Lower costs lure Americans abroad for health procedures

(Significant portions taken from the Kansas City Star, which I never do, but this was a fantastic story. )

Dawn and Brad Palmer had never ventured outside the United States until a trip last year to Brazil.

But rather than a trek through the Amazon River basin, their itinerary took them to Santa Cruz Hospital in the southern Brazilian metropolis of Curitiba.

That’s where they underwent obesity surgeries that were not covered by their health insurance policies. Their total tab, including medical costs, drugs, airfare and hotel bills: $24,000.

If they would have had the surgeries in this country, the combined medical costs alone would have totaled at least $140,000, Dawn Palmer said.

Besides saving more than $100,000, the Palmers have lost more than 290 pounds and feel better than they have in years.

“I’d tell people not to give up hope if there’s a procedure they want or need and their insurance won’t cover it, or they can’t get the care they’re looking for here in the United States,” Dawn Palmer said. “Just be open to the idea that you can find wonderful medical care from people in other countries.”

Growing legions of American patients — by one estimate, 150,000 last year — are following in the Palmers’ footsteps and traveling to countries such as India, Thailand, Brazil and Mexico for medical care. And while earlier waves of medical tourists sought mostly cosmetic procedures, more and more Americans are going abroad to get their hearts fixed, joints replaced and stomachs stapled.

“From a health-care competition and policy perspective, it’s significant,” said Gregg Laiben, president of the Metropolitan Medical Society of Greater Kansas City. “We are no longer operating on just a local or regional level. Once these other countries come into play, they become another marketplace that competes with U.S. health care.”

Most consumers who take the medical tourism plunge do it to save money. The cost difference between medical procedures in the United States and foreign countries can be huge. According to information presented at a hearing last year before the U.S. Senate Special Committee on Aging, the typical cost of a coronary bypass in the United States ranged from $55,000 to $86,000, compared with $7,000 to $7,500 in India and $15,612 to $16,913 in Thailand.

“It’s primarily a signal of the growing unaffordability, relative to American income, of health care,” said Arnold Milstein, chief physician for Mercer Health & Benefits in San Francisco. “For tens of millions of Americans, this is probably the only avenue to elective, non-emergency procedures.”

Experts attribute those whopping price differentials to lower earnings by most health-care personnel in developing countries. In addition, malpractice insurance premiums are non-existent in most foreign countries, and global health-care product suppliers sell to developing countries at cheaper prices.

American patients also are drawn to medical tourism by the high-quality reputations of many overseas health providers.

“Ninety percent of the doctors I recommend are U.S.-trained or board-certified, and they’re working in hospitals that are palatial and state of the art,” said Rudy Rupak, president of PlanetHospital, a California company that sets up overseas medical care.

Foreign hospitals that treat large numbers of English-speaking patients recruit U.S. surgeons. American doctors who make the trek typically are paid the same fees they earn in the United States, but enjoy the lower cost of living and lack of malpractice insurance premiums in the countries they move to, Rupak said.

Presidential candidates take note: We’ll just go overseas if you don’t fix the health-care industry.

Bill Clinton’s health push in SC

As the candidates themselves steadily worked toward the primaries in Iowa last week, their most important surrogates worked the South Carolina ground.

Along with Oprah Winfrey (which a whole different news story), former President Bill Clinton was in the state, stumping for wife Hillary’s health care plan, according to a report by The New York Times.

He said her plan would insure the 672,000 people in South Carolina who have no health coverage, including 99,000 children, and would save families thousands of dollars a year. Hillary Clinton has cared about health care for at least the nearly four decades her husband has known her, he said, and improving health care is “at the heart of” what she wants to do for the country.

He did not compare her health plan to those of her rivals, nor did he mention those rivals except to say that he was excited about the campaign because it featured not only a woman but “a really good African-American” and an Hispanic-American governor. He went on to note that women have been elected to head India, Pakistan, Germany, Argentina and Chile, and “America shouldn’t be behind anybody.”

