Harvard Medical School’s Atul Gawande has a fantastic investigative piece — with the structure of a detective novel — in this week’s New Yorker. “The Cost Conundrum” is about rising health care costs in America, but Gawande doesn’t weigh the piece down with predictable quotes or eye-glazing statistics. Instead, he goes from hospital to hospital in McAllen, Texas, to find out how that city became the second most expensive for health care in the US. (Miami is first.)

Why, Gawande asks, does Medicare spend $15,000 annually per enrollee here (twice the national average)? And why does health care in El Paso, Texas, which has pretty much the same demographic profile, cost about half as much as in McAllen?

Spoilers below.

As I noted, Gawande structures his piece almost like a murder mystery. (A passage in which Gawande flummoxes a hospital administrator with evidence of soaring costs is particularly Law & Order-like.) And what does he conclude? Here is a taste:

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

I’m eager to read any criticism of Gawande’s piece, especially from champions of the American health care system, but he makes a strong case that the free-market system is not going to bring costs down.