The Most Expensive Health Care in the World

In an excellent article for The New Yorker, Atul Gawande investigates health care in McAllen, Texas, “one of the most expensive health care markets in the country.” Gawande traces the high costs to overutilization and a culture of entrepreneurship among McAllen’s doctors. Lester Dyke, a cardiac surgeon in McAllen, told Gawande, “We took a wrong turn when doctors stopped being doctors and became businessmen.” Gawande advocates collaborative, accountable-care organizations, like Minnesota’s Mayo Clinic, and concludes that unless American health care moves away from the McAllen model and toward the Mayo model, “McAllen won’t be an outlier. It will be our future.” [%comments]


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  1. Nick Robinson says:

    “Gawande traces the high costs to overutilization and a culture of entrepreneurship among McAllen’s doctors”

    How does that work out then?

    Demand exceeding a supply and that supply limited by barriers to entry perhaps?

    Even here in the UK doctors, particularly General Practitioners and consultant surgeons, have always been very entrepreneurial and are in many ways private-sector suppliers to the NHS. We’re trying to hand more business-like powers to the doctors, not less, and are moving away from the collaborative model described. On the basis of this report, that’s a little worrying.


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  2. Imad Qureshi says:

    Great article and I can relate to it. I recently had an acid reflux problem and went to see a Gastroentrologist. He had over 30 years of experience and did an endoscopy to rule out. I am only 30 years old and I think endoscopy was an overkill for on and off acid reflux symptoms. But then I wore my economist hat and told my wife “where is he going to make more money? prescribing Protonix or endoscopy?” He did exactly what was best for him. I didn’t care because insurance was paying for it.

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  3. Hantra says:

    >>“We took a wrong turn when doctors stopped being doctors and became businessmen.”

    Give me a break! All the empirical evidence suggests that this is just wrong.

    What if this was worded: “We took a wrong turn when life expectancy nearly DOUBLED in the past century, and nearly EVERYONE survives a heart attack, compared with close to 0% not that long ago.”

    This is what annoys me about these people who want to take us back into the dark ages. Is it the best system possible? No. Is it the best system in the world? BY FAR.

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  4. Joel M says:

    Imad Qurieshi raises a good point, but leaves out the other reason for the test: You might sue if the doctor missed something rare. That’s a problem easily solved, such as it is in Canada with Judges deciding malpractice rather than juries, they are more likely to rule on evidence than emotion.

    And for Hantra you are missing the point totally. The US system is by most measures one of the weaker in the world. The wonders of life expectancy are shared, and in fact are even better in most other Western countries which spend far less on health care, cover more people and enjoy a healthier life. No one is saying to take us back to the dark ages, only that we need to improve our system to provide cost & health incentives to doctors and patients. Right now, we have neither.

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  5. Ian says:

    I am a Canadian citizen. I lived and worked in the US for a year. A colleague said to me, “Is it true how awful health care is in Canada?”

    hahahahahahahahahahahahahaha! Are you kidding me?

    Health care in my state was pathetic. Don’t dare say that in Canada what we don’t pay for health insurance we pay in extra tax. I made exactly 50K in the US. My employer paid a significant amount of my health insurance and I paid the rest. That being said, my NET pay was LOWER in the US than when I made 47K in Canada in the previous year. I also had to pay $25-$50 out of pocket for every doctor visit, every prescription, etc.

    Many people I knew in the US went to the doctor for what seemed like only spite. “I pay high premiums so why shouldn’t I go.”

    Here is the answer to the wait time question. It is not a simple queue. Urgent problems = urgent care. In the US, fatter wallet = better care. Call us communists or socialists or whatever you want. What we are is fair.

    Hantra – have you ever lived outside the US? What are you basing your “best system in the world” conclusions on?

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  6. Don says:

    Is someone actually claiming that the US system is the “best system in the world” based on life expectancy and survival rates? Among developed countries, the US has low life expectancy.

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  7. Hantra says:

    Joel you’re right. I probably missed the point. If implementing a system like Mayo was even being discussed in DC, then I’d be all for it.

    My problem is, the “solution” they’re clinging onto is federal government run health care. That’s probably why I tend to react negatively every time someone talks down the current system. As flawed as it is, it runs much better than the DMV, Social Security, government education, government owned car companies, etc. . .

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  8. Hantra says:


    The conclusions upon which I am basing that statement are simply that as health care goes, ALL of the innovation in drugs, medical care, you name it, come from the United States.

    - In the past 35 years, Americans have won more Nobel prizes for medicine or physiology than all other countries COMBINED.

    - Of the top 10 best selling drugs in the world, 8 were made by companies headquartered in the United States.

    - Of the top 10 most useful medical techniques or devices (as deemed by physicians), 7 are from the United States.

    * from the 2004 Economic Report of the President

    When the last ounce of profitability is sapped from our current system, who will innovate then? Government? That’s laughable.

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