Which is true if you think about it. When Middle Eastern countries are ahead of you in women’s rights, you’ve got a problem.

Edwards plan will stop insurance abuses

Former Sen. John Edwards (D-N.C.) this week presented a new plan that he says will stop health-insurance companies from abusing customers, according to an article on his Web site.

“Right now, even families that have health insurance are often unprotected from catastrophic events, as insurers reject legitimate claims, impose coverage caps, and look for technicalities to cancel policies,” he said.

“The truth is, the American health care system is broken because wealthy health insurance corporations and their lobbyists have rigged the system against the American people,” Edwards said. “I have spent my entire life fighting and beating those same special interest groups to protect the rights of regular Americans, and that’s exactly what I’ll do as President.”

Edwards is the only candidate who has not taken campaign money from health-industry lobbyists, the article says (and which I think is true, but could not be independently verified).

“Under the Edwards plan, insurance companies will be required to sell insurance to everyone, regardless of their pre-existing conditions, and prevented from denying coverage after a condition develops,” the article reads. “Edwards will put a stop to the practice of charging more to individuals with certain occupations or with pre-existing conditions, and will set national accounting standards requiring insurers to spend at least 85 percent of their premiums on patient care. Edwards will empower consumers by forcing insurance companies to be more honest and transparent about what they will ultimately cover and making sure all insurers guarantee comprehensive benefits. Edwards also called for an updated bill of rights for patients and providers.”

Health care and Iraq still tied

Health care and Iraq are “essentially tied” as voters’ No. 1 concern, according to an Associated Press/Pew Research Center for People and the Press survey released last week.

The survey, which researchers conducted by telephone between Nov. 7 and Nov. 25, included responses from 460 likely Democratic voters in Iowa, 594 in New Hampshire and 373 in South Carolina, according to the Kaiser Daily Health Report.
According to the survey, 41% of respondents in Iowa cited Sen. Hillary Rodham Clinton (D-N.Y.) as the Democratic presidential candidate most trusted to improve the health care system, about double the percentage of respondents who cited Sen. Barack Obama (D-Ill.) and former Sen. John Edwards (D-N.C.).

The survey found that Clinton “boasts even wider leads” in New Hampshire and South Carolina as the Democratic presidential candidate most trusted to improve the health care system. Overall, a plurality of respondents in New Hampshire and South Carolina favored Clinton over other the other Democratic presidential candidates, while she and Obama were “essentially tied” in Iowa, the survey found.

More than $40 million in U.S. cannot afford health care

According to a federal report released this week, more than $40 million Americans say they cannot afford health care.

“There has been important progress made in many areas of health such as increased life expectancy and decreases in deaths from leading killers such as heart disease and cancer,” Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said in a statement.

“But this report shows that access to health care is still an issue where we need improvement.”

The report, summarized by a Reuters article, contained an analysis of data from 2005, whereas now, nearly three years later, Americans’ health circumstances may have changed. And we know from polls that health care is the No. 1 most important domestic issue to voters and presidential candidates have responded, with nearly all of them presenting detailed health plans as a part of their campaigns.

Other details from the article and report:

• The report found about one third of all children living below the poverty level had not visited a dentist in 2005, compared with fewer than one-fifth of children from wealthier families.

• “The United States spends more on health per capita than any other country, and health spending continues to increase,” the report said.

• “In 2005, national health care expenditures in the United States totaled $2 trillion, a 7 percent increase from 2004. Hospital spending, which accounts for 31 percent of national health expenditures, increased by 8 percent in 2005.”

• Private insurance plans paid for 36 percent of total personal health care expenditures in 2005, while the federal government paid 34 percent, state and local governments paid 11 percent, and patients paid for 15 percent out of pocket.

• Prescription drugs accounted for 10 percent of national health expenditure in 2005.

• Some good news: life expectancy was up to 77.8 years for a baby born in 2004 — three years more than in 1990. “Mortality from heart disease, stroke, and cancer has continued to decline in recent years,” the report said.

