Exporting our Health Care??

[Chuckanut]

A recent article in the NY Times highlighted the difference in costs between health care in the USA and health care in Europe. Here is a quote about a fellow who had to pay for his own hip replacement:

Quote:

Michael Shopenn’s surgery in 2007 would have cost close to $100,000 in the United States. But it cost just $13,660 — including all medicine, doctors’ fees and round-trip airfare — at a private hospital in Torhout, Belgium

.

This has got me thinking. Why couldn't American health insurance companies offer this as an alternative to surgery in the USA for appropriate medical problems? Even tossing in an extra $10,000 for a partner to accompany the person and a week or two of rent on an apartment, the costs would be far cheaper. The insurance company, could reward the individual for having overseas surgery by giving them a discounted insurance rate for a certain number of years, or waiving deductibles and co-pays. They would also have to guarantee to pay for normal follow up visits in the USA as well as care for any complications. Still, one would think the insurance company would come out ahead in the long run. This seems to simple. What am I missing?

[CoolChange]

I know there were a few insurance companies experimenting with this, mostly within employee plans if memory serves me correctly, a few years ago. I found a couple of articles with a quick Google search:
Health care tourism, now covered by insurance? - latimes.com
Medical tourism draws more U.S. patients to travel for care | Tampa Bay Times

I honestly have no idea why this has not expanded further. Assuming it was better financially with at least as high a quality of care, I would jump on this kind of program. But, I may be in the minority since only around 1/3 of US citizens even hold a current passport.

[haha]

Quote:

Originally Posted by Chuckanut A recent article in the NY Times highlighted the difference in costs between health care in the USA and health care in Europe. Here is a quote about a fellow who had to pay for his own hip replacement: . This has got me thinking. Why couldn't American health insurance companies offer this as an alternative to surgery in the USA for appropriate medical problems? Even tossing in an extra $10,000 for a partner to accompany the person and a week or two of rent on an apartment, the costs would be far cheaper. The insurance company, could reward the individual for having overseas surgery by giving them a discounted insurance rate for a certain number of years, or waiving deductibles and co-pays. They would also have to guarantee to pay for normal follow up visits in the USA as well as care for any complications. Still, one would think the insurance company would come out ahead in the long run. This seems to simple. What am I missing?

Just wait. California has just now discovered that no way will they have enough doctors and surgeons to meet the needs of the 40 million newly empowered health consumers. PAs to the rescue. Well if you thought that primary care was devolving into a checklist, just wait until pas who really cannot do anything other than whatever their instructions from above are. Not sure what private insurers will do, but looking at age distributions of our current members very many of us are already or soon will be the ?happy participants in Medicare. I imagine that looking at what will be offered to us, many of us would happily foot the bill in Belgium out of pocket.

So much for ridiculous threads about the ethics of taking "what you don't need". A person's needs depend very much on what he wants his life to be.

Something interesting I have noticed lately. I've been going around to joint replacement seminars different hospitals and groups of orthopedists, just to get a feel for the situation. First thing I noticed- no young 'uns. In fact, the mode seems to be around age 60. Who knows why- perhaps because women take up roughly half of Medical schools now, and for various reasons that are no doubt unmentionable not too many of them want to take up a life with the bone saw and reamer, let alone trying to put some trauma victim back together at 4am.

So I am beating the oncoming panic before the damn breaks. Even if I could struggle along for a few more months, I am getting my hip done ahead of the bolus.

I spent a vacation with an old friend who recently retired from an orthopedic practice where he did a lot of hip and knee replacements. He said he was at a meeting of joint replacers in 2012 and someone took a poll- how many of you plan to drop Medicare? Almost 50 % said "I do unless they start paying a lot closer to what private insurance pays."

A tiny bit of thinking on the part of planners (I know, what am I smoking) would tell us that if a private pay guy gets $80,000 for an operation, and Medicare pays $27,000, who is going to get operated on by any surgeon who has a reputation for putting the leg back on straight?

Ha

[W2R]

Quote:

Originally Posted by haha So I am beating the oncoming panic before the damn breaks. Even if I could struggle along for a few more months, I am getting my hip done ahead of the bolus.

Ha, good luck with this surgery. Let us know how it went.

[REWahoo]

Quote:

Originally Posted by W2R Ha, good luck with this surgery.

+1

Some guys will go to great lengths to be hip...

[MichaelB]

Quote:

Originally Posted by REWahoo +1 Some guys will go to great lengths to be hip...

+2

Don't let those dancing shoes gather too much dust.

