October 29, 2007

The Rich Get Health Care

The British National Health Service has launched an entire new industry: surgical tourism. The Daily Mail reports that the numbers of Britons seeking an escape from the universal health-care system will exceed 70,000 this year and 200,000 by 2010, flying to all parts of the world to get medical attention, and better surgical conditions:

Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year.

And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report.

The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration of often waiting months for operations are fuelling the increasing trend. ...

India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting health tourists.

The European destinations seem understandable, given their proximity and easy access. The longer trips to India and Malaysia indicate a measure of desperation. The expense involved has a great deal of money flowing out of the country, and it shows that a free people find market-based solutions when possible.

India's popularity comes in part from their efforts to fight against antibiotic-resistant bacteria, something that the NHS has yet to do systematically. In fact, the DM says that surgical complications from Clostridium difficile have risen past the 55,000 cases known from the previous year, continuing a decade-long trend that has seen a 500% increase in such infections. Hungary's attraction comes from its access to dentists, while the NHS has seen most of its dentists flee the system.

And of course, what this shows is that those who have the money will have the resources to get medical care -- and they know better than to use the NHS. People who can afford the double hit of their taxes (which fund NHS) and private medical care manage to do so, and they don't stop at British private medical resources to get it. They have "globalized" medical care by shopping for services, using competition to drive down cost and improve delivery of services.

If Britain would allow those kinds of market forces to work in its health industry rather than impose the kind of top-down government management that NHS represents, they might keep that money in Britain. If the US wants to keep from creating its own surgical tourism industry as an export, we should learn this lesson, and quickly. (via Memeorandum)


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Comments (39)

Posted by Keith | October 29, 2007 7:39 AM

Tens of thousands of Americans are also going to India for surgery. Some took the risk of not carrying insurance. Most have been denied coverage for a specific procedure because of a pre-existing condition. For a few, their co-pay is more than the total cost in India.

Posted by patrick neid | October 29, 2007 7:39 AM

Over the next ten years I would imagine our medical tourism overseas is going to dwarf anything out of the UK/Europe. The savings and service are just too large to pass up in India and Malaysia.

I believe 60 minutes and others have already had segments showing as much. In fact, I think US insurance companies will ultimately be in the forefront in leading the charge. The inducement will be great service, a spa like environment, a one month recovery time at 1/3 the price. It certainly would be my choice. It's the free market at work.

In fact I hope it gains momentum in less than ten years as baby boomers age. Competition is the solution to our moribund health care service rather than Hillary care.

Posted by eaglewings | October 29, 2007 7:57 AM

Given that the NHS' muslim doctors and patients and their families refuse to properly sanitize their hands at the hospital, because of their religious beliefs, it's no wonder patients with means would seek service elsewhere and no wonder that superbugs would be abounding in these third world paradises.

Posted by dave | October 29, 2007 9:15 AM

First, let’s try to find out where this 70,000 number comes from. We go to the “Treatment Abroad” website and find this:

“It is believed that more than 50,000 people from the UK travel for treatment abroad (Source: International Passenger Survey 2005)”:


The “International Passenger Survey” that the “Treatment Abroad” website lists as a source is a survey conducted by the UK government. Looks like the number may be legitimate. So let’s take a look at this survey. We find, however, that this is a survey of people from inside the airport terminal which “usually takes 3-5 minutes” and asks very general questions:


As far as “purpose of visit”, we find that:

“The IPS records the many different reasons people have for making a visit. These are combined into four main analysis categories:
• Holiday;
• Business;
• Visiting friends or relatives (VFR); and
• Miscellaneous.
The categories describe the main purpose of the visit and where it is not possible to determine this, the respondents’ reason for the visit is categorised as ‘miscellaneous’”:


There is no “medical tourism” category, or anything close to it. We find that this is included in “miscellaneous”:

“Visits for miscellaneous purposes include those for study, to attend sporting events, for Shopping, HEALTH, religious or other purposes, together with visits for more than one purpose when no one purpose predominates (e.g. visits both on business and on holiday). Overseas visitors staying overnight in the UK en route to other destinations are also included in the miscellaneous purposes category”.

So out of the millions of travelers that list “miscellaneous” as their “purpose of visit”, the “Treatment Abroad” website somehow decided that 50,000 of these were for “medical tourism”. The number of 70,000 is the result of an expected future increase. This number, however, is simply picked out of the air, and no such number comes from the UK “International Passenger Survey”. That is why, when "Treatment Abroad" quotes the 50,000 number in connection to the UK government survey, they say "*It is believed* that more than 50,000 people...". The term "it is believed" really means "we made this number up". Quoting this UK government survey is a pathetic attempt to bring legitimacy to a bogus claim. It is a fabrication.

On another page of the “Treatment Abroad” website, they list a different source for their number. This time, the number of 50,000 (70,000 is again a projection) is obtained by a survey commissioned by the “Treatment Abroad” website from a company called “European Research Specialists Ltd”:


This company does not appear on the web, and also does not appear in Lexis Nexis in a search of UK companies. It is doubtful that it is real.

