If you set the time machine to “Way Back,” you may remember a blog post of mine about Dr. Atul Gawande’s New Yorker article, “The Cost Conundrum: What a Texas Town Can Teach Us About Health Care.” If you recall, the article was about why McAllen, TX had the second highest per capita Medicare spending of any city in the country.
The cost of living and doing business is much higher in a place like, say, New York but yet McAllen was ranked number two in the nation. Could McAllen’s high rate of Medicare spending be explained by demographic factors? Maybe people in McAllen were more obese than in other cities or had higher rates of hypertension?
By comparing McAllen to the nearly demographically identical city of El Paso some fifty miles away, Dr. Gawande was able to rule out the possibility that especially unhealthy lifestyles were responsible for the lavish spending in McAllen. The Medicare spending in El Paso was only half what it was in McAllen ($15,000 compared to $7,500).
Dr. Gawande ultimately concluded that the reason that health care cost so much in McAllen is that doctors had transformed it from a profession into a business; they were out to line their pockets with kickbacks that would be considered unethical in most cities, rather than to provide the patient with the amount of care needed.
In studying the Medicare spending levels of different cities, Gawande also identified cities that provided excellent health care for a fraction of the spending seen in McAllen. Two of these cities were Rochester, MN (where the Mayo Clinic is located) and Grand Junction, CO.
Both cities had excellent doctors but why health care spending should also be so low in these two cities remained a bit of a mystery. Now, the New England Journal of Medicine has published an article entitled “Low-Cost Lessons From Grand Junction, Colorado,” that delves into that mystery. Some of the reasons for Grand Junction’s low-cost success include the relatively plentiful number of primary care physicians, insuring that patients get more face time with their doctor; equal reimbursement rates for Medicare and private insurance (meaning that Medicare patients are less likely to have to go to an ER to get specialist attention) and payment of primary care physicians for hospital visits (making it more likely patients get to see doctors they are referred to).
It is clear that medical malpractice lawsuits are not contributing to the runaway cost of health care in our country. When Dr. Gawande went to interview the doctors in McAllen, they blamed medical malpractice lawsuits too. But, due to strict caps on pain and suffering in medical malpractice lawsuits that Texas had passed five years earlier, the number of medical malpractice lawsuits that Texas doctors faced had dropped “practically to zero.” The McAllen doctors admitted to Dr. Gawande that they were being disingenuous in blaming medical malpractice lawyers. Reforming health care requires the kind of creative thinking done by Dr. Gawande and should not be focused on blaming medical malpractice lawyers or limiting the rights of medical malpractice victims.