If President Barack Obama didn’t know where McAllen and the Rio Grande Valley were before, he does now, thanks to a recent article in The New Yorker magazine.

The article laid out in great detail how McAllen’s Medicare costs come out to $15,000 per year per enrollee - almost double the national average.  And yet, The New Yorker article reports, the rates of heart disease, cancer, HIV, asthma and infant mortality are lower  in McAllen  than the national average.

This obvious conflict between what is spent - on average - for medical care in McAllen vs. the rates of disease and injury got the attention of the president of the United States to such an extent that he made the article required reading in the White House. Members of Congress who have visited with Obama as discussions continue over health care reform say he brings the article to their attention as an example of why such reform is urgently needed.

“He (Obama) took that article and put it in front of a big group of senators and said, `This is what we’ve got to fix,’ ” said Sen. Ron Wyden, D-Oregon in a New York Times story.

The magazine article was hardly written by a novice unfamiliar with the world of medicine. The story’s author is Dr. Atul Gawande, a professor of surgery at Harvard Medical School. An online reviewer of the magazine article called Dr. Gawande “one of the brightest and most articulate authorities on health care issues in this country.”  

Gawande compared medical costs between McAllen and El Paso, (border cities with similar demographics), and found McAllen patients got “twenty percent more abdominal ultrasounds, thirty percent more bone-denisty studies, sixty percent more stress tests,” and over 500 percent more urine-flow tests to diagnose prostrate troubles.

And there’s more. McAllen patients, Gawande reported, got more gall bladder operations, knee replacements, breast biopsies, heart bypass surgeries, and more home nurse visits. For all of the extra medical procedures, the Harvard doctor wrote, there is no evidence that all of this care has produced better results.

The New Yorker article stung and angered the McAllen medical community. One local doctor, Linda Villarreal, an Edinburg internist, said the magazine article failed to address the high percentage of indigent costs in this area - and the ever-present fears of local physicians about malpractice lawsuits.

Villarreal made those comments to The Monitor newspaper, and she has a point when it comes to litigation fears given this area’s well-deserved, (unfortunately), reputation for being one of the more lawsuit-heavy regions of the country. Any local TV viewing is sure to include advertisements from 20-something lawyers freshly minted out of law school, and stuffed in their new three piece-suits as they exhort viewers to call them to get the cash they deserve.

It’s true the high number of indigent cases here, along with litigation fears, are sure to push medical costs up in this region as physicians order extra tests to protect themselves against lawsuits. It’s also true that in McAllen a number of physicians own medical facilities, hospitals, and test facilities, and one spin on Gawande’s findings is that extra tests are ordered to increase payments to these facilities.

Gawande appears to be a critic of profit-driven medical care in contending that it leads to quantity of care, (i.e. all of the tests and unnecessary surgeries), over quality of care. That’s for the professionals and experts to hash out, but ultimately, regular folks are the one affected.

In any case, it’s interesting to note that as the health care reform debate rages in this country that a community close to home - McAllen, Tx. - has found itself in the midst of this national discussion.

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