What a Texas town can teach us about health care.

In "The Cost Conundrum", a June 1, 2009 article in The New Yorker, Dr. Atul Gawande reports that McAllen, Texas, spends more per person on health care than almost any other U.S. city. His investigation provides suggestions for improving the health care system. For example, if a market-based health care systems provides doctors with more income when they order unnecessary tests and procedures, is it a surprise that they occur?

Dr. Gawande also discussed these issues on the National Public Radio (NPR) program Fresh Air on June 17, 2009:

Fresh Air from WHYY, June 17, 2009 · In "The Cost Conundrum," his latest article for The New Yorker, staff writer Dr. Atul Gawande reports from McAllen, Texas, a border-town with the dubious distinction of spending more per person on health care than almost any other market in America.

But higher spending doesn't necessarily correlate with better care, as Gawande discovers when he compares health outcomes in McAllen with those of El Paso, Texas — a city with similar population demographics, but where Medicare spending per enrollee is half that of McAllen.

Gawande writes that his findings, based on Medicare's 25 metrics of care, indicate that: "On all but two of these [standards of care], McAllen's five largest hospitals performed worse, on average, than El Paso's. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it's delivering better health care."

As the national debate about health care heats up, Gawande's article has become a must-read for President Obama's staff.

Gawande is an associate professor of surgery at Harvard Medical School and at the Harvard School of Public Health. In 2006 he received the MacArthur Award for his research and writing.

The Economic Origin of Celibacy

The May 5 publication of a photo of a Catholic priest frolicking on the beach with an attractive woman raised the issue of the origins of the rules that prohibit clergymen from engaging in sex. It is another example of how economic concerns influence religious doctrine, especially within the Roman Catholic Church. (See also "The Economic Origin of Eating Fish on Fridays.") One can argue the motive was purely theological - priests should devote themselves fully to God. The more practical reason was that supporting a family is a much larger financial commitment than providing for just the priest. And as M.J. Stephey points out in the May 25, 2009 issue of TIME magazine,

"celibacy meant no offspring vying to inherit church property."

Glenn Weisner published a more detained history of celibacy in the Roman Catholic Church. It begins:

"As it turns out, the wealth and power of Rome had more to do with the practice than spirituality. Clerics often married until the Middle Ages, until concern, mostly over the loss of Church lands to heirs of priests, led to the imposition of the celibacy rule."

The Future Church also published a brief history of celibacy in the church. It begins:

"First Century
Peter, the first pope, and the apostles that Jesus chose were, for the most part, married men."

Actor Gabriel Byrne (HBO´s In Treatment) mentions the celibacy issues in his April 30, 2009 interview with Terry Gross on NPR´s Fresh Air.

Update (May 28, 2009): Sex Scandal Miami Priest Quits Catholic Church:

A popular U.S. Roman Catholic priest photographed frolicking with a woman on a Florida beach announced on Thursday he had joined the Episcopal Church to pursue the priesthood in a faith that allows married clergy.