Or Lubbock? Or Oklahoma City? Or New Orleans? Or any of a dozen major and minor metro areas throughout the South? According to the Medicare Payments Advisory Commission, all of them have significantly higher usage rates and costs per Medicare enrollee than McAllen, which was high-cost locale ground zero for Atul Gawande's famous New Yorker article, "The Cost Conundrum," which has become, to use the New York Times' formulation, "must reading in the White House."
Gawande grounded his analysis on per-patient Medicare claims data compiled annually by researchers at Dartmouth Medical School. "The explosive trend in medical costs seems to have occurred here in an especially intense form," Gawande wrote after the Dartmouth Atlas of Health showed McAllen as the highest spending region in the country outside Miami, where Medicare fraud is an especially virulent problem. Not so, MedPAC said. Adjust for prices and McAllen's outlier status compared to the rest of Texas and large parts of the South all but disappears.
Don't believe me? Check out the appendix to the report. Medicare service utilization rates compared to the national average: McAllen - 118%; Houston - 122%; Dallas - 117%. Other areas: Oklahoma City - 120%; New Orleans - 125%; Pascagoula, Gulfport or Biloxi, Miss. - 124%.
In other words, Texas and large parts of the South have a problem -- not just McAllen. I'll return to that in a moment.
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