As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to bring in advantages of doing things in volume + some health insurance based innovations into the whole equation. And I do agree that he is pragmatically altruistic. But such people are exceedingly rare. We are simply fortunate to have him.
I've never been to US, but I can tell you the Indian health care system is if not less is equally greedy compared to their US counterparts. Its just the same.
These days if you don't have health insurance you are more or less screwed. Its just like the US. I mean from whatever I've read about US so far its the very same. Nothing changes. You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day.
Coming to our system. Forget greed, fraud in the system is so massively high nothing that I write here will explain it. It is extremely common for doctors to order lab tests wholesale even if they are dead sure the patient has no problems at all. Doctors get commissions from testing labs/pharmacies etc for ordering lab tests, medicines. Treatment is purposefully prolonged, patients made to eat all kinds of antibiotics, undergo all sorts of non sense tests because doctors get commissions for it.
The fees for completing your medical course is astronomically high. Capitation fee often runs in crores, the net fee by the time you finish your MD is so high no doubt most doctors have to practically turn into crooks to get something out of it. Add to this nearly more than a decade of studies sets a perfect stage for these sort of activities to happen.
Its just the same old game, as you see in US. Just served differently.
I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo.
Let's not even get started on the Korean Won...
Simply not true. Compare the cost of a beer in, say, Thailand and Norway. Are you suggesting if the exchange rate were fixed they would reach parity over time?
The Big Mac index is better for many reasons, one being Mcdonalds is large enough to mostly optimize everything wherever they operate:
Sometimes the economics do conveniently work out this way, which is why some people might get confused. For example I lived in Poland for a few years, and at the time a dollar got you about three zloty, and for the majority of day-to-day stuff you did indeed have about 3x the buying power. Of course for things like computers you ironically had about 1/3 the buying power.
So in this case 60x is a reasonable assumption except not including the Purchasing Power Parity.
Zimbabwe is printing trillion-dollar bills, so everybody there must be rich....
Why is this relevant?
I have worked in both types of systems and can see merits and pitfalls in both.
In the former system there can woeful output whilst in the latter there can be woeful quality.
Neither of these are inevitable.
In a salary system, if the lazy/incompetent can 'get away with it' and the industrious/competent aren't acknowledged it has a poisonous effect on the organisation.
In a fee per item system the lazy will earn less automatically but there needs to be careful monitoring of the quality of the output with particular attention paid to people at either tail of the output distribution. Also people with high output (because of poor quality) can drive down wages for everyone and create a treadmill where the quality of everyones' work suffers as they try to maintain their income.
I've thought about this a lot, and I don't think there is any objective way to provide outcome-based incentives. The best I could think of is peer-reviewed judgements of outcomes, but that could become pretty corrupt.
More on point, fee-for-service incentivizes unnecessary and expensive diagnostic tests. Let’s say a patient presents with an uncomplicated broken arm. If there’s a set payment for an outcome (successful treatment of the break, with fully restored function), and diagnostic and treatments costs come out of that fee, the incentive is to order as many x-rays as are necessary to successfully treat the injury and no more. In fee-for-service, the orthopedist has no incentive not to order superfluous imaging because it doesn’t cost her anything, and may have incentive to order extra imaging (if, say, she also owns the imaging center that bills for it).
Medicine is littered with examples where there are two tests whose diagnostic power is statistically equivalent, and yet doctors common write for the more expensive test. Fee-for-service is either a neutral or perverse incentive in these cases. Fee-for-outcome aligns the incentive with what society seems to want (lower-cost healthcare with good outcomes).
When I write a contract, there are often two prices: a minimum which is stingy and a bonus which is far from it.
The point is to say that if you do the minimum for this contract, you get a certain amount; if you excel, you get paid for that excellence.
Translated to health care, I think I'd like to see doctors doing less paperwork and more doctoring. It's not perfect, but I trust competition to pay that excellence price to those who deserve it.
That in turn means that if I need some kind of crucial care, I know where it can be found. If the system is over-regulated, that is not so.