We also find that even if this number were correct, the majority is not for “major heart surgery, hip operations and cataracts”, as the Daily Mail article says. 40% are for dentistry and 29% for cosmetic surgery. As far as I know, even US health insurers do not pay for cosmetic surgery. 20% are for elective surgeries. Again. All these numbers are from a phantom company that was hired by a website who’s business is selling medical tourism packages. Pathetic.

Another thing not mentioned in the Daily Mail article is that if a *real* surgery (not a boob job) is needed abroad, the NHS still pays for it, and it is not about "the rich get heath care":


They also mention a fear of superbugs as a reason that people are going abroad for surgery. Please show me that infection risk is lower in Malaysia or Turkey than in the UK.

Just like every other CQ thread on the NHS, this story is a complete joke. This story is nothing but a paid advertisement for a corporation. The reason you must always resort to pathetic stories like this, or to anecdotal stories, is because when any legitimate comparison is made between the US system and any other first world (or even some third world) country, the US always ends up on the bottom. So you must ignore these legitimate studies.

Posted by NoDonkey | October 29, 2007 9:36 AM


"is because when any legitimate comparison is made between the US system and any other first world (or even some third world) country, the US always ends up on the bottom."


Hospital infection rates in the UK are a huge problem, because they don't adhere to standards of practice. They are cheap, underfunded and they have physicians who were not educated properly and who cannot speak the native tongue.


1 in 10 patients in Scotland are carrying a secondary medical infection. That's abysmal and completely unacceptable.

I've seen hospitals in Europe with open windows. JCAHO will shut you down for that kind of stuff.

Meanwhile, in the nasty ol' US, newspapers are dinging hospitals with infection rates of 1.2% - not 10% with a bunch of excuse making and handwringing from the incompetent NHS, 1.2%.


There should be two systems in the US - people who want substandard care provided by socialists should be willing to be taxed accordingly to fund it.

The rest of us should be able to rely on the free market.

Socialism is also a complete and utter disaster, no matter how much lipstick is put on Hugo Chavez.

Posted by unclesmrgol | October 29, 2007 10:17 AM

Dave is right about the statistics -- they do not match what is available in the UK's government databases (which are available for free at the site).

However, Dave is wrong on the NHS. Note that the company offering up the data upon which the "Daily Mail" article is based is a private business whose business model is providing overseas medical care.

Why would such a company need to exist if Britons are getting the service they require from the existing system?

And, dave, while I think the "Daily Mail" is a place where the news needs to be looked at with a grain of salt (as with almost any MSM source), they seem to be seconded by this New York Times article outlining the problems obtaining dental care in Britain.. Note that the NYT article also cites at least one reason why Britons are seeking "overseas" (or, in their case, "underseas") treatment for their ailments -- costs for modern procedures not covered by the NHS (such as the implants [dental, not breast] mentioned by Britisher Josie Johnson at the end of the article).

So, your position that all is rosy in marqueritaville seems to be a bit tipsy.

Posted by dave | October 29, 2007 10:42 AM

"Why would such a company need to exist if Britons are getting the service they require from the existing system?"

In case you did not know, medical tourism is a booming business in many countries, including the US, where somewhere between 150,000 and 400,000 people travelled abroad for health care in 2006:


The number one reason for this business is cost. Much of this is for cosmetic surgery, which noone pays for. In the UK, if you have a need for a legitimate operation (not cosmetic, etc), it will be paid for by the NHS. If you need to wait too long, you may go to another country, and the NHS will still pay for it. In the US, if you need a legitimate operation, it will not be paid for if you don't have insurance, and even if you do, the copayment may still be too high. US patients, therefore, resort to medical tourism for different reasons.

I guess you have nothing to say about the subject of this thread, so you want to change the subject to hospital infection rates. You compare some rates you found in separate articles. After doing some reading, it does look like the UK has a problem in this area, but their rates are also coming down lately. It is easy to find out this information, because the UK is very transparent about this issue, and has been reporting their data for years:


The US, on the other hand, does not do this:


In this article, a news channel asked 29 hospitals for their infection rates, and only one answered:

“During a News Channel 8 investigation of infections two years ago, 29 local hospitals were requested to disclose their infection rates.
All but one - H. Lee Moffitt Cancer Center - declined or ignored the request.
Moffitt now says its current overall infection rate runs about 3 percent, which the hospital considers good for a cancer center”

The one that answered had a rate of 3%. I expect the ones that did not answer had higher rates. Until the US decides that its citizens should be allowed to see this data, like the UK does, a true comparison cannot be made. I wonder, if our infection rates are so wonderful, why are we so stingy about telling others what they are?

