Sinners and Saints

 

By Ernest Garfield

Former Arizona State Senator, Arizona State Treasurer, Arizona Corporation Commissioner

 

Americans will win in the 2008 elections if our political parties issue a non-partisan proclamation to guarantee Medical Freedom of Choice to all.  Promoting the expansion of global access to medical care and a return to the underlying American principle of free choice will give the people of this nation a victory.

 

According to Dr. Michael Horowitz of Medical Insights International, “Some 750,000 Americans sought offshore medical care in 2007, a number that is projected to rise to as many as 6 million in 2010.”  By comparison, according to Deloitte Center for Health, 417,000 foreign residents traveled to the U.S. for treatment in 2007.  That number is expected to increase by fewer than 40,000 patients by 2010.  Cost is not the only reason for change in the direction of the flow of care seekers.  Often it is quality of care.

 

In addition, Dr. Horowitz says, “It has been estimated that the global medical travel industry currently generates annual revenues up to $60 billion, with 20% annual growth.  McKinsey & Company and the Confederation of India estimate $100 billion annual revenue by 2012.  Often, this includes partnerships with large U.S. based medical institutions.  As examples, Duke Global Health Institute has medical services and educational partnerships in China, Singapore, Tanzania and Uganda; while Johns Hopkins and St. Jude’s operate facilities in Singapore.

 

This medical globalization trend will continue to increase as our population ages and the cost of health care continues to rise in America.  Dr. Horowitz correctly points out that medical, economic, political and social forces are shaping the emergence of medical tourism.  In any event, globalized medical care is huge business and will continue to grow with or without our approval or our voluntary participation.  All Americans need to hop a ride on this train!

To take advantage of this emerging trend, we need to understand why the public looks for medical treatment outside of the U.S.  Most often it is the availability of quality care at a lower cost elsewhere.  Price advantage is, of course, a major selling point.  The cost differential across the board is huge: only a tenth and sometimes even a sixteenth of the cost in the U.S.  Open-heart surgery could cost up to $150,000 in the US; in India’s best hospitals it could cost between $3,000 and $10,000.  See Chart I.

 

 

However, at times the reason is as simple as an immigrant living here who wants to be near family in time of need or is comfortable returning to his or her country of origin for treatment.  Many immigrants do not see any difference between traveling out side of U.S. borders for medical care than do our own citizens that travel across state borders to receive better care or care from doctors “back home”.  Immigrants of all nations understand the medical care available in their country of origin and often prefer it.

Insurance companies are beginning to recognize the value of reduced cost of overseas treatment to their insured.  Blue Cross Blue Shield of South Carolina has a subsidiary that provides its members help with arranging travel and care in foreign locations.  According to Getahn Ward of The Tennessean, Aetna, United Healthcare and Blue Cross Blue Shield of Tennessee are exploring or offering a medical tourism product.

 

Many of our neighbors from the South would happily return to their country of origin for medical treatment if we facilitate travel between our country and theirs, and if we support insurance companies, as some are now doing, to pay for treatment outside of our borders.  Numerous self insured domestic corporations pay for care of employees in foreign locations; and most certainly, multi-national corporations generally have local employees, Americans or otherwise, treated in countries where their factories and businesses are located.

 

Hispanic Americans now account for 15% of our country’s total population.  It is notable that there are nearly fifty thousand Hispanic physicians and surgeons in the U.S.  This constitutes a base of bilingual medical professionals who can readily communicate with Latin American counterparts to coordinate care.  Many Hispanics are among the uninsured and underinsured.

 

One of the major problems confronting our health care systems is that of the uninsured.  There are around 40 million uninsured in the U.S.  While many are uninsured as a matter of choice, for most it is a matter of circumstance.  Many of the uninsured are foreign nationals who are here legally.  When they are admitted to a hospital, the hospital usually has to write off the care to bad debt and shift the cost to the insured paying for covered care.  The availability to an individual of low cost government guaranteed loans with strict underwriting standards, funded by financial institutions – not government funds, would allow and encourage immigrants to return to their country of origin for medical treatment.

 

Dallas based Christus Health, a not-for-profit Catholic system, established six hospitals in Mexico to serve Mexican residents who live in communities along the Mexico-U.S. border.  A move by all Americans to facilitate and promote cross border medical treatment would show concern for their well-being and simultaneously reduce our health care cost.

 

The World Health Organization ranks hospitals around the world.  The WHO report is a reflection of the assessment of health systems of WHO’s 191 member states.  The performance assessment is based on a number of country-specific variables such as socio-economic, political and technological.  Believe or not, the U.S. ranked number 37.  In line with this, Americans trail 30 nations in life expectancy.

 

One of the great American myths is that we have the best health care system in the world!  In reality, we have a shortage of medical workers and our system is not readily available to about one third of our citizens.  Reuters, for example, reported that one out of six New Yorkers lacks health insurance, even though almost two thirds of these individuals are employed.  Many employers are dropping coverage or shifting costs to employees.  Few uninsured seek medical treatment until they are overwhelmed with a serious illness.  Dr. Frieden, New York City’s health commissioner stated, “All of this adds up to people landing in emergency rooms with costly, devastating health problems that could have been prevented or treated.”  Participating in globalized access to health care is the only real solution today that allows a patient to receive the best and least expensive care, alleviate the shortage of medical workers in the U.S. and guarantee that employers save money for employee benefits.

Health care has globalized.  The competitive marketplace is rising to the occasion and introducing features and benefits to consumers and employers.  Comparable medical outcome at lower costs than with our American system can be more readily available for middle to lower income citizens.  Many foreign hospitals have been told that American health insurance carriers plan to approve global medical care.  Large masses of Americans will go outside of the U.S. for health care when that happens.

Dr. Robert M. Wachter, Associate Chairman of the Department of Medicine at the University of California at San Francisco, said in the February 2006 New England Journal of Medicine, “Four things seem certain: the outsourcing of health care will grow; it will challenge traditional arrangements between patients and both physicians and institutions; it will require rapid and thoughtful development of new ethical, legal and quality standards; and it will be controversial.”

 Where Do We Start? 1.      Resolve the Hispanic issue by working with the states (primarily border states), the Mexican Government, insurance companies and medical entities to encourage patients return to their country of origin for medical treatment should they want to do so.2.      Pass federal legislation to allow Health Savings Accounts, Flexible Spending Accounts, Health Reimbursement Arrangements and other self-insured funds to be used on a global basis.3.      Pass federal legislation to encourage banks to extend loans with a government guarantee, subject to strict underwriting rules and creditworthiness, to all seeking medical care outside of the U.S.4.      Encourage and assist insurance companies to expand global health care insuring authority on a state by state basis, or by use of a federal exemption.5.      Encourage and assist the Bar to develop an appropriate liability level for medical malpractice for health care outside of the U.S.6.      Encourage and assist insurance companies to extend liability insurance coverage to patients who experience a medical malpractice overseas similar to the $1 million coverage provided by Barbados based AOS Assurance company.                                                                                              Chart I                                                                                                                                                                                                                 Comparable Costs 

Procedure	United States*	India*	Malaysia*
Heart Bypass	$130,000	$11,750	$18,500
Heart Valve Replacement	$160,000	$11,000	$12,500
Angioplasty	$57,000	$11,000	$13,000
Hip Replacement	$43,000	$10,000	$12,000
Hysterectomy	$20,000	$5,000	$6,000
Knee Replacement	$40,000	$9,500	$13,000
Spinal Fusion	$62,000	$7,500	$9,000

* Approximate costs