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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


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


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.


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?


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

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