Posted by dave | October 29, 2007 11:05 AM

As for your NYT article, the main reason for the issue discussed there is a shortage of dentists. The population to dentist ratio is high in the UK. The Captain already had a thread on this issue:


I showed on that thread how the US ranks in population to dentist ratio compared to European countries. The US comes in 13th out of 19, and the UK comes in 18th. The US is better than the UK, but not better than many other Eurpoean countries with socialized medicine. Also, the worst ratio in the entire UK was in Walsall, where the ratio was 3,359 people per dentist. In the US, we do not even consider there to be a shortage unless the ratio is over 5,000:1. So according to US standards, the UK has no shortage whatsoever. The US, however, has many shortages. The US has nearly 1,500 areas where the ratio is over 5,000:1. The US has nearly 1,500 areas (which cover over 31 million people) where the ratio is far worse than the worst area in the UK.
(See references in the CQ thead above)

Posted by Kevin | October 29, 2007 11:35 AM

Posted by dave | October 29, 2007 10:42 AM

"...If you need to wait too long, you may go to another country, and the NHS will still pay for it. In the US, if you need a legitimate operation, it will not be paid for if you don't have insurance, and even if you do, the copayment may still be too high. US patients, therefore, resort to medical tourism for different reasons."

The NHS does not pay for any medical care; the taxpayers do. This "free medical care" meme is getting really old.

Posted by daave | October 29, 2007 11:44 AM

"The NHS does not pay for any medical care; the taxpayers do."

Wow! Really! What an insight! Thanks for the info.

Posted by NoDonkey | October 29, 2007 12:02 PM


You are correct about the infection rates not being made public, they should be.

But the JCAHO checks them out, assuredly. And they will shut down a hospital if the infection rates get too high, for medical errors and for a vast number of things.

I've been a part of several JCAHO inspections and they are no joke.

As far as the medical tourism aspect, if people can afford to go overseas for treatment, then they can afford health insurance instead of expecting other people to foot the bill.

I made pretty much nothing while I went to grad school, but I was able to scrape up $50 a month for a catastrophic policy which would have covered me for expenses over $5,000.

I dislocated my pinky playing basketball and had it treated in the ER - $400 bill. I called the physician and worked out a payment plan. I negotiated down the bill and paid in installments. I didn't alert the local news media or perhaps they could have done a sad story on my behalf.

Much of the problem is education. People think insurance should pay for every dime of care or they're not worth buying. That's not the case.

Posted by dave | October 29, 2007 12:59 PM

“But the JCAHO checks them out, assuredly”

I cannot find what the JCAHO does in relation to HAI’s. I did find the following:

“Additionally, there has been a more focused effort to prevent all HAIs. Facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are required to follow the 2005 Patient Safety Goals, complying with the CDC’s hand hygiene recommendations. JCAHO also requires reporting cases of “unanticipated death or major permanent loss of function” from an HAI as a “sentinel event””


The way I read this, hospitals are basically required to have people wash their hands, and to report any death or major loss of function that results from a HAI. This does not sound extremely thorough. Once gain, there is no way to make comparisons from the US to Europe, but I agree that the HAI rate is probably higher in the UK than the US. As with the dentist to population ratio above, it is also quite possible that many European countries have HAI rates equal to or better than the US. If so, there would be no relationship to HAI rates and type of medical systems. Again, I wonder why the US does not report their rates.

Catastrophic insurance:
The rate you quote sounds affordable for someone in their early twenties who suffers nothing more than a dislocated pinky (although for many people $50 a month is a large amount of money). This rate will be much higher for someone 70 years old, and if you get cancer or other chronic disease, $5,000 a year is quite a lot to pay for many. Also, catastrophic insurance does not cover pre-existing conditions. So if you have diabetes and lose you job along with your health insurance, you cannot get catastrophic insurance for your condition. Also, these policies do not cover prescriptions or doctors visits, which can be very costly. Into the tens of thousands of dollars for prescriptions. Even with catastrophic insurance, many people will meet an early death due to not having enough money. I do not believe that an ethical society would allow this to happen. 18,000 people per year die from lack of health insurance. Education might have some impact, but I doubt it would be significant. I would prefer to have nobody die due to lack of money, even if it meant going out to dinner one less time per month. Also, there is no need for universal health care to cost more. All countries that have universal health care do it for less than what the US spends, and the results are better. I can't find a problem with that.

Posted by a-dougk1 | October 29, 2007 1:48 PM

dave says "18,000 people per year die from lack of health insurance. Education might have some impact, but I doubt it would be significant."

In the US, you do not need health insurance to receive health care. If 18,000 people are dying each year because of lack of health insurance, then education would have the MOST significant impact on improving these numbers.

My father once told me "Sometimes the penalty for stupidity is death." If 18,000 people are dying because they lack health insurance, maybe my father was right.

Posted by dave | October 29, 2007 2:48 PM

"In the US, you do not need health insurance to receive health care."

OK. Please educate one of us stupid ones. Let's say I am NoDonkey, in graduate school, and am paying $50 a month for catastrophic health care coverage. I have no money, and no family to bail me out. Instead of getting a dislocated pinky, I get colorectal cancer. This is a disease that can virtually eliminated through screening, but screening for this cancer and therebye virtually eliminating it would be "catastrophic" for the pharmaceutical industry, so we do not do it. If we did, I could have possibly went through life cancer-free, but now I will sooner or later almost certainly die from it. But at least I will die knowing I live in the country with the best health care in the world. Anyway, maybe my catastrophic insurance will pay for surgury and chemo, but I still have to come up with $5,000 a year. Also, I want to go on Avastin, which costs $50,000 a year, and is not covered by catastrophic health care insurance. Explain to me how I come up with $55k a year without having to quit school to "work" in the streets at night and end up getting AIDS as well.

