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.