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October 29, 2007
Medical Tourism
Andrew Sullivan's very excited by the fact that Britain has a burgeoning medical tourism industry. "Tony Blair poured millions into Britain's socialized healthcare system," he writes, "pumping unprecedented resources into a healthcare system that Michael Moore admires and the American left loves. This is the result." Take that, mediocre-to-bad health care system that nobody on the Left suggests we should copy!
Of course, Britain spends 41 percent what we do per capita -- and no one thinks Blair made up that shortfall, or anything close to it. So detractors are probably best served by not making funding the issue. I wouldn't have thought, however, that they'd try to move over to medical tourism as a point of comparison. But we can have that discussion. We can talk about the 50,000 Americans who go to Bumrungrad hospital in Thailand every year for cheaper surgeries. We can go into this article, about the Indian hospitals primarily serving Americans, or this one, about the waves of Americans traveling abroad because they're unable to afford heart surgery. Indeed, there are more Americans -- 100,000 -- traveling abroad for cosmetic surgery alone than there are Britons seeking any type of services in foreign lands.
America is actually driving the medical tourism industry that some Britons are taking advantage of. The growth of foreign treatment centers aren't a result of the failings of the British health care system (of which there are many). They're a result of the cost of American health care, and the huge numbers of sick individuals we price out. You'd think, paying two-and-a-half times what the Brits do for health care, that we could all access care, and wouldn't need to fly to India. But you'd be wrong. The Brits also have a bad health care system, but theirs is, on the bright side, very, very cheap. Ours isn't.
October 29, 2007 in Consumer-Directed Health Care, Health of Nations | Permalink
Comments
But, but, but, as Bush sez, the poor can always get care at the ER.
Posted by: JimPortlandOR | Oct 29, 2007 10:07:33 AM
I just can't understand why Andrew Sullivan is prominent. He is dishonest, emotionally unstable, and sees all facts only through the distorted lens of his ideology (as do Bush and Cheney). People like Sully still use the internet the same way they use the traditional media. He doesn't seem to understand that he will be immediately fact checked and debunked unlike the TV appearances and magazine articles.
Posted by: marvtoler | Oct 29, 2007 10:23:02 AM
Your post demonstrates that the current debate oveer healthcare is not addressing the real issues. The COST of healthcare and not the insurance coverage is the problem.
Allowing physicians to self refer patients to facilities that they, themselves, have a financial stake in is a problem. Unworthy lawsuites and ridiculous awards by the courts that Thailnad and India don't have to shoulder the burden could be important as well. Allowing the AMA (a union of sorts) to dictate where and when medical schools will or will not be built should be an issue. There are lots and lots of examples of why medical care is out of control.
Start speaking about the underlying causes instead of simply asking for a wealth transfer insurance scheme to keep the same bad system going.
Posted by: El Viajero | Oct 29, 2007 10:23:37 AM
Sullivan is a bit unstable, and tends toward libertarianish over-principled positions.
But his blog is fun. He's often a crank, but an interesting crank.
He is also the sole major war booster who dug deep and explored why he was so wrong on Iraq.
The right has many positions I can barely understand. For example, over terrorism all I can do is furrow my brow and ask myself if these people are actually as scared as they seem to be. al qaeda is so obviously a weak player.
Sullivan has this peculiar infection only halfway, so through him I can see that many many people really are completely unable to weigh risk or weigh costs and benefits. He is sincere in his stupidities.
He really is a bizaare Jekyll Hyde animal who can write, and there aren't many of those out there.
Posted by: tomtom | Oct 29, 2007 10:42:27 AM
But, but, but, as Bush sez, the poor can always get care at the ER.
No, Jim, only illegal immigrants are guaranteed care in the ER.
Posted by: Stephen | Oct 29, 2007 10:42:34 AM
But NHS care is 'free'. When youre offering something for free and a good chunk of people would still rather pay to fly off somewhere else to get it, the quality of what youre offering must be pretty shabby.
Anyway, its not clear that was his point(to be fair, it is not clear he even has one beyond 'aha!'). He may have been referencing what he believes to be the systemic tendency for governments to spend inefficiently.