Posted by Fred Evil | October 29, 2007 3:01 PM

I love all the people whining about 'socialism' and saying that as soon as we hand over our hospitals, everything goes down the tubes.

In fact, certain aspects of our society lend themselves well to socialistic behaviors and treatment.

Not many people are running around complaining about our 'socialist' military, or our 'socialist' educational system, or our 'socialist' law enforcement, or our 'socialist' infrastructure (roads, electricity etc). Imagine having to have 'Law Insurance' so you could get your stereo back if you were robbed, or 'Oppression Insurance' where you had to pay to get military assistance in case we're invaded. 'AMP Insurance' so your TV would run.

Common sense should easily lead you to the conclusion that a FOR PROFIT system, is NOT appropriate for life-saving activities. I much prefer some soft of hybrid system, where there is still monetary incentive to cure diseases (after all, Greed is good, right?), but the actual delivery of healthcare, should NOT cost people money! That's just capitalism run amuck.

After all, the founding document of this country, the Declaration of Independence, laid out it's fundamental tenets of a free society, and one of them was a RIGHT TO LIFE, and nowhere in that document did it specify only for the rich, but that's where we are today.

And contrary to popular opinion, I doubt our hospitals would EVER revert to 3rd world status, just sic the ACLU and some local politicians on the hospital, and it will get cleaned up right quick.

Posted by dave | October 29, 2007 3:14 PM

Fred Evil:
"still monetary incentive to cure diseases"

I am a medicinal chemist in the pharmaceutical industry. The result of this industry being run by market forces is that it is incredibly wasteful and redundant. What happens is that company A will find a truly unique medication that will actually help people. What happens next is that companies B, C, D, E, F and G will then work feverishly to find a whole in company A's patent that they can exploit. These companies will then expend a tremendous amount of effort finding a "me too" drug that is virtually identical to the original, just so they can use their sales force, another huge waste, to capture a share of the market. 95% of the work I have done in my career was a total waste of time, and had nothing to do with finding new drugs, but rather making money by copying someone else's drug and spending hundreds of millions for a sales force to wine and dine doctors to buy it over the original, identical drug. In a socialized pharmaceutical system, all this wasted time and money would instead be used to find truly unique medications. Also, the extra money saved could be used for things like screenings and vaccine research, which would save countless more lives than pharmaceuticals, but are not nearly as profitable. 95% of the money put in the pharmaceutical industry is wasted. And guess where nearly all of the "real" pharmaceutical research is really done? In Universities (socialized institutions). The Universities hand over the projects to the pharmaceutical industry once they are ready to make a profit.

Posted by NotAlwaysRight | October 29, 2007 3:15 PM

"screening for this cancer and therebye virtually eliminating it would be "catastrophic" for the pharmaceutical industry, so we do not do it"

Please tell me that you do not honestly believe the pharmaceutical industry has that sort of value system. That is akin to saying that the fire department encourages arson and that the police sponsor street gangs.

Posted by dave | October 29, 2007 3:23 PM

"Please tell me that you do not honestly believe the pharmaceutical industry has that sort of value system."

As I said, which you might not have seen, I have worked for the pharmaceutical industry for over 20 years. That is exactly the value system they have. It is about money, like any other corporation. It's what this country is about.
One of the first projects I worked on was an AIDS compound. The company ended up dropping it after the bean counters decided it would not be profitable enough, because there was too much pressure being brought on companies with AIDS drugs to give it away to people who could not afford it. So we dropped the project because there was not enough money in it. Not a great way to run a health care system.

Posted by Terrye | October 29, 2007 3:26 PM

I read an article in Good Housekeeping not long ago about medical tourism for Americans as well. They even listed agencies you can contact to help you line up hospitals and clinics.

I do know a young couple who went across the border to Mexico to a clinic to have a tubal ligation reversed a couple of years. They have a little baby boy now. The price for that procedure was a fraction of what it would be here in the states.

Posted by Terrye | October 29, 2007 3:30 PM

This the link to the article: Passport to cheaper health care

Posted by dave | October 29, 2007 3:30 PM

"Please tell me that you do not honestly believe the pharmaceutical industry has that sort of value system."

Screening for colorectal cancer would cost about $4,000 for every life-year saved. Avastin for colorectal cancer costs $250,000 for every life-year saved. Guess which approach is used in the US. Do you think the pharmaceutical industry is out there promoting colorectal cancer screening in order to save lives?

Posted by Rachel | October 29, 2007 3:39 PM

the fact of the matter is we will pay for health care either in money (big bills up front) or time (waiting lists). There is no magic wand for health care, regardless of which side you are on.

Posted by Fred Evil | October 29, 2007 3:47 PM

dave - Thanks for dedicating yourself to the ending of diseases, whether or not you actually get to do that on a daily basis.

