Prevention Matters

Atul Gawande has an incisive piece in The New Yorker on what accounts for the vast differences in per capita Medicare spending in different parts of the country. He focuses on McAllen, Texas, where the average annual Medicare expenditure per patient exceeds the average annual income and is double that of Medicare spending in El Paso County, Texas - even though the demographics and treatement facilities are roughly equal and the quality of health care is ranked lower in McAllen than in El Paso County.

Basically, Gawande concludes that the situation in McAllen and many areas with extremely high costs is attributable to an "across-the-board overuse of medicine" fueled by a local economic culture that "came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers."

At the same time, he says, "patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed."