Low cost care at the Mayo Clinic? Yes, here’s why

Atul Gawande, a physician who is writing about health care costs and reform of the system for The New Yorker, decided that one way to get a handle on the subject was to study cities where costs were high and compare them with low-cost centers.
His search took him to McAllen, Texas, in Hidalgo County, which has the lowest household income in the country.
“McAllen has another distinction, too,” he wrote, “It is one of the most expensive health care markets in the country. Only Miami, which has much higher labor and living costs, spends more per person on health care.
“In 2006, Medicare spent $15,000 per enrollee here, almost twice the national average. The income per capita is $12,000. In other words, Medicare spends three thousand dollars more per person here than the average person earns,” his article reports.
Dr. Gawande then summarized the problem:
“ ...The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. 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. ‘The greatest threat to America’s fiscal health is not Social Security,’ President Ba-rack Obama said in a March speech at the White House. ‘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.’”
Dr. Gawande then looked for a low-cost area similar to McAllen in population and average income and found El Paso County, 625 miles up the border. Both counties have a population of roughly 700,000, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of overall spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)
The article went on to show that the huge difference in medical spending between McAllen and El Paso could be explained entirely by medical practice styles. Providers in McAllen grossly overused the system. Those in El Paso practiced leaner medicine. Health outcomes in El Paso were at least as good and in some aspects better.
The writer then left Texas and studied Ro-chester, Minnesota, the home of the famed Mayo Clinic, which long has set world standards for the quality of health care it provides.
Gawande learned that Medicare spending in Rochester falls in the lowest 15 percent in the country — $6,688 per enrollee in 2006, “which is $8,000 less than the figure for McAllen.” Costs are lower because, among other reasons, Mayo pays its physicians salaries, taking away the incentive to bring in more income with more testing, more operations, more high tech imaging, more, more, more.
Dr. Gawande then observed: “Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next 50 years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.”
The New Yorker’s intensive look into health care costs, which includes some prescriptions for reform, runs 10 full pages in its June 1 edition, which is available at the Iola Public Library or may be read online at New Yorker.com.

— Emerson Lynn, jr.