. Don’t get me wrong, preventative medicine is very important, and is a desperately lacking feature of health care in this country. But, what is also a problem is the culture of profit. Liability costs often serve as the classic argument that doctors use for ordering excessive tests and for employing the most aggressive procedures, even when less-invasive procedures or a "watch-and-wait" approach might be the most appropriate answers. However, in the case of McAllen, Texas, lawsuit payouts were capped–a facet of tort reform–and medical costs did not miraculously go down. Why? Because doctors continued to order the unnecessary tests and procedures because it puts more money in their pockets. Adding insult to injury, patients aren’t even "better off" from all these extra tests and procedures:

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

Maybe we just need to take a step back, stop listening to all the finger-pointing used by insurance, pharmaceutical companies and the like. Are all doctors inherently consumed by this "culture of profit"? Of course not. I’m arguing no such thing–doctors are a vital and necessary group of people. What I am arguing against is bad medicine–kickbacks and conflicts of interest alike–that is, medicine that wants to go that "extra mile" simply because it means more money in someone’s pocket.

One Comment

  1. Gravatar for Mike Bryant

    Basically, Yes let's talk about Texas. Odd how this is the state the tort reformers keep pointing at. Higher costs, issues on who is getting the care, and bad for the consumer. Looks like a bad deal all the way around.

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