"Un-American" Surgery Abroad

Is it unpatriotic to fly halfway around the world to have a knee repaired?

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I noted in my story on medical travel online and in this week's issue of U.S. News that more Americans are boarding flights to have bypasses, joint replacements, and other needed procedures performed at hospitals in India, Thailand, and other far-flung destinations. How many, as I also wrote, is several notches below uncertain. Figures as high as 500,000 U.S. patients per year have been tossed around.

Yesterday at a major medical travel conference in Las Vegas, consultant McKinsey & Co. reported that the number is more like 60,000 to 85,000. That's more like travel writer Josef Woodman's rough guess of 50,000, which appeared in my article.

The McKinsey report might deflate a few hospitals' claims. While Thailand's Bumrungrad Hospital, an excellent facility in Bangkok, had reported that more than 35,000 Americans came to the hospital for surgery in 2007, administrators there conceded to me last week that the real figure is about 10,000.The higher number was derived by including expatriates—and by counting every time a patient walked through the door. (A patient who comes for a preop study, then is admitted for surgery, and after discharge returns for physical therapy would count three times.)

Meantime, toward the end of a radio interview I had Sunday about having serious surgery abroad, the interviewer posed a question. Did I think it might be considered unpatriotic or un-American to go outside the country for care? "Unpatriotic?" I said, caught offguard. "In all of the talk and articles, I've never seen any suggestion of that. How is it unpatriotic to find care that's affordable?"

The question seemed strange. Why should someone with bad hips or a bad heart and no health coverage—the sort of person fueling the foreign-surgery trend—be criticized for seeking care at a perfectly good hospital 10,000 miles away at a quarter or a fifth of the price a U.S. hospital would charge? To suffer is patriotic?

"I am back walking normally," wrote a Florida woman in an online comment to my story, "which was a dream for me." She had both knees replaced in India, where the total cost averages less than $20,000 for bilateral replacement. In the United States, typical hospital charges would have been above $85,000. Few people can pay such a sum out of pocket.

The radio interviewer backed off. It is our health system that might be considered un-American, he said, by leaving millions of people vulnerable and in poor health. Hmm. Do we even have a "health system"? Most experts I know think we have a tottering, wheezing Rube Goldberg contrivance. Hospitals are part of its gimcrackery. They could make a tidy profit if they opened the doors to self-payers and charged them half as much as they are now told they will have to pay. Operating rooms in India and Thailand are filling up because that isn't happening.