An Interview With Atul Gawande
You’ve gotten some pushback on your article about McAllen, Texas. Today, in fact, some doctors from the area held a press conference rebutting your claims, and you published a blog post re-rebutting theirs. What have you found to be the most convincing counterarguments against your piece?
The three lines of criticism were ones I anticipated or even talked about. The idea that these people in McAllen are unhealthier. The idea that it’s all malpractice. The one point I didn’t get into was the snowbirds [retirees from colder areas who summer in Texas], but they’re not in the spending calculations anyway because Medicare counts them in their home area.
The criticisms I’d been hearing and seeing but that hadn’t been going away was pointing out that McAllen is the poorest county in the country. They’d say you couldn’t compare it to Mayo. But I didn’t. El Paso, which I did compare it to, was the sixth poorest in the United States. They’re very closely similar in poverty, in immigration, in physician supply, in rates of disease, and so forth.