Saturday, November 04, 2006

Americans Head Abroad for Medical Care

It's no longer just Californians who head to Tijuana to fill prescriptions or get affordable medical care. Nor is it just Canadian pharmacies where the same drugs cost half their US price. Americans head to Singapore, Thailand, India and elsewhere to obtain affordable medical care.

Why did excellent British-trained medical care in Hong Kong cost less than half of equivalent US-care when I lived there? No insurance, no clerical staff to complete endless insurance forms, no waiting months - even a year or more - for payment. Patients paid cash on-the-spot, and if they had insurance, they filed the paperwork and got reimbursement. Less overhead for the doctors and hospitals, even though rents for office space exceeded NYC rates.

When I worked for a California hospital, the Administrator told me 25% of each hospital bill was administrative costs - insurance billing, record keeping, et al. Another 25% was cost-shifting - covering uncompensated care for illegal aliens. In one case, a wealthy Tijuana man smuggled his grandmother over the border for $100,000+ heart surgery, knowing she could claim to be "unable" to pay the bill and get the care for free. The cost of the same surgery in Tijuana's premier medical facility would have been about $10,000.

While illegal aliens and "medical tourists" come here for "free" (i.e. paid by American patients and their insurers) care, Americans now have to flock overseas to find needed care at a price they can afford. Half a million went abroad for needed surgery last year.

Heart bypass surgery averages $130,000+ in the US; $10,000 in India; $11,000 in Thailand; $18,500 in Singapore.

Over 46 million uninsured cannot get or cannot afford insurance premiums, no less the care itself. So why is medical care so unaffordable in the US?

1. "Free" care for illegal aliens is not free - the costs are shifted to paying patients, i.e. American citizens.

2. Insurance used to be non-profit, like Blue Cross-Blue Shield; now insurers have armies of high-cost "marketing" staff, advertising expenses. And they have to make a profit after paying all the bills.

3. An astounding amount of the cost of medical care is administrative, especially billing staff to handle the complex insurance reimbursement red tape. You're not just paying for doctors, nurses, and the actual medical care.

4. Medical schools love foreign students - they get federal funds for each one, but nothing for training Americans. So many qualified Americans are closed out of medical careers, their school spaces taken by foreigners. The ones who do make it in end up with humongous debt loads - over $125,000 is the average. So when they graduate, they have to go where the money is to pay off their debts: high-paid specialties in affluent areas. They cannot go to rural areas where needed and still pay off student loans. The more foreign doctors we bring in, the tougher it is for Americans to cover the costs of their medical education.

What to do?

1. Stop subsidizing medical education for foreigners and put that money toward educating Americans. Stop bringing in foreign medical personnel. Americans need those jobs.

2. For American citizens who can't pay the bills, the hospital will apply for Medicaid, work out payment plans, put a lien on their home - anything to get paid. For non-citizens, they shrug their shoulders. Hospitals should have to go to the foreign citizen's consulate for assistance in transferring funds from home and transportation home for continuing care. "Stabilize and transport" must be our policy for non-citizens. Insist consulates fulfill their mission: transfer patient's funds from home or foot the bill and get reimbursement in accordance with that country's laws. (This is exactly what the US consulates do for Americans who have medical emergencies while abroad. It is the purpose of a consulate!)

3. Uninsured patients should not be charged two to three times as much as insurance reimbursement. One price for all. If the uninsured only had to pay the same as the hospital gets from insurers, the bills would be much more affordable!

4. Require tourists present proof of medical insurance to enter the country. End the medical "tourists" who drive straight from the airport to the hospital for "free" medical care. Short-term travellers' medical insurance does not add much to a vacation's cost. Those who can afford to fly to the US for a month's "vacation" can afford travellers' medical coverage.

American medical services should be available to Americans, not just foreigners.

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