Friday, October 30, 2009

Confessions of a Medical Tourist

Considering that no country will ever have a perfect health care system, it makes sense to cross borders in search of a better deal. Americans go to Mexico to get their teeth fixed, and they drive to Canada for prescription medicine.
Canadians get stuck in the MRI line, so they come down here where they don’t have to wait, if they have the cash.

This is going to expand. If a common surgery costs $20,000, and a round trip ticket to Europe or Asia cost a little more than a $1,000, we can see that various countries will offer competitive deals, to offer the same surgery for $15,000 plus airfare.

Right now, Filipino women come to America to work as nurses and nursing aides. But it could work the other way -- if you needed six weeks to recover from an illness or a surgery, and it’s winter here -- why not fly to the Philippines and get your rest at a seaside care center. Insurance companies have started to offer these options on an incentive basis.

Or fly to India or Bulgaria and buy a kidney -- oops. People sell kidneys in poor countries, to unscrupulous middlemen, who then forge documents and pass on the kidneys and other body parts to people in desperate need of same and not willing to question the source.

In fact, if you can imagine a way to abuse new choices in international health care, there’s probably already some shady character who is already in that business. The corrupt mind is highly creative, being motivated by greed. The mind of the honest reformer is usually one or two steps behind.

Medical tourism will expand and -- cover your years, Libertarians -- it will be regulated by international agreements that make sure your new kidney was honestly donated.

I’m only writing about this because I don’t want us to get stuck in a deadlocked debate over the health care reform bill. This is not a two-dimensional situation, it is far more complex and far more interesting than that.

Reform? A hundreds ideas come to mind. I think that no one should enter nursing or medical school until they have served at least one year as a nursing aide. Everyone in health care needs to begin at the beginning. As it is, doctors today do not know what nursing aides do. They think they know, but they do not know, because they have never done it.

If a doctor or nurse had, for that one year, the experience of being a nursing aide, then they would never again treat nursing aides like idiots. This is such a good idea, but it’s too simple and too easy to understand, so it’s not in the health care reform bill.

Tort reform is not in the bill either. Conservatives are crying for tort reform. They’re right about that. It is a corruption of the Democratic Party to ignore health care reform because of the enormous financial contribution of trial lawyers.
And we need a new army of nurse practitioners to spread out across the land and do battle with the common cold, the flu, the aches and sprains and minor injuries that make up half of all the medical problems we deal with.

I went to the doctor two weeks ago because I had the flu. He was overqualified for that. It would have been much better if I had been seen by a Nurse Practitioner. The flu is her game and she’s good at it.

In Massachusetts where they have tried to insure everybody, they discovered that they did not have enough doctors to handle a flood of newly insured patients. Not enough family physicians, not enough pediatricians, and not enough nurse practitioners.

It’s not in the health care bill -- the means and the cost of training thousands of more people to do primary care.
But they have a surplus of barefoot doctors in Cuba. Could we induce some of them to immigrate to our shores, as part of the long overdue mutual recognition between our two countries?

Most objective reviews of American health care state that we are good at the high end and poor at the low end. Good at dramatic interventions and end-of-life care, but poor at the broadest primary care and prevention.
At my hospital, we have a brand new portable kidney dialysis machine. It has to cost near to $200,000 and it can be wheeled into a patient’s room -- for patients with kidney failure so advanced that they cannot be transported for dialysis at the kidney center.

If it was you or your relative, you would be glad we have this machine.
That’s what I mean by the high end. At the low end, where we are not very good at all, you only have to look at the waiting room of our Emergency Department -- full of people who should have seen a doctor or a nurse practitioner, but who did not, primarily because they lacked the money.

Transparency is needed. My hospital is owned by the residents of the hospital district it serves, and yet if you tried to find out just how much the hospital paid for that kidney dialysis machine -- paid partly with our tax dollars and partly from other sources of income -- they won’t tell you, which is why I am guessing it cost $200,000.

We should know the cost of that machine to the penny. Such information should be instantly available on the hospital’s website.
But it’s not and that makes you think they’re might be some monkey business going on. I sometimes see the medical equipment salesmen waiting in the lobby. They wear very expensive suits.

So, be a medical tourist and take a cruise through our wonderful but troubled health care system. And don’t just talk to the people who already agree with you, because that accomplishes very little.

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