Posted by: pimp hand strikes! | Oct 29, 2007 11:04:53 AM
Er, the U.S. has 5 times the population of Britain. So adjusting for population, it's the equivalent of 350,000 Americans seeking health care abroad. Forecast to rise to 1 million by 2010. The Brits can keep their cheap health care system.
Posted by: JasonR | Oct 29, 2007 12:20:54 PM
JasonR,
You might want to take an actual look at the subject before confidently assuming that the number of American "medical tourists" is actually less than 350,000. We can even exclude the 100,000 who traveled for cosmetic surgery, if you like.
With 50,000 going to Thailand alone, Indian hospitals that serve only Americans and with what appears to be an entire publishing industry focused on medical tourism books, I'm willing to bet that 350,000 Americans traveling abroad in one year would be the low end of the range.
And remember, England's system is the one that progressives hold up as an example of what not to do, so if we have proportionately more people seeking care in foreign countries than they do, that puts our system in a fairly bad light.
Posted by: Stephen | Oct 29, 2007 12:34:22 PM
Even more to the point: if you look at where Britons are going, many of them are going to India. India has partial universal health coverage; only 1,300 of its over 7,000 hospitals are privately run and funded. Over 4,000 of those hospitals are run outright by the national or local governments.
And every other country listed in the article that Britons are "fleeing" to? You guessed it: they all employ some form of government-subsidized care. In Germany, for instance, working citizens are legally required to purchase insurance either privately or through the state.
I like Andrew. I read him daily. But he still hasn't thrown off his illogical attachment to some of his conservative/libertarian sacred cows - free-market health care being Cause #1.
Posted by: Jay Andrew Allen | Oct 29, 2007 12:39:17 PM
I'm willing to bet that 350,000 Americans traveling abroad in one year would be the low end of the range.
That's nice for you, but I'm not willing to bet that what you're willing to bet has any meaningful relationship to reality.
Posted by: JasonR | Oct 29, 2007 12:50:17 PM
Sullivan was on full display on Maher's HBO show this weekend. He was terrible. He gets so dogmatic on certain issues, or more likely I only notice his dogmatism on issues where we disagree.
Sure he has come around on many issues. He hates torture and civil liberties abuses, can't stand the profligacy of Bush and Company, and seems to believe that the Christian right and global warming deniers are much bigger threats to America than the "fifth column" of Ward Churchill. Great.
But Sullivan cannot let go his stance against the Clinton health care plan and Hillary herself. He remains PROUD of the role he played in dooming America to 15 more years of failed health care policy. He seems to think that as long as he personally keeps getting improved HIV medications the market is working. Well Sully, markets seek out steady states, and death is the ultimate steady state. The market will dictate that some never get those or other treatments because they cannot afford them. And they will die. And others will be impoverished. And others will remain wedded to dead-end jobs they cannot leave. And economic production goes down the drain. But the market found a steady state, optimal or no. And people have died because that plan did not pass.
His personal animus toward the Clintons is almost as bad. Despite turning his back on Bush, DeLay, Gingrich, Limbaugh, and the movement they champion, Sully writes about the Clinton administration's secrecy and stonewalling of investigations without any sense of irony. If I hear him saying or read him writing "Nixon in a pantsuit" one more time, I may scream. He just can't get past his hatred of them to admit he was wrong. Not about liberalism vs. conservatism. He is entitled to be a conservative. But Clinton was no liberal, the republicans aren't conservative, and the vast right wing conspiracy isn't something Hillary dreamed up.
Posted by: tomboy | Oct 29, 2007 12:51:33 PM
"Of course, Britain spends 41 percent what we do per capita" our government spends more than that on healthcare! Healthcare is highly regulated by our politicians. They tell us who can do what etc. We are being screwed by our politicians and doctors.
BTW I think the French spend even less!
