Health Care: Wealthy Jet to America; Regular Folks Get Good Care and Savings Everywhere Else

Congress gets back to work this week: time to get on the health care horse again!

An eager reader asks, if foreign medical systems are so wonderful, why do folks "flock" to America for treatment?

Sure, if you're a rich jetsetter for whom cost is not an issue, flying to America for cutting-edge treatment is a good deal. Going by a very narrow defintion of medical tourism, consulting firm McKinsey & Co. estimates about 40% of the world's 65,000–80,000 medical tourists are coming to the U.S. Interestingly, study co-author Paul Mango says the trend of medical tourists coming to America reflects only the perception that American health care is the best, not any empirical truth. That perception is fueled by vigorous marketing campaigns by the hospitals, who recognize they can really boost their revenues by drawing the highest-paying clients.

Meanwhile, a growing number of Americans are going overseas to save money on health care. For a big bibliography, see the Wikipedia article on medical tourism. One of those articles, a June 2007 Arizona Republic report, put cost savings for Americans seeking health care overseas at 25% to 80%, with very rare stories of botched procedures (and remember: American hospitals screw up, too, killing 98,000 Americans a year).

Americans and foreigners alike travel the world looking for better health care deals. But does medical tourism prove that America has the best care in the world and that we don't need serious reform of how we pay for that care? Hardly:

It is, I guess, politically correct, widely believed, that to say that American health care is the best in the world. It's not. There's a much more complicated story there. For some kinds of care my colleague Brent James calls it rescue care. Yes, we're the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you're pretty lucky to be in America.

You'll get it faster and you'll probably get it better than in at least most other countries. Rescue care we're great. But most health care isn't that. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care. No no, we're no where near the best. And it's reflected in our outcomes.

We're something like the… We're not the best health care system in the world in infant mortality rates. We're like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care [Dr. Donald Berwick, pediatrician, quoted in the film Money-Driven Medicine, as excerpted on Bill Moyers Journal, 2009.08.28].

Jetting to Mayo is not a model for everyday affordable health care for 300 million Americans. America needs to spend less and do more in health care, the way pretty much every other industrialized country does with some form of national health coverage.