KevinMD November 14, 2025
“The most expensive piece of medical equipment is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.” Dr. Atul Gawande, an endocrine surgeon practicing at Brigham’s Women and Children Hospital in Boston, Massachusetts, wrote those words in the June 1, 2009, edition of the New Yorker in an article entitled, “The Cost Conundrum.” In that article, Dr. Gawande compared health care expenditures in McAllen, Texas, to its neighbor 800 miles up the road in El Paso, Texas. He found that Medicare expenditures in McAllen were $15,000 per enrollee, nearly twice the national average. Gawande could not attribute the rate of obesity, diabetes, and alcohol use to the differential because the town of El...
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