We recently had a baby (in Aus). Our Indian neighbour (been in au for 7 years) was amazed at how little medical intervention we had. His comment was that in India there was much more incentive to recommend drugs, c-sections, etc.
Get one and be safe, one serious illness can bankrupt you these days(actually it always has). But my point is even a week of hospitalization can be pretty expensive. And don't be under an impression you will be able to travel to Bihar or wherever when the need arises. During cases of emergency those are not practical solutions.
I am not too sure about that. I think medical insurance hasn't yet become all pervasive in India, and thankfully so.
Insurance companies are there to make profit, and so will tend to exploit fear to maximize their profits. Leading to inflated costs, as it has happened in US.
So I am against insurance in this form, unless it works like a non-profit cooperative. In fact Dr. Devi Shetty has also innovated here, with a scheme which costs as little as Re. 5 per month (1/60 USD per month) and provides heart coverage to rural Indians. It works as a cooperative scheme of course.
I am surprised, Insurance companies, even exist. As they should be the first thing to be replaced by Software (as in 'Software eating the world' by Marc Andressen)... It should happen, will just take some time, I guess.
So, I think, India can still save itself from corporate medical insurance. As seen in some countries like Canada, a fully public health care system, works as good, if not better.
On a personal note, after having, earlier, taken medical insurance for me and family by paying some 9000/- Rs per annum and getting a cover of 300000/- Rs. I decided this year to not renew it.
But of course, I won't dare to prescribe it generally, each person must take his own decision.
Appendix: 1) http://arachnoid.com/wrong/index.html (ctrl-f 'Insurance is a wise investment')
I'm assuming the the HN-India audience can hustle Rs500k. My two cents is that you shouldn't sweat it in India if you don't have health insurance.
However, if you get something like cancer in India, not insurance policy will help: the cost of treatment is just too high. You will go bankrupt.
Its NOT the same. High costs in the US are essentially a result of policy corruption - a systemic issue with results in the exorbitant prices. Greed amongst doctors is prevalent in India as well as the US - maybe more prevalent in India due to general poverty. But health care in India is more 'free-market' than in the US, which is why it is more efficient.
>>I've never been to US, but I can tell you the Indian health care system is if not less is equally greedy compared to their US counterparts. Its just the same.
I have been to the US and I have spent a huge time in India. I have witnessed the Indian health system in close quarters and have close family members undergone major surgeries. There is greed in India, no doubt about it. But the American system is completely EFFED up - there is no comparison. If you go to the US and spend some time understanding/experiencing the system, you will be thankful for what you have in India.
>>These days if you don't have health insurance you are more or less screwed. Its just like the US. I mean from whatever I've read about US so far its the very same. Nothing changes. You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day.
You are completely wrong about this only because you don't know what happens in the US if you dont have insurance. My close family members have undergone major heart surgery at Narayanan Hrudyalaya. They had insurance, but even if the insurance did not cover it, it was not a big deal. I could have easily paid from my own pocket - it cost just over $2K USD - not a big amount for middle class Indians for life threatening surgery. All the prices are transparent - so if you dont want to pay as much you can choose cheaper options (shared post-op bedding etc.) which will reduce prices in half - with very little difference in medical care.
In the US if you dont have insurance for something like this - you will go bankrupt. The only reason you don't know about this is because most of your NRI friends work for bigger tech companies which provide good coverage.
Infact one of the reasons why health care is reasonable in India is because insurance coverage is limited and not mandated by law. The resulting free market delivers the economies quoted in this article.
>>Coming to our system. Forget greed, fraud in the system is so massively high nothing that I write here will explain it.
No it is NOT. There is a tendency in Indians to think that they are completely fucked up. Travel around the world - especially to the US and you will thank your stars - and please dont go with what NRI's say - they have a vested interest.
It is true that there is greed in the system and there is fraud - but there is a relatively freer market. You can 'choose' your doctors/hospitals. If you dont have a good experience with a hospital you can choose to write a review on Mouthshut.com and have them get less business. You can do your research and choose a better doctor/hospital over a worse one. This 'choice' and the enabling free market makes India health care deliver economies at scale which are impossible in the American system.
