The Mystery of the Cost of Healthcare
By Manuel E. Yepe

A CubaNews translation by Mercedes Rosa Diaz.
Edited by Walter Lippmann.

A New Yorker magazine investigative report about why McAllen, Texas, a city located in Hidalgo county—which has the lowest per capita income in the country—has one of the highest medical costs per person in the United States (surpassed only by Miami, Florida), has stirred an unusual controversy over the rarely discussed contradictions that affect the quality and coverage of health services in that country. 

The article that originated the debate appeared in the June 1, 2009 issue of the New York-based magazine, entitled, “The Cost Conundrum.”  The author, Dr. Atul Gawande, who is a frequent contributor to the magazine, is a professor affiliated with Harvard University’s schools of medicine and public health and the author of various medical books.   

A few days after the publication of this article, the New York Times reported that the White House had labeled the article “required reading” for all administration officials.

The report states that in 1992, Medicare spent $4,891 per person in medical care in McAllen, in line with the national average.  In 2006, Medicare spent $15,000 per person in that same city, close to twice the national average.  The per capita income in McAllen is $12,000; it means that Medicare spent $3,000 more per person than what the average person in the city earns each year. 

Medicare is a Social Security program for residents over 65 who meet specific criteria.  The program is administered by the government through companies that work as contractors.  To be eligible, one must generally be a U.S. citizen or permanent resident who has contributed to the program for at least 10 years.  That contribution is a tax that ranges between 2.9 and 5.8 percent of the total income connected to employment.  As a rule, the insurance doesn’t include prescriptions.

The New Yorker article covers just one angle of the complex contradictions that make the superpower one of the few industrialized nations whose citizens receive some of the world’s worst health care.  It only covers the explosive tendency to raise medical costs—to the highest in the world—by illustrating this propensity in the small Texas city where those escalating costs have been particularly intense.      

This situation has led to a situation in which the focus of reform has switched from extending health care coverage to all citizens, to simply controlling the costs associated with medical care, he noted.

“Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government,” he assures.

Gawande reminded his readers of the words of President Barack Obama during a speech he gave at the White House in March:  “The greatest threat to America’s fiscal health is not Social Security.  It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care.  It’s not even close.”

The author goes on to say that many of the people in McAllen are not surprised to know that their city is the most expensive in the country with respect to medical services. 

However, he also noted that McAllen’s residents are not healthy: they suffer from an elevated poverty rate, a high incidence of alcoholism (60 percent above the national average) and an obesity rate of 38 percent.

He also drew attention to the number of heart surgeries that are performed at McAllen hospitals, especially those performed on obese patients, diabetics or patients suffering from both afflictions.  He noted that few were treated with drugs that could have prevented the surgeries. 

The author’s interviews highlight the way that medical and allied health personnel authorize tests, drugs, surgeries, treatments and other unnecessary procedures in order to attain greater economic benefits.  He also notes that low cost preventive services, vaccines and primary medical attention are rarely advised. 

The writer asks himself if in today’s USA, a patient who goes to the doctor with chest pains, a tumor or a simple cough will encounter a health professional who is eager to help him above all things, or whether he will encounter a person who is eager to maximize his own earnings.

He proposes various organizational models of that have obtained better results than the current archetype that can be imitated.  However, he never addresses the unmistakable fact that the practice of medicine is incompatible with the dehumanizing economy of the free market.