James Stewart is an internist in McAllen, TX, a rapidly growing city just a few miles from Mexico, far south of where the border lies in most of the rest of the U.S.
But when he woke up one morning a few weeks ago, his life and that of many other health providers with whom he works had changed. Suddenly they were in the national spotlight of the health reform debate, and not in a good way. Even President Barack Obama was pointing to McAllen as an example of how not to provide healthcare.
"We were shocked," Stewart said.
Thousands of miles away, writer and Harvard surgeon Atul Gawande had used the Dartmouth Atlas, a compendium of Medicare statistics, to accuse McAllen of providing too much expensive medicine, implying much of it is unnecessary, at the expense of the federal government. He referred to some of the doctors practicing in McAllen as "entrepreneurial," and echoed that for many, medicine had become like another business run by people interested mainly in profits.
And he did it in The New Yorker magazine, in an article entitled "The Cost Conundrum," which the White House has classified has required reading or those in the health reform debate.
"I am not normally a conspiracy theorist," Stewart said in an interview this week.
But in researching and writing his article, Stewart says, Gawande "totally brushed off the poverty we live with here" and the fact that by the time many people get to a health provider, they are diabetic, morbidly obese, have some degree of organ failure, and in some cases have their first medical encounter in an emergency room.
The thought has crossed his mind that Gawande had an agenda from the start, "motivated by reasons I don't pretend to understand."
Stewart characterized the article as being "intellectually dishonest" and says it did not take into consideration the essential fact that makes providing healthcare in McAllen a lot different than it is in Boston.
Gawande, Stewart says, should have run some risk adjustment calculations for that.
"How did we get in there (The New Yorker) this way when we have 30% of our population with no resources, and so many don't even qualify for Medicaid," he said during an interview yesterday.
Stewart and many of his fellow practitioners from McAllen and surrounding towns joined the Texas Medical Association for a visit to Washington, D.C. this week. They're holding meetings with the Border Health Caucus in an effort to persuade policy makers that there is a much more accurate story about what's wrong with healthcare in the U.S., one told with a visit to south Texas.
Gawande neglected to take into account the fact that hospitals in McAllen and many in the larger county of Hidalgo receive a lot of federal disproportionate share money because of the high number of uninsured, many of them undocumented immigrants.