I don't understand why pharmaceutical companies NEED a salesforce. Don't the doctors who prescribe the drugs find out about them through published research and documentation? Or is big Pharma allowed to direct market? Which in itself is more than morally questionable. Are doctors supposed to up the level of diagnoses of a certain condition, so they can push a particular drug? Since they know that many insurance companois will go ahead and pay for it, so it won't truly harm the patient? Other than forcing them to ingest chemicals they don't need.

NotAlwaysRight - "That is akin to saying that the fire department encourages arson and that the police sponsor street gangs."
Partially, but not entirely true. The police and fire departments aren't allowed to CHARGE you for the fire being put out, or for the lawbreaker being caught. And they DO sometimes catch firefighters setting fires, so they can play/practice. Hence, the drug companies have a financial incentive to NOT find the diseases until they're significantly more expenive. One more reason that a pure capitalist system is fundamentally flawed. Those who value the dollar more than human life, will always find a way to sacrifice the latter for more of the former.

Posted by a-dougk1 | October 29, 2007 4:14 PM

Dave, I wasn't calling you stupid. Putting that aside, the theoretical illness you describe for NoDonkey is pretty lame (because if the person is young - an assumption on my part for NoDonky - you are highly unlikely to get this disease). However, putting that aside, people do get colorectal cancer. My father died of this cancer, and I am genetically inclined to get this cancer later in life, so let's use that as an example. I know this because I was educated to the causes and preventative measures required to lessen the possibility of getting this type of cancer. So, education about this disease early in my life has already helped me.

You say "This is a disease that can virtually eliminated through screening, but screening for this cancer and therebye virtually eliminating it would be "catastrophic" for the pharmaceutical industry, so we do not do it."

What are you talking about? Currently, since I am over 50, I get a colonoscopy - the "screening" you mention - every 5 years (although I will probably change this to every 3 years later in life). If I didn't have medical insurance, I would still get these exams and pay for them out of pocket. It might take me months to pay for each one, but I would work with the doctor to come up with a payment plan. That would take care of preventative measures. Anyone could do this - all it takes is a little effort. (BTW, when I was younger and didn't have health insurance, I did this all the time when I needed to see a doctor. And I was making very little money then.)

You say "If we did, I could have possibly went through life cancer-free, but now I will sooner or later almost certainly die from it. But at least I will die knowing I live in the country with the best health care in the world."

Now you're just being smarmy. Nothing, not even every preventative measure, ensures that you will go through life cancer free. Cancer seems to be the way people die if nothing else kills them first (my opinion).

You say "Anyway, maybe my catastrophic insurance will pay for surgury and chemo, but I still have to come up with $5,000 a year."

Like I said, I was educated early about how to take preventative measures for colon cancer. If, God forbid, I eventually get some kind of cancer later in life when I no longer have company health insurance, I've worked hard at saving enough money to be able to pay for individual health insurance when I retire. If it runs out and I can't afford the very best health care, I'll take what I can get. If I have to negotiate with the doctor for payment of the $5000 (if I can't get them to lower the cost), I'll manage. So could anyone else with a little effort.

You say "Also, I want to go on Avastin, which costs $50,000 a year, and is not covered by catastrophic health care insurance. Explain to me how I come up with $55k a year without having to quit school to "work" in the streets at night and end up getting AIDS as well."

Avastin is a secondary treatment for colon and lung cancer if other treatments fail. There is no guarantee that even this treatment will save your life. Is it worth $50,000? Maybe to some it is. Should I be required to pay for your use of this drug through socialized medicine? Hell, no. If you can afford it, be my guest - spend whatever you want. Just don't make me pay for your extraordinary treatment.

I guess, overall, what I'm trying to say here (probably badly) is that people need to educate themselves about their health and what they need to do to keep it. It's that ol' personal responsibility thing again. If you are overweight, you're going to die early. If your family has a history of heart disease or lung cancer, you shouldn't smoke. If you have a genetic inclination for colon cancer, you have to take preventative measures. People also need to realize that eventually, no matter what you do, you are going to die.

Sorry this post is so long, but I've thought about this a lot. It seems that some people think that by handing out "free" health care, they can keep themselves and others alive forever, regardless of the bad health (and life) decisions many people have made in their lives. Does this apply to everyone? No, some people, because of mental problems or very, very bad luck may not have many choices. Sometimes life sucks and you die.

(As an aside, socialized medicine may even prevent longer lives because there is no financial incentive to come up with radical new methods of prolonging life.)

Posted by nightjar | October 29, 2007 5:56 PM

"If Britain would allow those kinds of market forces to work in its health industry rather than impose the kind of top-down government management that NHS represents, they might keep that money in Britain. If the US wants to keep from creating its own surgical tourism industry as an export, we should learn this lesson, and quickly. (via Memeorandum)"

A single payer system is not a top down government run health care system like the Brit's have. Dems are not calling for a Canadian or British system.

How does the 70,000 affluent Brits who go the Health tourist route compare to 34 million US citizens without health insurance. Not to mention the 500,000 {via AARP] American health tourists who go abroad each year because of lower prices for health care.

Posted by dave | October 29, 2007 6:28 PM

Fred Evil:
“Don't the doctors who prescribe the drugs find out about them through published research and documentation?”

