Beauty from Afar

It was really in 2004 and 2005 when the U.S. media “discovered” Medical Tourism … about the same time I did. (Maybe just a little after I did. 😉 ) And it was discovered because the media noticed that people were going overseas for serious, life-saving procedures, not just cosmetic surgery and dentistry.

Chapter 3 Page 5 | The Media Imprimatur

Medical tourism and travel has been episodically in the news in the U.S. ever since and remains a story in parallel with the dominant narrative about healthcare reform in the U.S. that arose in 2008 — 2009.  I’ve often been asked if real healthcare reform in the United States would be the end of medical tourism, and the answer is no. Medical tourism and international medical care will remain less costly alternatives and U.S. patients and insurers will continue to explore and integrate the travel-for-care options that are available.

We’ve hit the end of Chapter 3. Chapter 4 will look at what surgeries and procedures that patients choose to have done overseas — specifically, it is mostly a list of cosmetic procedures and average prices and savings in 2004 — 2005. As I go through it, I’ll try to put forth any updates of which I am aware. Chapters 4 and 5 (which is a tutorial on doing Internet research) are, to me, the driest parts of the book but I’ve encountered readers who thanked me for them. So … off we go. Tomorrow, probably.

It’s hard not to be a little pleased with myself, sometimes, as I slog through my own four-year-old prose. It looks as though I managed to not allow myself to be blinded by the sun bouncing off the shiny newness of medical tourism. I was cautious and felt my way. There’s not a lot of money in that but smugness, years later, is worth something.

I used the *T* Word — Trend — in the segment of Beauty from Afar that I just posted. Editors just love trends. They love to turn good stories into stories about trends. And I am a little guilty there — maybe even a lot guilty. After all, I took a story about going to Costa Rica for major dental work and turned it into a story about lots of people going every-damn-place for medical care. I mean, I wanted a book contract and I knew I had to … extrapolate.

But I was careful. In today’s segment:

Chapter 1 Page 8 | Tip of the Iceberg — and a Trend

… I said what a lot of people have been saying …

“One can imagine that 10 years from now, the lion’s share of the U.S. cosmetic and other elective surgery businesses will be offshore; that U.S. insurers and Health Maintenance Organizations (HMOs) will be putting a hefty percentage of nonemergency-care patients with expensive treatment or surgical needs on airplanes out of the country rather than sending them to local doctors, hospitals, and surgeons.”

But had the smarts to walk away:

“This is a highly exaggerated scenario.”

(Pats self on back. Hey, I have to come up with some motivation to do this every day.)

Chapter 1 Page 5 | U.S. Health Care and Spiraling Costs

There is no denying that a public rush to embrace medical tourism could have significant impact for the more expensive or overburdened healthcare systems of the West, particularly for the United States. The healthcare system in the United States has been considered to be in crisis for much of my adult life due to rapidly increasing costs. Health-care spending in the United States reached 15 percent of Gross Domestic Product(GDP) in 2003, even with 42 million or so individuals uninsured.

The United States has, by far, the most expensive health care in the world, by almost any measurement. It may  in some ways also have the best quality of medical care in the world, though that is a contentious statement. What is most important right now for the future of medical tourism in the United States is that most Americans believe they have access to the finest doctors, the most advanced medical technology, and the top facilities in the world. They believe this at a gut level; it is something they have been told all their lives.  They hold this conviction only slightly less absolute and dear, perhaps, than they do the notion that the United States is the best and/or greatest country in the world.

We Americans, deep down, have difficulty believing that individual doctors, dentists, surgeons, and medical facilities abroad can be every bit as good as the ones at home.  It is mostly because we have been instilled with a belief in the superiority of the U.S. medical system, mostly by people who are part of that system. It is close enough to the truth that it is a difficult notion, psychologically, to abandon. It is a part of the American mindset.

At some level above that gut feeling, however, we are profoundly concerned about the quality and cost of medical care in the United States, which leaves open the door to the possibility of medical tourism. We may believe we have the best, but we also think it is not nearly good enough,  and that it costs way too much. According to a poll released in November of 2004, (3) 55 percent of Americans were dissatisfied with the quality of health care compared to 44 percent 4 years earlier;  just 17 percent said the quality of U.S. care was improving.  Another survey, this one released in June 2005, (4) found that 45 percent of Americans were “very worried” about having to pay more for health care and insurance.

In fact,  more respondents were “very worried” about rising health-care costs than having an income that wasn’t keeping up with rising prices (40 percent);  not being able to pay rent or the mortgage (24 percent);  losing money in the stock market (19 percent);  being the victim of a terrorist attack (18 percent);  or losing a job (17 percent).

Despite these numbers,  I am glad not to have to challenge the notion that U.S. medical care is generally the best in the world.  After a year of researching medical care around the world, I have greater esteem for the U.S. medical community than I did previously, and I count myself among the minority that thinks that quality in the United States is generally getting better.  I think we have terrific doctors and surgeons, the finest medical technology, bar none, and more of the finest medical facilities than any other country. You might disagree.  But that is really an argument for politicians, doctors, and health-care policy analysts.

Whether the quality of health care in the United States is getting better, or worse, or is treading water,  is an interesting question, certainly.  But does a patient care about the overall quality of the $1.7 trillion American medical system when making a personal decision about what doctor to go to or what surgeon to choose?  The answer would seem to be immaterial to someone who is making the personal, one-on-one choice as to what doctor to see or what surgeon should operate.  It would seem to be the case, anyway, unless and until one is considering choosing a doctor or surgeon outside of the United States.  For most people, a powerful caution kicks in.

It certainly did for me.

(3) Harvard School of Public Health Survey conducted with the U.S. Agency for Healthcare Research and Quality in Rockville, Maryland, and the Kaiser Family Foundation, based in Menlo Park, California. November 2004.

(4) Kaiser Family Foundation, Kaiser Health Poll Report, June 2005.

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Chapter 1 Page 2

Fast forward to April 2005, a year later. My phone rings in Connecticut, a little too early. “Did you see 60 Minutes last night?” the voice asks. I hadn’t, actually; instead, I had been sitting in a gymnasium in West Haven listening to my son play clarinet with his high school concert band. But I had known what 60 Minutes was doing. Weeks before, Ruben Toral, who is responsible for public relations at Bumrungrad Hospital in Thailand, had told me that CBS had been filming there.

Later, I watch a tape of the show and am frankly astonished that it portrays medical care in Thailand and India as being of the highest quality, and at a fraction of the cost of the same care in the United States. The lid is off, I think. It is not a new story to me, of course; but that 60 Minutes had done it raised the credibility level. If there was something awful about medical tourism, anything especially dangerous about going overseas for health care, surely they would have found it?

Millions of people saw the show. Hundreds of thousands of people — at least the ones who have already been overseas for health care — felt vindicated, a little less crazy. The next morning, I read, on a prominent mailing list on the Internet, this comment:

“This could turn out to be one of the most important stories 60 Minutes has ever produced. First, because it addresses one of the most critical issues in America: rising health-care cost (combined with the uninsured), and second, because the show’s audience are the prime consumers of these services: the aging baby-boomers. While I can see that it might take a few years for flying to Asia for major surgery to catch on, I predict that insurance companies will eventually find a way to use these options to force U.S. health-care providers to lower their prices. (Of course, then the battles in Congress will start …)”

Whatever sense I had of being privy to a secret vanished.

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