McAllen: Trade Story, Not Health Care Story
There has been much discussion over Atul Gawande's expose' on the health care costs in McAllen, Texas. Allow me to add some back-story.
Back in 2001 the factory I worked in for over a decade relocated to Reynosa, Mexico. A group of us were sent down to train our replacements. We stayed just across the border at, guess where, McAllen, TX. I was there for just over a month
The best way to describe McAllen, at least while I was there, is a business resort in semi-Mexico. At all of the McDonalds and Wal-Marts and gas stations, all of the employees were Mexican while all of the customers gringos on their way to and from work from Mexico.
The apartments we stayed in were locked down like Fort Knox. The police presence was very heavy. Strip-malls (and strip-clubs) were everywhere. The entire city was merely an enticement for businessmen to stay as they relocated their factories.
My guess is that this is what also brought all of the high-tech medical professionals to the area. A CEO dying of a heart attack because of subpar health care would be bad for business. Plus, these management folk had top-notch insurance to pay for all the bells and whistles.
Now that NAFTA's effects are tapering off in the area, the only option for doctors is to sew up the locals, most of whom would likely be on Medicaid or Medicare economically. Our bringing the crappy pleasures to the area probably didn't help either.
This is a trade story, not a health care story.
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And a true story, and much appreciated.
May 29, 2009 12:52 AM | Reply | Permalink
Interesting affects, huh?
I had a deposition down there, probably in the eighties. I DROVE.
I had some biz in Oklahoma first. Went to Macallen.
I remember thinking I was making good time when I hit the Texas border. Two days later I made it to the twin town of brownsville.
Holy crap. It really is the ends of the earth.
May 29, 2009 12:56 AM | Reply | Permalink
Gawande's article was an interesting read. I think he missed something in his analysis as to how we institute the types of controls he suggests without having a single payer system, but that's a different blog. You may be right that because of the location of McAllen on the border, trade plays a role in the high health care costs, but it doesn't negate most of the arguments Gawande makes. The real issue, I think, boils down to eliminating the incentives so many modern day physicians have for gaming the system through referring tests to clinics, etc. which they have a fiduciary interest in. It will be a bitter pill for many to swallow as they drop down from their entrepreneurial role to being a wage earner, but without some serious thinking going into this, I see health care costs continuing to escalate at what has been the highest rate of increase in any of the OECD nations.
May 29, 2009 3:59 AM | Reply | Permalink
I take issue with the story and with some of the above comments. The real reason that medical costs are so high in McAllen- I can't believe the writer didn't uncover this very basic fact- is that the hospitals are forced to accept uninsured patients from Mexico. I don't know about legally, but from a humanitarian standpoint, there is no option.
McAllen has consistently been rated one of the country's fastest growing cities for the past 12 years. Comments on that kind of city from a perspective of almost a decade ago is bound to be out of date and inaccurate, and the above comments are just that.
Yes, there are a lot of strip malls. That's because McAllen is the #1 shopping destination in the entire U.S. for Mexican National shoppers. The city therefore has loads of shopping and loads of restaurants, from fast food to the best chains to terrific, unique mom and pops.
I know of 3 strip clubs in the area, though there may be more hidden away. They certainly don't dominate the vista- unless, I guess, if you're looking hard for them. There are 750,000 residents in the McAllen area. How many strip clubs are in YOUR hometown of 3/4 of a million residents?
As for workers, there's a difference, you know, between Hispanics and Mexican Nationals. Assuming all Hispanics are Mexicans is either ignorant or racist. People who live and work in McAllen are predominantly Hispanic, and they speak at least two languages. How many do you speak?
And yes, Texas is a BIG state. This is common knowledge, even among elementary schoolers. To complain about how long it takes to drive from the very top to the very bottom is kind of silly, isn't it? All it would have take to be prepared for the distance is a rudimentary knowledge of geography or, barring that, looking at a map before the trip.
I could go on, but my point is this: it's so easy to diss a person or a place. It takes much more time and energy to make more thoughtful comments.
May 29, 2009 10:35 AM | Reply | Permalink
Nancy,
I appreciate your comments. I never meant to offend your sensibilities nor the city of McAllen. I had a great time the month or so I stayed there. That said, let me address a few of your points:
First, this post was meant to express my personal obervations only,observations that I openly admit are dated.
Second,I never offered my opinion as fact, hence qualifiers like "my guess is."
Third, I probably shouldn't have generalized the Hispanic population as Mexican. I did so only because the city's proximity makes it likely that a majority of the Hispanic population is of Mexican origin.
All your points are taken, but I never meant this to be a hit-piece on McAllen nor a complete bio of the city. I was addressing an article someone wrote about the city on a specific aspect of the city (health care) using anecdotal observations I made in 2001.
May 29, 2009 12:25 PM | Reply | Permalink
Perhaps you two were in different parts of the same city.
May 29, 2009 1:03 PM | Reply | Permalink
I think your assertion that the reason medical costs in McAllen are so high "is that the hospitals are forced to accept uninsured patients from Mexico", may be erroneous. Gawande speaks of the money spent by medicare per enrollee as the metric he's using to gauge medical costs. Uninsured Mexicans, I believe would not show up under that metric.
May 29, 2009 1:42 PM | Reply | Permalink
Everything written about McAllen is true and more! I was an MD in south TX for a few years and left ASAP. South TX is a medical hellhole. The problems are so pervasive that you wouldn't know how to solve it. There are so many issues that you don't know where to start.
1. Most people are poor, uneducated, on Medicaid or Medicare
2. Most people are obese. I have never seen so many diabetics in my life. You can't assume that the young are healthy.
3. Fraudulent surgeries and billing by doctors are rampant. Kickback schemes are common. Illegals and Medicaids go to government hospitals. The insured go to Renaissance where charges can be racked up.
4.A lot of the medical cost is due to futile care (end of life in the ICU) When you don't pay for the healthcare, you want everything done for your family member, no matter what.
5. Pregnant women from Mexico "drop-in" to deliver their sixth child and the US taxpayers foot the bill for the c-section or the epidurals. Contraception is a foreign term and teenage pregnancy is high. Medicaid is a vicious cycle.
6.You lose if you're a doctor with a conscience. The winners are the medical businessmen without ethical standards.
7.They love to sue doctors, legit or not. There is no one (sheriffs, doctors, judges) who can't be bribed.
Coincidentally, I did residency training in the Midwest right before I went to the Valley. The medical culture there is completely different and l love the training I received. Even the VA hospital there is better (and that is saying a lot about government health care)
May 30, 2009 7:56 PM | Reply | Permalink