Posted by: Floccina | Oct 29, 2007 1:12:13 PM
You would think consuming 2 to 2 1/2 times as much healthcare as the British, liberals would understand why we pay 2 1/2 times as much when viewed from a macro prospective.
http://www.bmj.com/cgi/content/full/324/7330/135
The NHS Plan (2000) states: "The public's top concern about the NHS is waiting for treatment. Waiting to see a GP, waiting to be seen in a casualty department, waiting to get into hospital and, sometimes, waiting to get out of hospital."1 On 28 February 2001, 45 500 people in England alone had been waiting for more than one year for admission to hospital.27
in the NHS 80% of patients referred to a consultant are seen within 13 weeks whereas in Kaiser 80% are seen within two weeks. One third of NHS patients wait more than five months for hospital admission whereas in Kaiser 90% are admitted within three months.
I treasure living in a free nation that allows me to exchange the fruit of my labor for services I so choose, such as surgery to cure a potentially life threatening illness. How can one consider themselves civilized when they can pay to expedite delivery of a package or to slip to the front of the line at a club but not medical care that could save their life?
Why don't you make the question real simple for people; would you be willing to wait 6 times longer to see a doctor if we cut your insurance premium in half...personally no, when I am to the point I need to see a doctor I want it now not three months from now.
Aren't the liberals who propose single payor and universal care the same ones that attack HMOs over denying expensive care with questionable results? Is it acceptable when it is the Single Payor doing it?
http://www.nytimes.com/2006/02/16/international/europe/16cancer.html?ex=1297746000&en=d1533b4a8742d562&ei=5088&partner=rssnyt&emc=rss
National Health Service Trusts in Britain refused to treat women with breast cancer with the drug Herceptin arguing that is was just too costly. They did eventually back down like most HMOs do.
Now the NHS wants to limit access to various drugs for Alzheimer's disease patients on the grounds that they are not cost-effective
Universal Care proponents claim all the benefits of the system without confessing or admitting to the considerable draw backs. When HillaryCare was fully presented in the light of day it was soundly shot down as will any other bills presented. How many examples of failure do you need to see before you get the idea it just doesn't work. Seeing how many commenters on here admit to Marxist and communist yearnings apparently no amount will ever get the point across
Posted by: Nate O | Oct 29, 2007 1:21:54 PM
If the numbers are proportional, neither speak well for either system do they?
Two questions for Ezra:
Why bring elective cosmetic surgery into the discussion? It seems to me that it detracts from your point (raising the question of how many of those 50,000 going to that hospital in Thailand are there for nose jobs) or do you think elective cosmetic surgery is something that an American single-payer plan should provide?
As I think you know, one of the ways the Brits have been able to operate at reduced costs has been the difference in standard hospital accomodation. In the UK, the norm has always been an 8-bed ward with no frills, while in the United States the norm has become a 2-bed semi-private room with individual televisions, telephones and shared private bathroom. Do you think Americans are willing to adapt to the UK model in order to save money?
Posted by: Randal Rogers | Oct 29, 2007 1:29:00 PM
"The market will dictate that some never get those or other treatments because they cannot afford them. And they will die. And others will be impoverished. "
Do people care more about people who are impoverished by an event than people who have always been poor? If so why? It is interesting because the poor can get medicaid.
Posted by: floccina | Oct 29, 2007 1:31:53 PM
in the NHS 80% of patients referred to a consultant are seen within 13 weeks whereas in Kaiser 80% are seen within two weeks.
What's the percentage for uninsured Americans, Nate? Apples should, generally, be compared with apples.
Posted by: ajay | Oct 29, 2007 1:32:54 PM
I'm willing to bet that JasonR lacks critical thinking skills and is not worth engaging in any debate.
Posted by: elliottg | Oct 29, 2007 1:37:08 PM
Nate O., perhaps you missed that fact that AMERICANS also have to wait for important health care. I will quote Paul Krugman's column "The waiting game" to point out this little fact, which you have conveniently overlooked:
----------------Quote start------------------
"A recent article in Business Week put it bluntly: “In reality,... the American people are already waiting as long or longer than patients living with universal health-care systems.”...
