The McAllen Problem: Why Are Latino Communities The Prototype For Bad Healthcare?

McAllen, Texas, an 88.3% Hispanic border town located in the one of the poorest counties in America (Hidalgo), spends almost twice the national average on the healthcare of its patients, but the result is often inferior healthcare to other communities of its size. This, it turns out, is the textbook dysfunctional American healthcare scenario. And, as one journalist from the BBC News says, “This town of cheap shops and poor immigrants…” (Hey, hey unnecessary roughness, blonde, anglo lady.), “…has caught the attention of the President. The puzzle of why some places spend so much on healthcare without providing better healthcare is now known as ‘the McAllen problem’. Fix that and you’re on your way, they believe, to fixing healthcare.”

While one of the glaringly obvious problems is that healthcare providers have become businessmen first–both the BBC News story and one in The New Yorker point to Doctors Hospital at Renaissance, a McAllen-area institution owned by the very same doctors in charge of prescribing tests and procedures to their patients–our interest in this story rests on the less noticeable issue of how this system seems to thrive in predominantly Hispanic communities. After all, the number one most expensive place to buy healthcare in the U.S. is Miami, where being a senior costs almost two-and-a-half times what being a senior in Minneapolis–the home of some of the cheapest healthcare–does.

From the outset, people are inclined to believe that the healthcare industry makes so much money in the Rio Grande Valley–the region of Texas where McAllen is located–and communities like it because of the proliferation of chronic health problems like diabetes and heart disease that are brought on by poor dietary habits often found in poor, ethnic minority communities. But, says The New Yorker:

Public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, 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 over-all 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.)

So what do McAllen and Miami have in common? Retirees. While everyone knows that many Jewish bubbies and zaydes retire in Miami, not so many know that the Rio Grande Valley is home to thousands of Winter Texans, retirees from the frigid midwestern states to the north. Is it this combination of the elderly and the disenfranchised minority that make for the perfect storm of medical wolvery that has become the local business culture in McAllen?

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

It seems that Medicare could be the clue to finding what creates an environment ripe for the picking by such unethical medical practitioners. After all, if it’s coming from the government, it’s a little easier to sleep at night knowing you’re profiting on someone else’s health problems and who has more government subsidies than the aged and the poor?

What we can learn from the McAllen problem and what we can learn from its opposite, the Mayo Clinic where costs have remained down because of a doctor pact to put the patient first, is that ultimately, the kind of healthcare system we have depends on the culture we choose. If in Latino and aged communities we are less prone to educate ourselves, we must remedy that situation. We must question the doctor on whether we need all the tests he or she prescribes and we must shop around before we spend money that ultimately is costing us all in the long run.