In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice as much as the national average. The income per captia is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person than the average person earns.Why is it so high? Gawande finds out, from much research in town and from studies, it's because the doctors in the town operate like individual entrepreneurs, who are looking to "increase their high-margin work and decrease their low-margin work." The "high-margin" work--stuff that makes them the most money--is things like expensive tests and surgery. It doesn't necessarily lead to healthier people. So the town is less healthy than other towns, and it's paying more.
Gawande points out much better models, like the way things are run in Rochester MN, where Mayo's located. There, doctors work together to provide the best care, rather than working as individuals to make the best money. Those two models are two ways our country might go in the future--which would you like??
I hope you'll look at the article. It's very readable, and gives you some idea of what would make a successful health care approach.