[T]he Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice... [and] is the worst place ... if you need care after hours or on a weekend.
We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures...
In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money."
----------------Quote end------------------
Of course if you are not bound by insurance but have enough money to pay cash for whatever care you need in the US you can get it instantly. But the same goes for all European systems which also have private hospitals. At the end of the day, though, someone has to be at the back of the line...
It's hard to see ANY real advantages to the American system. Any universal health care system receiving as many funds as the American would vastly outperform it, due to the lack of bureaucratic layer of insurance adding no value but taking out enormous resources to function. This is one of these truly few cases where there are hardly any disadvantages to reform, the system is so bad that only progress can be made.
Posted by: Esben | Oct 29, 2007 1:45:37 PM
Anecdotal note - a friend with diabetes waited four months to see a specialist; I waited 2-3 months to see a surgeon for a hip replacement consultation, and then 7 months for the operation. And I had really good insurance.
Posted by: Barry | Oct 29, 2007 1:47:46 PM
but there are 300 million Americans ... of course we have more medical tourists than the UK! the more damning critique would be to point out the fact that these UK folks are leaving their universal coverage system to seek care in countries with ... universal coverage.
Posted by: anon | Oct 29, 2007 1:48:34 PM
Sullivan still thinks Israel can do no wrong. I guess he worked at The New Republic too long.
Posted by: Laney | Oct 29, 2007 1:55:43 PM
tomtom: Sully supported the war because it was divisive and made him feel manly. He opposed the war because it turned out Bush wasn't in favor of gay marriage.
He hasn't really discussed either of these on his blog, so we're back where we started.
Posted by: Kimmitt | Oct 29, 2007 1:59:54 PM
Kimmitt: He opposed the war because it turned out Bush wasn't in favor of gay marriage.
Huh? You're claiming that when Bush, a conservative evangelical Christian, was elected, Sullivan thought he was pro-gay marriage, and only later discovered he wasn't? I think you're hallucinating.
Posted by: bobo the chimp | Oct 29, 2007 2:09:01 PM
Note that British people also have cosmetic surgery (because we are so ugly) and that this is not available on the NHS. If you look at the underlying survey, 14,500 of these 50k "health" tourists were going overseas for cosmetic surgery. Another 20,000 were going overseas for dentistry - there are such things as NHS dentists but it is basically impossible to get onto the patient lists for them these days, so dentistry is not free either for a lot of British people. A large chunk of the remainder will be laser eye surgery (not usually available free on the NHS) or IVF (only two cycles available free on NHS).
Posted by: dsquared | Oct 29, 2007 2:19:03 PM
That's nice for you, but I'm not willing to bet that what you're willing to bet has any meaningful relationship to reality.
Gee, JasonR. Having a hard time countering facts?
Posted by: Stephen | Oct 29, 2007 2:58:13 PM
Close your tags until Typepad gets a clue, please.
Posted by: Stephen | Oct 29, 2007 2:58:53 PM
I lived and worked 32 years in France. I can't recall any member of my family ever having to wait more than a fortnight for any type of care. Floccina is wrong: the French system is dearer than the British (because much less centralised) but cheaper than the American, with far superior results.
Posted by: James Wimberley | Oct 29, 2007 3:05:12 PM
In trying to check up on Rudy's claim in his ad about socialized medicine ("My chance of surviving prostate cancer, and thank God I was cured of it, in the United States: 82 percent. My chances of surviving prostate cancer in England: only 44 percent under socialized medicine."), I ran across a skeptical post by (of all people) AllahPundit, who linked to this National Post article, in which a Canadian medical tourism guru says "that medical tourism is far less of a big deal in Canada than it is in the U.S., where 500,000 Americans went overseas for treatment in 2005. The reason for the difference is cost. Americans are used to paying for medical care, said Ms. Sayeed. Canadians aren't because of their country's universal publicly funded health care. Medical care overseas for Canadians means money out of their pocket, she added."
500,000 Americans would be way above the 350,000 proportional representation cited in the comments above.