There’s way too many drugs out there for every indication, many of which are nearly the same. Many times it comes down to who has a better sales force. I don’t know the stats, but a huge percentage of a pharma budget is sales and marketing. It’s silly. I never understood the concept of thinking that competition produces innovation. To me it produces redundancy. Everyone ends up making essentially the same thing, then you have to spend a fortune on sales and marketing to convince people yours is better. Worldwide one trillion dollars is spent on advertising alone. It’s all a waste.


Maybe my theoretical should not have been so detailed. My basic point is that sometimes people have no money and no health care. Sometimes this is not a result of laziness or stupidity, but bad luck and maybe some bad choices. Sometimes these people then get sick and need the type of medical care that you cannot bargain with a doctor or pharma company to get. Therefore, many of these people die. To respond to this situation with a statement like “Sometimes life sucks and you die” to me is very immoral. I don’t think 18,000 people per year die because they are stupid. I think it is because they are not provided health care. You disagree. Fine. Maybe you think it is moral to invade countries because 3,000 people died on 9/11 (invasions which have led to the deaths of hundreds of thousands). I disagree. Six times as many people die *every year* from lack of insurance than died on 9/11, and you say “life sucks”. So how do you respond to someone who responds to the loss of life on 9/11 in the same way, and essentially says “who cares”?

Posted by viking01 | October 29, 2007 6:47 PM

Since beer is a necessity it too should be "free."

There are too many brands out there and many are nearly the same so we may as well blame the breweries. Imagine what gets spent on those Super Bowl ads for beer and it's no wonder a six pack is so expensive nowadays. Breweries should be penalized for pricing it so high and advertising it so much. There should be a National Marxist Beer Fund so people don't have to pay as much as that sneaky rich guy down the street who can get the imported stuff on tap yet his lazy neighbor can only afford domestic lager. It's a true moral drinking dilemma for a bum swilling cost cutter lager when somebody who works harder and is more successful quaffs porter, pale ale or stout.

The answer, of course, is more regulation. Then crowning Al Gore to use his Gulfstream jet and Barley Credits to solve the Global Drinking Initiative where all brews are equal and enjoyment of them, however bad, is compulsory.

Posted by MartyH | October 29, 2007 6:56 PM


You said:

"I never understood the concept of thinking that competition produces innovation. To me it produces redundancy."

And that misunderstanding explains why you are at odds with much of this board.

Even if the only effect of competition is redundancy, that's a net good because it eliminates monopoly pricing power. If Company A announces a cholestorol lowering drug, the price of that drug will decrease once Companies B, C and D release their versions. That redundancy-which is not truly redundant because side effects and efficacy will vary-enables choice which drives prices down.

And because competition drives prices down, it also drives innovation. Company A seeks to protect its future revenue through introduction of new, more effective drugs because the value of its current drugs is always eroding.

Posted by dave | October 29, 2007 8:50 PM

So I spent 95% of my career making me-too drugs so company A with the original would be forced to lower their price 20%. In my world, I would have spent that 95% of my career making unique, novel medications. Maybe I would have been part of a team that made an antibiotic to kill the MRSA Staph infection 10 years ago, and people would not be dying from it today. But I guess it's better for me to repeat what everyone else has done in order to drive prices down.

We could cut drug prices by half if we did not have to advertise them and pay people to sell our version over the other guys. This would lower costs much more than any price pressure. I guess I don't understand.

Posted by Fred Evil | October 30, 2007 12:20 AM

It sounds to me like the process for informing doctors about medications is a shambles. Why in the world, would anyone want a salesperson when it comes to buying drugs? What can the salesperson introduce that is beneficial? A cozy relationship, that he can use to pressure the doctor to buy his form of a drug over another? What ethical doctor would make such a choice based on the sales reps personality, as opposed to the medical benefits/detriments of the chosen remedy?

And yes, there is much to be said for competition, it usually leads to lower prices, better products etc. Unfortunately, the medical system is not always conducive to competition, or choice. When it's time for someone to get a tracheotomy, nobody should be blithering about which hospital to use, or which doctor, you use the one that's closest, and you pray. For elective surgery, you have more choice, but very often doctors aren't accepting new patients, or you have to wait a month for a specialist, or they don't take your insurance. So the question of choice is really up in the air, we may have choice, but it's not easy, and it certainly isn't complete.

And I'm one of the lucky ones who has insurance. Although I've had to change insurers 5 times in as many years, what with my company changing insurers, my wife's company changing insurers, and her company deciding it won't offer insurance to spouses who can get insurance through their own company, regardless of the quality of that insurance. So now we're forced to have seperate insurers, different coverage, different doctors (different plans), and I have to fill out pre-existing condition worksheets every year. Just to have my insurance company turn something down because they felt like it. And good luck arguing with them, it's not their credit rating torm to crap while you try and get them to pay for your appendectomy, because you had it out of state, and out of plan.

Yeah, health insurance is your own problem. But if someone rips off your stereo, Officer Jack will hunt them down, and put them in jail.

Why is your stereo more important than my cancer?

Posted by Michael | October 30, 2007 2:21 AM


It is called Rule of Law. Rule of Law is more important to the general population than your individual cancer.