Study: Illegal Hispanics not a health-care burden

Despite the fact that many anti-immigration activists say illegal immigrants are a burden to U.S. health-care programs, a new study by researchers at the University of California’s School of Public Health found that illegal Latinos are no more burden to our health-care system than legal or American-born Latinos.

The study, based on a 2003 telephone survey of thousands of California residents, specifically found that although such immigrants tend not to have a regular doctor or other health-care provider, they do not visit emergency rooms – often a last resort in such cases – with any more frequency than Latinos born in the United States, according to a report by Reuters.

The makeup of the studied group:

• 1,317 undocumented Mexicans
• 2,851 citizens with Mexican immigrant parents
• 271 undocumented Latinos from countries other than Mexico
• 852 non-Mexican Latinos born in the United States

What researchers said:

“One recurrent theme in the debate over immigration has been the use of public services, including health care,” wrote lead researcher Richard Ortega and his team in the report, which was published in the Archives of Internal Medicine (pdf).

“Proponents of restrictive policies have argued that immigrants overuse services, placing an unreasonable burden on the public. Despite a scarcity of well-designed research … use of resources continues to be a part of the public debate,” they said.

• Illegal Mexican immigrants had 1.6 fewer visits to doctors than people born to Mexican immigrants
•  Other undocumented Latinos had 2.1 fewer physician visits than their U.S.-born counterparts

Conclusion?

Perhaps critics shouldn’t worry so much about illegal immigrants draining resources meant for Americans.

“Low rates of use of health-care services by Mexican immigrants and similar trends among other Latinos do not support public concern about immigrants’ overuse of the health care system,” the researchers wrote.

“Undocumented individuals demonstrate less use of health care than U.S.-born citizens and have more negative experiences with the health care that they have received.”

Then again, illegal Latinos may have had fewer doctors’ visits than others, but they still had some, and in my opinion, any unauthorized use of social services meant for Americans is illegal and should be stopped.

Kucinich calls for non-profit health care

During a visit to Phillips Exeter Academy in New Hampshire this week, Rep. Dennis Kucinich [D-Ohio] was approached by a man whose wife’s cancer treatment costs are so high that the couple are struggling to make ends meet.

“I need your help in Congress to look into the cost of drugs that are being prescribed,” the man, Fred Anderson, told Kucinich, according to an article on SeacoastOnline.

In response, Kucinich told the group assembled at the academy that he is advocating for not-for-profit health care.

“Under my plan, the prescription drugs are free, the long-term care is covered. Anyone who has cancer is covered for all their treatments,” Kucinich said, citing the hundreds of thousands of dollars it can cost to treat the disease.  “[Health coverage] should be a basic right in a democratic society, not a privilege based on your ability to pay.”

NE Journal of Medicine examines candidates’ health-care plans

In an article published last week in the New England Journal of Medicine, social medicine and health policy expert Jonathan Oberlander critiqued the health-care plans of the leading Democratic and Republican presidential candidates.

Oberlander’s findings on the Dems:

• The three front-runners – Sen. Hillary Clinton [D-NY], Sen. Barack Obama [D-Ill.] and former Sen. John Edwards [D-NC] – all have very similar plans. Their goal is to provide coverage for all or nearly all of the 47 million currently uninsured Americans.
• The Democratic plans all rely on a “play-or-pay” employer mandate to move toward universal coverage, requiring businesses to either offer workers insurance or pay a tax.
  • “Employer-sponsored insurance has been a cornerstone of the U.S. health care system since the 1940s and now covers about 160 million nonelderly Americans. Play-or-pay models enable reformers to finance universal coverage mainly through employer payments rather than creating a publicly funded system that would require new broad-based taxes.”
• Medicare would be retained, and Medicaid and SCHIP would be expanded to cover more low-income Americans. In addition, the Clinton, Edwards, and Obama plans all create a new public insurance plan that would be available alongside private options.
• The  top three candidates avoid any explicit budgeting of health care spending or centralized cost controls, instead offering a politically friendlier assortment of cost-saving measures, including electronic medical records and a focus on prevention and disease management. These measures may be good health policy, but their capacity to generate large savings is uncertain, and they are unlikely to restrain health care spending for long.
• The Democratic plans are financed largely by rolling back tax cuts adopted by the Bush administration for families making more than $200,000 (Edwards) or $250,000 (Clinton and Obama) annually.
  • “Democratic presidential candidates are, in essence, betting that the public would rather spend federal money on covering the uninsured (and making coverage for the already-insured more secure and affordable) than on extending tax cuts for the wealthy.”
• All of them contain provisions designed to reassure insured Americans that they can keep their current coverage if they want to.

