A recent New Yorker article by Atul Gawande has been getting a lot of coverage lately–there are even rumors that Obama has made it required reading for his White House Staff. In the piece, Gawande shares an extensive evaluation of the medical system in McAllen, Texas. We at NLIRH know McAllen well, because it is where for over two years we have been working with the women in the video above, the amazing activists affiliated with La Voz Latina and Migrant Health Promotion.
He started by looking at numbers: “In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average.” Gawande asked long standing community doctors why the spending rates of Medicare are so high in this area of Texas. They told him: “There is overutilization here, pure and simple.” There is no evidence that the city provides better quality care than any other city, even with it’s up-to-date medical technology. Actually, the health outcomes are worse. Looking outside the community for help analyzing this “Cost Conundrum,” Gawande solicited Jonathan Skinner, a Dartmouth economist, to analyze why the cost of care was so high in McAllen. Skinner also concluded that is was “very simply, the across-the-board overuse of medicine.”
In his analysis of the medical delivery system in McAllen, Gawande did not address many of the concerns of the women we’ve worked with, some of whom are featured in the video above. We know a large portion of the people in this region are undocumented immigrants from Mexico and other Latin American countries. Even if they have documents, these immigrants do not qualify for federal programs like Medicare for the first five years they are here. So how do these immigrants get health care? Many reportedly cross the border to Mexico if needing medical attention, or some pay out-of-pocket for services in the area.
Gawande may not be talking about these women, but they are doing their own organizing to address the health care gaps in their communities. We’ve collaborated with them on reproductive justice organizing and advocacy, and it’s amazing to see what they are achieving despite all the barriers they face.
Contributed by Robin Mangini, Research Intern