This week’s New Yorker has another article by doctor and health care policy expert Atul Gawande. In the article he attempts to probe why medical costs in this country are spiraling out of control, singling-out one particular outlier in Texas:
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 it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami–which has much higher labor and living costs–spends 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. [Link]
By systematically eliminating all the likely suspects (e.g., it’s the lawyers and their malpractice suits that cause health care costs to soar), Gawande comes to a conclusion that many doctors probably already grudgingly realize through experience. It is doctors (not all, just the ones who increasingly advocate for tests that the patient probably does not need) who are driving up health care costs for everyone:
“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.Continue reading
That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?
“Practically to zero,” the cardiologist admitted.
“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures. [Link]
like, sticking your thumb out at motorists, hoping one of them stops, hoping it isn’t someone who wants to take you home and introduce you to his 