[haha]

Thanks guys. I really appreciate your good wishes.

I guess I may have put it off longer than I really had to. I would read about how bad people felt, how they could hardly walk, and think well that is not me. But I haven't been dancing in almost a year now. And before long I may be too ugly to find partners, so best get going. I still have a while to wait, as he has a backlog to work off.

My surgeon showed me the x-ray. Really no joint left. He said that is not uncommon- some people just don't seem to recognize pain the way most people do. I used to have a tee-shirt "Pain is just weakness escaping the body". I thought is was a joke.

Ha

[Chuckanut]

Quote:

Originally Posted by haha A tiny bit of thinking on the part of planners (I know, what am I smoking) would tell us that if a private pay guy gets $80,000 for an operation, and Medicare pays $27,000, who is going to get operated on by any surgeon who has a reputation for putting the leg back on straight?

In the original NY Times article it pointed out that a replacement joint that costs well over $10,000 in the USA can be purchased in Europe for about 1/4 of the USA price. So, maybe the problem isn't all medicare's low payments. Maybe it is high prices in the USA? At some point the medical community has to come to terms with their prices compared to the rest of the world, and do something about it. That is the best way for them to protect their own interests. (What!?!? Doctors are like auto union members? Say it ain't so!)

No doubt doctors will still be among the best paid people in the country. They should be, IMHO. But the money has to come from somewhere and like we say when discussing pensioners in Detroit and Illinois - "you can't squeeze blood from a turnip."

[haha]

Quote:

Originally Posted by Chuckanut In the original NY Times article it pointed out that a replacement joint that costs well over $10,000 in the USA can be purchased in Europe for about 1/4 of the USA price. So, maybe the problem isn't all medicare's low payments. Maybe it is high prices in the USA? At some point the medical community has to come to terms with their prices compared to the rest of the world, and do something about it. That is the best way for them to protect their own interests. (What!?!? Doctors are like auto union members? Say it ain't so!) No doubt doctors will still be among the best paid people in the country. They should be, IMHO. But the money has to come from somewhere and like we say when discussing pensioners in Detroit and Illinois - "you can't squeeze blood from a turnip."

I suppose you may be right, but a Medicare patient is buying in competition with Medicaid and private insurance in the US. In the past, private insurance>Medicare> Medicaid. And of course, we all know that it has often been hard for a Medicaid patient to get quality care. If a Medicare patient is losing in competition with other payment amounts available to doctors in the US it may be theoretically interesting to look at those other factors, but if you are a sick person under Medicare and in competition with better payers in the US, you are going to lose at the margin.

There is no real reason, now that everyone is to be covered, that Medicare has to be its own separate system. That is not the way other countries with some public healthcare participation work. If you are a second class player, you lose, and in the US, the Medicare participant is increasingly second class.

Ha

[Mulligan]

Quote:

Originally Posted by haha I suppose you may be right, but a Medicare patient is buying in competition with Medicaid and private insurance in the US. In the past, private insurance>Medicare> Medicaid. And of course, we all know that it has often been hard for a Medicaid patient to get quality care. If a Medicare patient is losing in competition with other payment amounts available to doctors in the US it may be theoretically interesting to look at those other factors, but if you are a sick person under Medicare and in competition with better payers in the US, you are going to lose at the margin. There is no real reason, now that everyone is to be covered, that Medicare has to be its own separate system. That is not the way other countries with some public healthcare participation work. If you are a second class player, you lose and in the US, the Medicare participant is increasingly second class. Ha

Your above paragraph succinctly describes the macro problem that is getting more pronounced year by year. My awareness of the issue has become more pronounced as I creep closer to Medicare age and more than likely when I really will need medical care. Medicaid never hit my radar as it wasn't "my problem". But it really is foreshadowing the future of Medicare. I have 15 years left until then, so the problem will more than likely be fixed by then, or become a totally useless insurance program. Could the increasing divergence in care amongst the 3 programs unwittingly be the unifying element to a single payer system down the road?

[packrat44]

Ha

Have you made a short list of counties to have your hip replacement?

[ERhoosier]

No one can predict the future, but I suspect routine/scheduled medical care will indeed become more of an international commodity in the coming years (decades?). As a part of that process, US health care costs will eventually moderate down towards ave of the developed world. All players in US health care (inc. docs, nurses, hospitals, drug/equipment makers, etc) will gradually get paid less under a system of tighter gov't control. What this means to care quality & access in US remains to be seen. But it's worth remembering that many foreign docs trained in the US, there are some great teaching centers throughout the world, and many of the top advances in care were/are being developed in a number of countries across the globe. And as has been noted before, the very high $$$ of US care nets very little (if anything) in terms of statistically measurable better outcomes vs many other developed nations with lower ave costs.

