A Texan health care mystery

What makes the town of McAllen different from the rest of the U.S.? The New Yorker explains

By Andrew Leonard
Published May 29, 2009 10:53PM (EDT)

The blog mind told me: Read Atul Gawande's extraordinary opus on health care in the June 1st New Yorker, "The Cost Conundrum: What a Texas town can teach us about health care." (Blogger who broke the camel's back: Noam Scheiber.)

I listened to the blog mind, which was, as usual, correct. Gawande's exploration of why health care costs in McAllen, Texas are far higher than the national norm is one of the most insightful things I've ever read on the health care dilemma in the United States. And a great read, to boot.

A ridiculously short summary would be that in McAllen, a culture of maximizing revenue rather than patient care has taken root more deeply than elsewhere. The good news: It doesn't have to be that way. Different cultures can take root, with the right leadership and incentives.

One paragraph resonated especially with me, as it connected to the work I did reporting on the free software movement in the late '90s.

Woody Powell is a Stanford sociologist who studies the economic culture of cities. Recently, he and his research team studied why certain regions -- Boston, San Francisco, San Diego -- became leaders in biotechnology while others with a similar concentration of scientific and corporate talent -- Los Angeles, Philadelphia, New York -- did not. The answer they found was what Powell describes as the anchor-tenant theory of economic development. Just as an anchor store will define the character of a mall, anchor tenants in biotechnology, whether it's a company like Genentech, in South San Francisco, or a university like M.I.T., in Cambridge, define the character of an economic community. They set the norms. The anchor tenants that set norms encouraging the free flow of ideas and collaboration, even with competitors, produced enduringly successful communities, while those that mainly sought to dominate did not.

The challenge facing us: Finding a way to institutionalize norms that encourage the free flow of ideas and collaboration, or, in the case of health care, encourage good patient outcomes at reasonable cost. The health care system is a mess, but Gawande's piece made me think that maybe there's a way out of the labyrinth.

Andrew Leonard

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

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