Your analogy fails because it is absurd.

Cancer treatment does little good if a thugs are running people out of homes onto the street, into the bushes with no food to eat or shelter or clothing. Thus we have police to enforce Rule of Law.

Geesh, people are going nuts faux "what-if" scenarios and bad analogies.

You do not respond to important issues with hysteria and political fear. The competition of ideas in how to best address healthcare issues is important, but lets try to keep perspective. If your Doctor who performs surgery on you is shot by some criminal stealing his stereo, then it does little good to have any funding at all.

Remember, it is the intellectual class that first flees chaotic places for safety and stability.

Finally, you should not be absolved of paying fairly for your healthcare. Nor should incentive be given to people like you to not pay up front for coverage. And the burden of your individually made bad choices in life should not be shoved off on me or anyone else.

Whereas criminals and unenforced laws lead to chaos and fall of society. Your individual choices lead to individual loss. I should not be forced, mandated to pay for bad decisions by a person that can resonsibly pay for healthcare coverage. I should not have to subsidize your car, house, satellite TV coverage, etc., etc., while you decide NOT to pay for healthcare insurance.

The Federal Government was never agreed upon, setup, nor intended to be a socialist regime playing nanny, nanny to everyone, putting diapers on you.

As to Dave.... if you define Life as stated by our Founding Fathers with such reverence, then lets save the lives of babies first, the ones who have no one advocating for them to live.

Oh, hold it, that is individual "choice" to murder a baby or birth it into Life and I have no right to interfere on the babies behalf, right?

What utter hypocrites.

Posted by Michael | October 30, 2007 3:19 AM

Oh yes, I so want our system to be like Englands. But what is England? Is it Scotland?


"PATIENTS will soon only have to wait a maximum of 30 weeks from seeing their GP to undergoing surgery, under a new pledge by Health Minister Nicola Sturgeon."

Ohhh goody! NHS, we need one in America!

"The deputy leader of the SNP told delegates at the party's conference in Aviemore yesterday that the reduction will apply across the country from March 2009, reducing the current waiting limit by six weeks."

Wow, from 36 weeks to 30 weeks by March 2009. I'm so there, moving there. Granny might die before she gets her pacemaker, but at least we know that NHS is trying.

"Ministers say they are still working towards a maximum wait of 18 weeks by 2011, and the new target will be a key milestone on the road to meeting it."

4 months and two weeks... by 2011!!!! wooohooo! In time for the Olymipics!

Boy, socialized medicine works!

Reality - my Grandmother was diagnosed for a pacemaker within 2 days of seeing a GP, and was in the surgery room the following week.

This is America. We paid a $300 Insurance supplemental. Whatever problems we have, they're no where near the issues of England. Notice that they will have to increase funding to establish their goals.

Note the headlines on the right side...

345 deaths attributed to "mismanagement and appalling hygiene standards."

The NHS system is in disarray, to few staff, etc., etc., and the list goes on.

We need to be careful and not allow the fear mongoring of the left to goad us into some large overwhelming healthcare system that is mismanged by our own government. Note how the blame for these deaths is put onto "targets" of UKs NHS.

People there are saying go to Singapore. Geesh!

Finally, healthcare staff are being attacked, numbers are up...

One person in the comments section solution? Now gee, what would someone in a secular socialist society say? "Mandatory sterilization of anti-social" people.

Go figure, always the solution. "cull" the herd of chattle and sheeple. What great brains they have. Darinian land and eugenics to the rescue.

Oh my, more socialized "efficiency" for Daves world....

This is not healthcare, this is tomfoolery, its Monty Python sketch gone MAD. A man with a fractured hip was not diagnosed for 15 days. He ultimately died of kidney failure. So why didn't the socialized healtchcare save him? Forget the hip, why was a donor not found, or what happened to the wonderful medical care?

The hip fracture is total incompetence. But the fact that he died from kidney failure shows that no system can save you at times. I'm not trying to put the blame on their healthcare system for that, although, who knows after missing a hip fracture?

Finally, the SCHIP program is already allotted to cover children and upwards to 200% above the original. And yet now, there are some here advocating universal health care.

What happens is the poor then get saddled with terrible healthcare. Because ultimately, the government cannot regulate itself.

These articles posted at Scotsman.com should be a warning for all of us.

Posted by dave | October 30, 2007 8:44 AM

You brought up waiting times. The same issue brought up by NoDonkey above about infection rates is true for waiting times. "There is no systemized collection of data on wait times in the U.S.":


As with hospital infection rates, you cannot make comparisons between countries when one country fails to keep track of their data. The same argument holds true, then, with waiting times as with infection rates: if the US waiting times are so short, why are we so reluctant to keep data on it? Wouldn't we want to advertise our superiority? Anyway, read the article above about wait times, it is very enlilghtening.They had this to say:

"In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems."

There is one area where the US did come in first:

"The Commonwealth study did find one area where the U.S. was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close."

That's impressive. But maybe it's my source. Business Week is just a Progressive rag, right?