[haha]

Quote:

Originally Posted by packrat44 Ha Have you made a short list of counties to have your hip replacement?

No; I am getting it no more than 1/2 mile down the street from where I live. So far I have ben able to get good doctors with Medicare, though my GP-1 was a member of a clinic that dropped Medicare.

Ha

[packrat44]

Quote:

Originally Posted by haha No; I am getting it no more than 1/2 mile down the street from where I live. So far I have ben able to get good doctors with Medicare, though my GP-1 was a member of a clinic that dropped Medicare. Ha

That is very convenient. As tough as you are, you can probably hoof it home after surgery without any assistance. Good luck.

[Gatordoc50]

The only ones who would consider going abroad for healthcare are those not being subsidized by the government. If you want affordable care, just quit your job.

[ERhoosier]

Quote:

Originally Posted by Gatordoc50 The only ones who would consider going abroad for healthcare are those not being subsidized by the government. If you want affordable care, just quit your job.

Money is not the only consideration. Sometimes one must seek care outside US to get the most advanced techniques. For example many advances in heart catheterization & stenting were first used in other nations (e.g. France, Germany, Switzerland).

History Center -- Angioplasty.Org

[MooreBonds]

While I agree that the concept of going to another country for medical care is interesting from a variety of aspects, there are 2 items which might make public funds (Medicare/Medicaid) not pursue it:

Fraud - look at how many billions of $ are already lost to fraud. And now you want people going overseas for expensive operations? Imagine how many taxpayer-funded flights people get to get 'treated' by a surgeon that never actually does any work. ("Hmmm...didn't know there were that many surgeons in Rome or Paris...and they're all doing operations during the summer tourist season.")

Liability - may not be as much of an issue, but think of the extra layer of legal headaches there are when just even a small % of patients have to fly somewhere for treatment, and end up getting injured during their journey/during treatment. "If it hadn't been for the gov't forcing me to fly for treatment for _____, then I wouldn't have had a heart attack/stroke on the plane, or fallen in that non-ADA hotel bathroom I had to stay in while waiting to check into the hospital the following day".

Not to mention no direct oversight on things like hospital cleanliness standards.

It's true that many hospitals outside of the US in medical tourism areas are far cleaner/safer than US hospitals - but accidents and bad things still can happen in even the best/cleanest hospitals. And all it would take is a tiny % of patients to sue, go before a jury of their peers, and convince them that the gov't 'forced them' to go overseas for treatment to save money, and sent them to a place that didn't conform to US standards (even if the US standards are lower than the hospital's standards), and it caused them to get even more sick with ________.

Not to mention the possibility of legal cases now taking place in foreign countries, and the gov't dealing with the expenses from that.

Private insurers may be willing to try the concept of sending people overseas for care, but the average gov't bureaucrats have far less incentive to argue claims and investigate fraud and battle lawsuits than a profit-maximizing insurance company.

[MichaelB]

From USA Today this morning, it seems the data does not support the oft-mentioned bullet point that doctors are not taking Medicare patients. Report: More doctors accepting Medicare patients

Quote:

WASHINGTON — The number of physicians accepting new Medicare patients rose by one-third between 2007 and 2011 and is now higher than the number of physicians accepting new private insurance patients, according to a Department of Health and Human Services report obtained by USA TODAY.

[Gatordoc50]

Quote:

Originally Posted by ERhoosier Money is not the only consideration. Sometimes one must seek care outside US to get the most advanced techniques. For example many advances in heart catheterization & stenting were first used in other nations (e.g. France, Germany, Switzerland). History Center -- Angioplasty.Org

I agree that there are alternative treatments available outside the United States that many take advantage of. And I would expect that other countries are influential in the advancements of medical technologies. The same argument can be made for corporations leaving the U.S. They can produce products cheaper and better using foreign labor.

[Mulligan]

Quote:

Originally Posted by Gatordoc50 I agree that there are alternative treatments available outside the United States that many take advantage of. And I would expect that other countries are influential in the advancements of medical technologies. The same argument can be made for corporations leaving the U.S. They can produce products cheaper and better using foreign labor.

Our experience obviously affect our biases, but I would not consider it based on my fathers experience with a hip replacement. Many problems and follow ups for 2 years including more surgery. I would hate to be caught up in constant travel across the planet on follow ups and corrective procedures.