From: Rakesh Bhandari (bhandari@BERKELEY.EDU)
Date: Wed Jun 13 2007 - 01:32:50 EDT
>I don't think any number of unskilled labour hours can perform the >work of a skilled surgeon, but for that reason I don't think that the >hours worked by surgeons etc count as expenditures of labour power, >defined as the group of skills common to all human labour: surgery is >the expenditure of a skill that is not shared across people to a >higher or lesser degree. You may be right but... Whether uninsured or fully covered, Americans getting surgery abroad save big bucks Posted 11/2/2006 10:22 AM ET By Margie Mason, The Associated Press NEW DELHI, India - Greg Goodell flew from Iowa to India to have his arteries unclogged. Rick Thues made the trip from California for a new hip. John Terhune ventured from Indiana for a hip-and-knee combo. Combined, all three saved about $140,000, including the cost of travel and hotels, by having their surgeries last month in New Delhi instead of America - where the health care system had simply failed them. All in their 50s and fully employed, these men are among the estimated 500,000 Americans who are taking their health into their own hands by choosing medical care abroad. Many are stuck in a growing gap of uninsured or underinsured who are too young for Medicare and left with only losing health care options: siphoning their retirement, living in pain or possibly dying. "Our share of the American dream has been lost in the past five years," said Thues, 53, a computer consultant from Orange, Calif. "Look at what we've outsourced - I'm even outsourcing my own health for God sakes." He is fully covered under his wife's insurance and could have had total hip replacement back home for about $5,000 out of his own pocket. But it's not the newest procedure available and would have severely limited his mobility, kept him from his passion of skydiving, and possibly sent him back to the hospital in 10 years with more problems. Thues lobbied to undergo hip resurfacing, a new, less invasive technique approved in the U.S. this year. But he was denied. So, he and his wife, Paula, hopped on a plane to Delhi and visited Dr. S.K.S. Marya, chief surgeon at the Max Super Speciality Hospital's Institute of Orthopedics & Joint Replacement, who has performed some 150 hip resurfacing operations over the past two years for about $7,000 each. Within a few days, Thues was up walking and already talking about his next jump from a plane in six months - the whole trip including the surgery, airfares, lodging and a trip to the Taj Mahal totaled about $12,000, none of which was covered by his insurance. "I was so let down by my HMO. The whole idea that they denied me because they could," he said while recovering at his hotel near the airport in New Delhi. "I've paid thousands of dollars in premiums over the years. It's their job to look after me." Greg Goodell, 57, from Shenandoah, Iowa, ended up at the same Indian hospital as Thues. In August while bicycling, he felt a strange tightening in his chest and realized something was wrong. But the self-employed finishing painter was uninsured and knew the price of an angiogram test alone, quoted at $4,000 to $29,000 by nearby hospitals, could have put a big dent in the family's savings. With a wife and five kids to consider, he said he put his faith in God and had an angioplasty with two stents inserted in India for about $10,000. "When you first start, you're not sure. You think, 'Wow that's a long ways away.' But when you're faced with the other option, you want to check it out," he said two days after being discharged. "We felt comfortable. We didn't really have any red flags ever." But Goodell did encounter a few downsides of traveling. He and his wife, Kriss, both experienced bouts of diarrhea during the trip and their luggage was lost for three days. Goodell also had a slight mishap while walking near Delhi's congested roads: He sliced his head open on a metal sign, resulting in six stitches. Still, he said the setbacks were minor, given that his heart was fixed without breaking the bank. The couple's whole trip ran about $16,500. Uninsured Indianapolis chiropractor John Terhune, 57, didn't need any persuasion. He underwent hip resurfacing surgery in his left leg a year and a half ago in the southern Indian city of Chennai and was so pleased with the results, he came back to have the right hip done by Dr. Marya in New Delhi. And he got a partial replacement for his left knee to boot. Both surgeries totaled less than $12,000 - about 85% off the U.S. price tag - plus another $3,000 for travel and accommodation. "There's just no decision to it. I mean, the writing's on the wall," he said from his hospital bed. "I would still come over here for resurfacing if I were insured." Copyright 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. More Americans Seeking Surgery Abroad High Costs in U.S. Is Driving Some Patients to Seek Treatment in India and Elsewhere WebMD Medical News Reviewed by Louise Chang, MD Oct. 18, 2006 -- Dismayed by high surgical costs in the U.S., increasing numbers of American patients are packing their bags to have necessary surgery performed in countries such as India, Thailand, and Singapore. "This is not what is sometimes snootily referred to as 'medical tourism,' in which people go abroad for elective plastic surgery," says Mark D. Smith, MD, MBA, president and chief executive officer of the California HealthCare Foundation in Oakland. Today's "medical refugees," the term Smith uses in an article published in the Oct. 19 issue of The New England Journal of Medicine, are going to foreign countries for lifesaving procedures such as coronary bypass surgery and heart valve replacement, and also life-enhancing procedures such as hip and knee replacementknee replacement. "People are desperate," Smith tells WebMD. "This illustrates the growing unaffordability of the U.S. health care system, even to people who are by no means indigent." The report by Smith and his colleague, Arnold Milstein, MD, MPH, documents the case of a self-employed carpenter who couldn't afford private health insurance and would have faced financial ruin if he had surgery in the U.S. It also shows how some insured workers are being steered toward receiving less-expensive procedures outside the U.S. Indian Hospitals Booming Vishal Bali, chief executive officer of the Wockhardt Hospitals Group in Mumbai, India, says there has been a 45% increase in the number of American patients seeking care at his 10 Indian hospitals during the past two years. "Cost is a major factor," Bali tells WebMD. Some examples: Wockhardt Hospitals usually charge $6,000-$8,000 