Posted by: Molly | Oct 29, 2007 3:26:53 PM
Ajay 300 million should wait 13 weeks to see a doctor so some small fraction of 40 million will also only have to wait 13 weeks? If one suffers we all suffer huh? That depends on why someone is uninsured, if you have the money to pay, the uninsured can get seen quicker then the insured in America, there is always a doctor with a spot open, just not always a doctor on your list.
Krugman knows slightly less about insurance and Healthcare then I know about Journalism. Nothing about Krugmans quote is accurate, the vast majority of Americans are covered by plans that mangage cost post delivery. The insurance company doesn't even know you went to the Dr till days after. Stating delays in seeing a Dr in US are due to managed care is flat lie. Most HMOs even allow for direct referral to specialist.
If your knowledge of the US health system was developed solely from Krugman and the NY Times it's understandable why your so misinformed. America has the most advanced care in the world, the latest medicines, test and surgeries. If your insured and take advantage of the care available there is not a system on earth that even comes close. I'd rather pay extra and know if something happened I had the best care possible available then have a "free" meedicore system.
Posted by: Nate O | Oct 29, 2007 3:37:44 PM
Nate O: Your ignorance might look less obvious if you acknowledged that you can get private health care in the UK if you want it...
Posted by: Meh | Oct 29, 2007 4:33:31 PM
Nate O. knows slightly less about insurance and healthcare than the Pope's firsthand knowledge about sex. The vast majority of Americans who have insurance are covered by plans which require "pre-approval" -- managed care *does* cause delays in seeing a doctor; everyone I know has experienced it -- and I don't have any idea why "Nate O" is just lying about this. Perhaps his knowledge of the US health care system is informed entirely by lying rightwingers, and not at all by personal experience.
If you're rich enough that you can afford to pay for comprehensive insurance, several thousand a year -- necessary *just to get doctors to agree to treat you promptly* -- and are still rich enough to actually pay for all your medical costs out of pocket and ignore the insurance whenever it demands pre-approval -- the US "system" is the best system on Earth. If you're not a multi-millionaire, it's the crummiest system in an industrialized country (yes, it's better than Somalia, Haiti, etc.).
Britain's system isn't very good, but that's because they don't spend nearly enough money on it -- and it's *still* better than the US. The French, Danish, German, etc. systems are incomparably better.
Posted by: Nathanael Nerode | Oct 29, 2007 5:27:19 PM
"Allowing physicians to self refer patients to facilities that they, themselves, have a financial stake in is a problem."
Wrong. Stark laws expressly prohibit this practice and any doctor who does so not only loses the ability to participate in insurance/Medicare, he faces huge financial penalties. You are making up a problem that doesnt exist.
"Allowing the AMA (a union of sorts) to dictate where and when medical schools will or will not be built should be an issue."
Wrong again. The AMA has ZERO CONTROL over new medical schools. Thats why there are 28 new medical schools either built or planned within the last 5 years. Florida just opened up 4 new medical schools wtih ZERO APPROVAL from AMA. You can open up a new medical school anytime and anywhere.
BTW, its flat out illegal for doctors to unionize. They've already tried it before and got slammed by the courts. They're the only healthcare professional who is barred by law from unionizing.
Posted by: joe blow | Oct 29, 2007 6:05:38 PM
I have a blog post at the link below about a recently released white paper on medical tourism that was recently prepared for MedPharma Partners and MedTripInfo.com. The authors predict, among other things, that U.S. health insurers will begin to provide coverage for medical tourism by 2008.
http://my.barackobama.com/page/community/post_group/MyPolicyHealthcareHQ/CSKy
Posted by: Jennifer | Oct 29, 2007 6:12:11 PM
Nathanael Nerode - Pre Approval is only required for hospital admission and some large cost testing. Most plans have even droped that. I challenge you to show me any health plan in the US that requires pre approval for a visit to a primary care physician. I administer, sell, and quote insurance plans that cover 100,000s of members a year, what do you do? The problem with our health system might have more to do with illiterate consumers such as your self incapable of reading a SPD or COC then the cost of it.