Oberlander’s findings on the Republicans:

• None of the top three candidates – former Massachusetts Gov. Mitt Romney, former New York Mayor Rudy Giuliani and Sen. John McCain [R-Ariz.] – has introduced a health plan as detailed or comprehensive as any of the Democrats’.
• The leaders generally favor incremental expansions of insurance coverage and changes in tax policy to improve access and control costs.
• Giuliani and McCain would offer tax credits to Americans purchasing their own insurance. The aim is to shift enrollment from employer-sponsored into the private market. Romney, on the other hand, would have the federal government work with the states to form a health solution, and his tax credits would also allow individuals to purchase private insurance.
• All the Republican plans call for deregulation of insurance markets, investments in health information technology, medical malpractice reform, and expansion of health savings accounts (tax-preferred accounts that can be used to pay for medical expenses in conjunction with high-deductible health insurance).
• “Without more details, it is difficult to assess the plans’ potential impact, but their incremental measures are unlikely to substantially increase health insurance coverage or effectively control costs.”

Clinton calls Obama’s health-care ad “misleading”

Sen. Hillary Clinton’s [D-NY] campaign called on Friday for fellow Democratic presidential candidate Sen. Barack Obmama [Ill.] to pull one of his campaign television commercials, which asserts that his health-care plan covers all Americans.

Clinton’s campaign manager, Patti Solis Doyle, told reporters on a conference call that Obama’s suggestion that his health-care plan will cover all Americans is “demonstrably false” and that the ad is misleading.

According to an article in Friday’s Boston Globe, Solis Doyle even sent a letter to Obama’s campain manager asking him to stop running the ad.

“On an issue of this magnitude, Americans are looking for more than a nice ad or a good speech. It’s not enough for Sen. Obama to say he covers everyone, especially when that is inaccurate,” Solis Doyle wrote. “Until the time comes when Sen. Obama has a plan that will cover everyone, you should stop running this false advertisement. The American people deserve an honest debate about health care.”

Obama’s response:

The campaign does not plan to pull the ad, which has been running for about a month in Iowa. It just began airing in New Hampshire this week.

The polls show a tight race in both states between Clinton, Obama and former Sen. John Edwards [D-NC], which Obama’s manager referred to in a response to Clinton’s criticism.

“The Clinton campaign didn’t say a word when this ad was released a month ago, and the only thing that’s changed since then is the poll numbers,” Obama spokesman Reid Cherlin said in a statement.

“Rather than spending their time attacking Barack Obama, the Clinton campaign should explain how exactly they plan to force every American to buy health insurance even if they can’t afford it,” he said.
Is the ad truly misleading?

It depends on how you look at it. If you read into it that Obama’s plan will provide health coverage for all Americans, then yes, it is misleading.

Let’s take a look at Obama’s proposed health plan (pdf):

• The plan will make available a new national health program that will allow (not force) individuals and small businesses to buy affordable health care similar to that available to federal employees.
• It will not turn anyone away or charge more due to illness or pre-existing conditions.
• It would require insurance companies to accept all applicants.
• It would require employers to make a “meaningful” contribution to the health coverage of their employees.
• The plan would require hospitals to collect and report health-care cost and quality data.
• Drug costs would be lowered by allowing importation of pharmaceuticals from other countries.
• The only sect of society that would be required to have coverage is children.