for coronary bypass surgery, $6,500 for a joint replacement, and $6,500 for a hip resurfacing, which represent a small fraction of the typical costs at U.S. hospitals. "Another major factor is what we call 'the Indian advantage,'" Bali says. "At some point, most American patients have been treated by an Indian physician in the United States and they have tremendous faith in Indian clinicians." Partly because of the influx of foreign patients, not all of them American, Bali plans to open 10 new hospitals in India during the next two to three years. Safety Concerns May Be Overblown "Our American patients don't just pack their bags and fly to India," Bali says. "They have multiple conversations with patient coordinators and clinicians, many of whom have been trained in the U.S. and have American board certifications." All Wockhardt Hospitals are accredited by the international affiliate of the Joint Commission on Accreditation of Healthcare Organizations, the group which accredits U.S. hospitals, Bali says. More than 80 hospitals in India, Thailand, Singapore, China, Saudi Arabia, and other countries have received this accreditation, according to the new report. "These institutions are reporting gross mortality rates of less than 1%," Smith says. "I'm unaware of any evidence that surgery at these institutions is less safe or of lower quality than that in the average American institution, and there's some reason to believe it may be better." "The downside, however, is that if you are harmed in an Indian hospital, you have less legal recourse than if you harmed at an American hospital," Smith says. To compete with less-expensive offshore hospitals, the U.S. hospitals should do more to reduce costs, improve efficiency, and increase quality, Smith says. "Regrettably, I fear that some people's response to the offshore trend may be to moan and groan and try to shut it down or engage in scaremongering about quality." A Sign of Globalization "This trend shows that the world is flattening," Smith says. "We're no longer just outsourcing back-office functions such as the reading of X-rays, medical transcription, and billing. Now it's the actual clinical care that can be outsourced." The report concludes that the trend is a "symptom of, not a solution to" America's affordability crisis. "I'm not suggesting it'll ever be the main way people get surgery," Smith says. "But it certainly is a wake-up call. If the cost of surgery continues to go up, particularly in settings where there's no relationship between cost and quality, this trend will continue." Bali believes the trend represents a sea change in global health care economics. "This is only the beginning," he says. "This trend is not going to reverse. It's as strong a trend as the outsourcing of information technology because it is advantageous for patients." Although most of Wockhardt Hospitals' American patients are uninsured, Bali predicts that will change. "Insurance companies are looking at this trend, their own viability, and the need to save money," he says. "They're telling patients that there are international destinations where they can be treated, which may mean paying much lower premiums than they're paying to receive treatment in the U.S." A Call for Reform "The need for American citizens to go abroad for care -- and their willingness to do so - represents a crushing indictment of numerous myths about the U.S. health care system that have gained popular currency in recent years," says Peter Budetti, MD, JD, chairman of the department of health administration and policy at the University of Oklahoma Health Sciences Center. Budetti was not involved in the report. Budetti says the report dispels the myths that "foreign systems of universal coverage are so flawed that people in those countries who can afford to do so flock to the U.S. for care; that our health care is the best in the world; that everyone in the U.S. will get the care they need whether they can afford to pay for it or not; and, most telling, that increased consumer cost-sharing will reduce cosmetic or other nonessential care, not medically necessary care. "The profound irony of these myths is a sad commentary on the state of our health care coverage and delivery system," Budetti tells WebMD. "The understandable focus in the past decade or so on improving quality and promoting patient safety may have played a role in distracting us from paying sufficient attention to growing problems with access and equity. Perhaps the emerging sight of Middle America traveling thousands of miles for medical care will spur new attention to the need for universal coverage with adequate benefits in this country." < Previous Page 1 | 2 Next Page > SOURCES: Mark D. Smith, MD, president and chief executive officer, California HealthCare Foundation, Oakland. Vishal Bali, chief executive officer, Wockhardt Hospitals Group, Mumbai, India. Peter P. Budetti, MD, JD, Edward E. and Helen T. Bartlett Foundation Professor of Public Health; chairman, department of health administration and policy, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Milstein, A and Smith, M. The New England Journal of Medicine, Oct. 19, 2006; pp 1637-1640. © 2006 WebMD, Inc. All rights reserved. Find this article at: http://www.usatoday.com/news/health/2006-11-02-health-overseas_x.htm SAVE THIS | EMAIL THIS | Close Check the box to include the list of links referenced in the article. Copyright 2007 USA TODAY, a division of Gannett Co. Inc. >On the other hand, it is arguable that an >amateur plumber can do plumbing work but at the cost of a lot of >hours finding out the regulations, planning the work, and doing the >job slowly (the ratio might perhaps be 8 to 1, so nearly everyone >hires a plumber, not to mention those jobs where the work has to be >inspected and by regulation must be done by a qualified plumber - so >bricklaying might be a better example) > >>Marx says that commodities are commensurate in the market, but there >>is no way to >>get behind the market to get a handle on the abstract labor >>measures. How many >>hours of abstract labor does a surgeon represent. Can 20 or 50 >>unskilled labor >>perform the same procedure? >> -- >>Michael Perelman >>Economics Department >>California State University >>Chico, CA 95929 >> >>Tel. 530-898-5321 >>E-Mail michael at ecst.csuchico.edu >>michaelperelman.wordpress.com > > >-- >Associate Professor Ian Hunt, >Dept of Philosophy, School of Humanities, >Director, Centre for Applied Philosophy, >Flinders University of SA, >Humanities Building, >Bedford Park, SA, 5042, >Ph: (08) 8201 2054 Fax: (08) 8201 2784
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