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 

* Approximate costs

The school drop-out rate is wreaking havoc in America.  We are rapidly falling behind educational results of other countries.

Income level of a family is a factor in drop-outs.  The overriding issue, however, is attitude towards education and method of instruction.  I served as Vice-chair of the Arizona Senate Education Committee many years ago.  The problem then and now starts with legislative unwillingness to pay teachers salaries competitive to what they can earn elsewhere in society.

To put our predicament in perspective, consider what I call the hard-to-believe “50 Rule”.

·        The drop-out rate over a 4-year high school term approaches somewhere in the neighborhood of 50%.  In Arizona, the annual rate ranges from 8.5% to 15% depending on race.  Highest is among Native Americans, followed by Hispanics, Blacks and then Anglos.

·        A drop-out rarely moves more than 50 miles from home-base.

·        50% or more of prison inmates are school drop-outs.·        The recidivism rate of ex-convicts exceeds 50%.The obvious truth is that the problem we let happen remains tucked away in our backyard forever.

When troubles arise, we either succumb or overcome. Can the problem be solved?  You bet!   I serve on the East Valley Institute of Technology Foundation Board, Mesa, Arizona, where the drop-out rate is less than 1% a year.  Why the big difference?  Results-based education!  Dedicated staff!  A student is given the vision to see the outcome of completion.  Additionally, we are able to keep some of the students in school with small scholarships ranging from $50 to a couple of thousand dollars a semester.

One of my grandsons was expelled from Paradise Valley High School at the end of his sophomore year.  It is a testament to teachers that he wasn’t expelled sooner.  I would be surprised if he ever got a better grade than a D. However, at the end of his second week in EVIT, he scored an A in math and an A-minus in biology.  I didn’t know he could read as well.  In his sixth week he and two others from his class were selected to attend an Arizona State University program where he received a $500 grant.  He graduated from EVIT on schedule.

Teachers help mold our children.  Isn’t there more we can do for teachers so they can do a better job of helping us parents give our children strength, energy, vision and motivation?

In 2005, approximately 149,234 children were physically abused, 83,607 were sexually abused and 1,371 died as a result of abuse or neglect.  The majority were under 4 years of age.  According to CWLA, many experts believe the number of abuse- and neglect-related deaths may be much higher than the official figures.

Learn startling and disturbing national and state facts on the CWLA Web site.  See how your state stacks up in this horrible fight.

www.cwla.org/advocacy/statefactsheets/statefactsheets08.htm 

www.cwla.org/advocacy/nationalfactsheet08.htm 

CWLA lists other Advocacy Organizations helping with this horrendous problem at

www.cwla.org/advocacy/advocacyresourcelinks.htm. 

The possibilities are staggering!

There are approximately 12,000,000 illegal immigrants in the U. S. according to the Pew Hispanic Center. That is nearly 1 out of every 26 people in the U. S. There were 7,200,000 undocumented employees in the U. S. in March 2005.  The penalty for hiring an illegal can result in one of the most severe and damaging effects to a small business.  In Arizona, for example, the employer-sanctions law will revoke the license of any company caught twice with undocumented workers knowingly on the payroll.  A business with multiple locations could face a shutdown of its entire operation if one undocumented employee is found at one location.  Wal-Mart was fined $11,000,000 because their cleaning contractors hired illegal workers.

This is a staggering, wide-spread, monumental, out-of-control problem! Phony records to convince an employer, such as a Social Security card, can be purchased for $50. The media reported in June of 2007 that the Social Security number of a young woman in California is being used by at least 81 people in 17 states to get work. The Social Security Administration was powerless to stop the practice, so they issued the young woman a new number. A 2005 report by the Federal Government Accountability Office cited that between 1985 and 2000 more than, believe it or not, 9,000,000 people got hired using Social Security number 000-00-0000.

This is a national epidemic over which a business can be destroyed.  For protection, a business must participate in The E-Verify program, formerly known as Basic Employment Verification Pilot (“Basic Pilot”), to determine employment eligibility of all newly hired employees.  It is administered jointly by the Department of Homeland Security through United States Citizenship and Immigration Services and the Social Security Administration. Visit the USCIS Web site: https://www.vis-dhs.com/EmployerRegistration.

Sinners and Saints and www.uscriminalrecordsagency.info, our affiliate, are not in any way connected with the Federal program.

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Other research has shown consistent patterns of animal cruelty among perpetrators of more common forms of violence, including child abuse, spouse abuse, and elder abuse. In fact, the American Psychiatric Association considers animal cruelty one of the diagnostic criteria of conduct disorder.