I'll give you some pointers, check Anthem, United Health Aetna and Kaiser, they all have benefits posted on their site, find one that requires preapproval then post again.
Meh what does being able to get private health in England have to do with my argument?
Posted by: Nate O | Oct 29, 2007 7:20:26 PM
Hey all you dingbats complaining about British health care. Did you even read Ezra's blog entry?
Allow me to quote:
The Brits also have a bad health care system, but theirs is, on the bright side, very, very cheap. Ours isn't.
The British have a BAD health care system. Possibly that's because they pay 1/2 of what we do in the USA.
Sheesh. Learn to F'in read whydontcha?
Posted by: tweez | Oct 29, 2007 9:35:26 PM
I am shocked, shocked, to hear that Nate O makes his living from the health insurance industry.
Posted by: John Protevi | Oct 29, 2007 9:52:49 PM
I think these are always interesting graphs to show when engaging in this sort of debate:
OECD life expectancy against per capita healthcare spend
OECD life expectancy against per capita public healthcare spend
OECD per capita spend against number of operations
Posted by: PJ | Oct 30, 2007 8:52:29 AM
"in the NHS 80% of patients referred to a consultant are seen within 13 weeks whereas in Kaiser 80% are seen within two weeks. One third of NHS patients wait more than five months for hospital admission whereas in Kaiser 90% are admitted within three months."
So Kaiser Permanente, covering some 8 million people in the US is representative of US private healthcare? Because this article says:
"There is no systemized, nationwide collection of data on wait times in the U.S., making it difficult to compare delays to those in countries with national health systems, who typically track and publish data on wait times. But a 2005 survey conducted by the Commonwealth Fund of sicker adults in six highly industrialized countries found that only Canada was worse than the U.S. when it came to waiting six days or longer to schedule a doctor's appointment for a medical problem.Of the countries surveyed, 81% of patients in New Zealand got a same or next-day appointment for a nonroutine visit, 71% in Britain, 69% in Germany, 66% in Australia, 47% in the U.S., and 36% in Canada. Those lengthy wait times in the U.S. explain why 26% of Americans reported going to an emergency room for a condition that could have been treated by a regular doctor if available, higher than every other country surveyed.
The Commonwealth survey did find that patients in the U.S. had shorter wait times than every country except Germany when it came to getting an appointment with a specialist for nonemergency elective surgery, such as hip replacements, cataract surgery, or knee repair. But Gerard Anderson, a health-policy expert at Johns Hopkins University, says most doctors know how to "game the system" in those countries where there are queues for elective surgery, by putting at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference."
The Commonwealth survey found one area in which the U.S. assumed first place—by a wide margin: 51% of U.S. adults surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close to that percentage."
Posted by: PJ | Oct 30, 2007 9:08:33 AM
I am shocked, shocked, to hear that Nate O makes his living from the health insurance industry.
Actually, it give him a knowledge base that no one here has. Looking at charts and graphs from the Ivory Towers, as most critics do, doesn't expose the undercurrents of human nature and how their insurance is utilized.
I found Nate's unique insight to be refreshing on a stale, stale subject.
Posted by: El Viajero | Oct 30, 2007 10:47:55 AM
Indeed, there are more Americans -- 100,000 -- traveling abroad for cosmetic surgery alone than there are Britons seeking any type of services in foreign lands.
Bwahahaha! Are you trying to suggest that cosmetic surgery should be covered under nationalized health care. Joan Rivers would have to wait forever while her skin sags. I realize that was not your point but being that you're a "respected liberal blogger", you should know the difference between going off shore to save a few bucks as oppose to going off shore to avoid the bureaucratic mess that is socialized medicine. While the former is cost beneficial, the latter can save lives. to wit:
But the couple paid a heavy price to get treatment outside Canada. Catherine is still outraged that the Ontario system considered her cancer too expensive to treat.
"Too expensive? What's your budget? What am I worth?"
Posted by: mishu | Oct 30, 2007 11:25:52 AM
"I challenge you to show me any health plan in the US that requires pre approval for a visit to a primary care physician."