Then you show an article mentioning 345 deaths due to infection, If you look at my "infection control today" link above, you'll see that 90,000 people a year die from hospital infections in the US (from a total of 2 million infections). The way to make a point is not to point at one problem in another country, and then say ours is better. You actually have to make a DIRECT comparison. So what about the UK? I find that:

"The National Audit Office estimates there are 300,000 cases a year of hospital-acquired infections, including C.diff and MRSA, and at least 5,000 deaths."


90,000 deaths in the US, 5,000 deaths in the UK. After correcting for population, the US death rate from hospital acquired infections is still over 3 times higher in the US than the UK. See what happens when you make a DIRECT comparison?

You also bring up an anectodal article. Typical. Find me an article or study that makes a direct comprehensive comparison between the US and several socialized systems where the US comes out on top. That is your quest.

We have the same pattern in this thread as in every health care related thread at CQ. One issue after another is brought up, I immediately show the issue to be BS (nobody has mentioned medical tourism on this thread in a while), so the subject gets changed. One by one I show that each change of subject is also BS, so the discussion turns into "universal health care sucks". That's all you can really come up with. There is no data to support your general statements, and there are mountains of data to support the opposite. But just keep repeating your mantras and ignoring data, you're good at it.

Posted by dave | October 30, 2007 9:31 AM

"People there are saying go to Singapore. Geesh!"

I could not find a number for Singapore, but 55,000 people from the US were patients at a single hospital in Thailand:



Posted by danforth | October 30, 2007 10:02 AM

dave is for socialism/national healthcare. his arguments parrot the hillarycare he hopes for. i doubt he works for the pharm industry. sounds good but that's how the dems debate things. fake but true...

Posted by dave | October 30, 2007 10:13 AM

Good rebuttal. I've changd my mind after reading your well thought out arguments. I am now in favor of keeping our health care system as is. Damn those facts!

Posted by Fred Evil | October 30, 2007 10:55 AM

Michael - I disagree, keeping the workforce healthy as a whole, is a societal goal, our GDP depends on everyone being available to work (I know, very commie of me, but it's also true).

"You do not respond to important issues with hysteria and political fear"

Are you sure you're a Republican?

You don't buy a burgler alarm, or put up a fence, or bars on your windows, and your robbery is not my problem. If you don't take reasonable steps to protect yourself, why should I be concerned? That's the analogy you're pushing, it's ludicrous, and you should know it. If you are not taking sufficient measures to protect your stereo, why is it MY problem that yours got stolen? For that matter, why should I care if you get shot in the process? After all, a bullet, cancer, they're both pretty lethal, but you choose to take action only when a bullet is involved? What about genetic diseases? Not the sick persons fault, they could do nothing about it. Communicable diseases? Everyone gets them, whether they're a health nut or not, but since they didn't take care of themselves, screw 'em, huh? Wow, you must be fun at parties.

Rule of Law is more important than healthcare? Interesting position, but not valid in my eyes. Not everyone ends up involved in the 'Rule of Law' but EVERYONE ends up in healthcare. Who pays for the homeless and uninsured who are cared for now? You and I do. Do they get good care, enough so it keeps them from weighing down the system? Many studies say no. In fact, there are programs in place that give a homeless person a home, simply to keep them off the streets. And whether you believe it or not, they are finding it MORE cost effective to give them free room and board. Why? Because they aren't care-seeking to stay out of the cold, they aren't getting constantly sick from the exposure. Healthcare is EXPENSIVE, and whether you like it or not, their costs of care are already being passed on to you. The process of basic universal healthcare (NOT Hillarycare, very different, and I am NOT in favor of HillaryCare, where people are forced to pick insurance, I want to do away with insurance companies entirely), Univ Health is actually better for hospitals, because they don't end up with millions of dollars of unpaid debts, which they then pass on to the insurance companies, and the little guy(you and me).

In reality, we already have Universal Health, hospitals cannot turn away someone who is in an emergency situation. True Univ Healthcare gets a handle on things, and makes sure those who provide assistance, get paid for it somehow. Not only that, but it may get folks through the door when it's still easy and inexpensive to fix, instead of waiting until it's a life or death emergency, and will cost piles of money to fix (which won't get paid back anyway, because they're broke or homeless).

You can quote all the horror stories about 'socialized' medicine you want, if we were to start posting links to everyone screwed by OUR medical system the server would overload. Sure other systems have flaws, but they're being addressed. Our present system's flaws are NOT, primarily thanks to folks like you. Folks for whom the status quo is good enough. Every system has flaws, but our present system is beyond flawed, it is broken, it is letting down the citizens of our country, and it's costing you and ME more than it has to.

They may have to wait in Scotland, but at least no one is pushed into bankruptcy to live(and
therefore unable to buy a stereo to have it stolen so they can get free government cheese!)

Posted by danforth | October 30, 2007 12:01 PM

you can tell the quality of ed's blog by the quantity of lefty lib comments and opposition to what he writes. other websites aren't monitored so closely by trolls. good work captain!

Posted by Fred Evil | October 30, 2007 12:32 PM

danforth - Have anything useful to conribute other than snide comments and ignorant rhetoric? I thought not.

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