Funny, funny. You know, there's a prominent political crazy who argues like this. He takes an argument, places arbitrary limits on it that inordinately advantage him -- and which pretty much miss the entire point of the initial criticisms he faces -- and then pretends to have a "debate". Shomsky, Domsky, something like that....
[/sarcasm]
Honestly, Nate-O, the f*ck? If you start the debate by saying, "Let's only look at folks with insurance", and then 'clarify' following criticism by arguing that "No one needs a referral to see a PRIMARY care provider", well shoot.
Kind of like arguing that human beings can walk on water, but starting by saying, "If you look only at people who are the Son of God, or fictional kung fu masters..." -- well damn, you have 100% the dubious quality of argument that some MIT wacko named Choam Nomsky has.
Or, you know what? My 5-year-old nephew. Who "argues" the exact same way, but continually changing the context of the argument by arbitrarily resetting the parameters of discussion to his benefit.
Damn, boy, you not even a good concern troll. BOOOOOOOOOOORING.
Posted by: DHS | Oct 30, 2007 2:47:59 PM
Many of the problems of the British National Health System derive from its being given half-hearted support by the government, who since Thatcher have followed in a sort of a way neo-liberal obsessions about the importance of privatisation (which in Britain, incidentally, was a strategy for breaking industry-wide and Health Service-wide unions); Thatcher starved the NHS of funds, and, contrary to Sullivan, New Labour hasn`t done much different, and the NHS is now a curious beast, half public, half private, and this has much to do with the problems that people like Sullivan like to point to in order to bolster their dubious claims.
Posted by: tim harris | Oct 30, 2007 6:24:23 PM
DHS - Nathanael specifically stated pre-approval was required to see a doctor. I was respnding to a specific point someone made. There is little to no pre-approval required in the us healthsystem. Instead of challenging the point you try changing the subject, score a point for you. Show me how pre-approval stops people from getting treatment, your silence will be enjoyed
Posted by: Nate O | Oct 31, 2007 10:14:39 AM
Well Nate, Nathanuel said "The vast majority of Americans who have insurance are covered by plans which require "pre-approval" -- managed care *does* cause delays in seeing a doctor"
And what you said in reply was "Pre Approval is only required for hospital admission and some large cost testing. Most plans have even droped that."
Yet you then said "I challenge you to show me any health plan in the US that requires pre approval for a visit to a primary care physician" [my emphasis]
Making your challenge unrelated to your claim, since pre-approval for secondary referrals is excluded by your claim, yet your challenge explicitly rules out that example, rather confirming DHS's line that it "places arbitrary limits on it that inordinately advantage him".
Posted by: PJ | Oct 31, 2007 3:25:54 PM
Wow, I had to stop reading every post because it was like my two daughters bickering.
The reality is that regardless of how many have or will engage in the practice of medical tourism or transplant tourism the fundamental issues driving it are:
1) Cost: High health care costs in the US is making it an attractive and reasonable option for the uninsured and the underinsured.
2) Quality: A full 25% of physicians in the US today are foreign born. Many, many more have been trained in the US and then return to their home countries to practice. That means that there are a lot of really, really good physicians outside the US and if you have the means and the desire, why not go international to get health care. So, now the wealthy (www.transplanttourism.info) will find it attractive (and trendy). I have a list of 50+ 'medical tourism' and 'transplant tourism' companies and that barely skims the surface.
3) Acceptability: HCA International has recently announced a relationship and access to a facility in Pakistan. HCA subscribers will soon be routed offshore to receive elective, non-emergency care and it will cut the cost of health care. It will result in higher profits by HCA. It will also put some physcians in an interesting position because as this trend continues they will be replaced one-by-one to some degree by those that can deliver the same or better quality services at a lower overall cost.
In summary, this means that it will attract the rich and the poor, the insured, the underinsured, and the uninsured regardless of what country you come from. I'm guessing, but in my mind that just about covers everyone.
It's a big world folks. It's hard to not imagine this as a natural event.
Posted by: JD | Nov 14, 2007 5:58:58 PM