>>The fees for completing your medical course is astronomically high. Capitation fee often runs in crores, the net fee by the time you finish your MD is so high no doubt most doctors have to practically turn into crooks to get something out of it. Add to this nearly more than a decade of studies sets a perfect stage for these sort of activities to happen.
Assuming that this does turn them into 'crooks', they have an easy way to get their money 'out' - migrate to the US/UK after completing their residency. Some doctors are greedy, some are good. The greedy ones land up outside India as much if not less than inside.
You could have, sure easily! Besides a person who has traveled to US doesn't fall under middle class category anymore. Sorry you don't. In a country where kids die of hunger and where parts of the country manage to barely eat two rotis a day with salt- traveling and working in the US is a rich man's luxury.
Sorry to be putting it this bluntly, but in India anybody apart from Mukesh Ambani thinks he belongs to the middle class.
Most people(The middle class- People who make around 10/15K rupees a month) can't pay for expensive medical treatments, medication, post-op follow ups etc and that's a fact.
>> If you dont have a good experience with a hospital you can choose to write a review on Mouthshut.com and have them get less business.
Yeah right. I find it hilarious when techies offer solutions like these to common people who don't even know how to turn on a computer.
Mouthshut.com was just an example to demonstrate what it means to have a free market. My cook obviously can't access it - but he will ask me and his relatives on which doctor/hospital is good/cheap. He faces greater infomation assymetry - but the fundamental advantages of a free'r market still accrue.
Well, the article says 2/3 of people live on $2/day, implying this surgery is $1600/$2/day = 800 days worth of work.
Taking the US median income of $45k (since I don't know the 2/3 number off the top of my head), that implies the equivalent price in the US would be ($45k/365) * 800 = $98,630. So, right about the same as at the Cleveland Clinic.
Per-capita income in India is $1492 Per-capita income in the USA is $49,922
So, it's around 1583/1492 = 1.06 years of work in India. And, 106385/49922 = 2.13 years of work in the USA.
And since the hospital price is actually 95k Indian rupees, exchange-rate fluctuations do not matter.
Chronically ill patients can still seek treatment, they may or may not be able to afford it though.
In general?
http://blogs.worldbank.org/developmenttalk/shocking-facts-ab...
> It’s also pretty staggering that hiring qualified staff doesn’t appear to increase this probability. Das and colleagues suggest that part of the issue might be the variation in the quality of instruction in Indian medical training institutions. So there may be some institutions from which a qualification does make a difference. But given the paper’s results, the effect of such institutions must be rather small. The fact that providers working in better equipped facilities don’t have a higher probability of prescribing the right treatment is also alarming.
Obviously, heart surgery isn't rocket science, and our medical training is a bit overpriced, but is it so easy to compare two disjoint systems?
In any case, there is a difference between the general level of competency of doctors in a given country, and the level of competency available to wealthy foreigners travelling to the country for medical tourism.
There's something seriously wrong with both the healthcare system and the education system in US if the prices are 20x+ more than in any other country.
Careful here. I live in London for several years now, and from my experience Eastern European doctors are much better qualified then Western European. I'm originally from Poland, and medical studies are really hard, and people spend whole 6 years cramming just to become an apprentice to the doctor (it's Bachelors and Masters degree combined). On the other hand in western countries you can do undergrad degree in anything and only then apply to med school.
This was a few years ago though, from what I've seen the costs for eye lasering here seem to be catching up a little.
Frankly I'm a bit surprised by all the people in this thread saying "well that's a huge price difference, but how do you know Indian doctors are as good as US doctors"--as good? On what basis is the default assumption that US doctors would be better and the Indian ones need to prove themselves? All I know of the US healthcare system is that it's ridiculously overpriced, but just like that $8 bowl of ramen (wat) someone mentioned upthread, doesn't mean it's better, it might even be worse.
This isn't quite right. If you want access to anything but a fly-by-night medical school, they're wanting hard science and most likely a focus in biology.
The difference between these two ends is incredible. While I can imagine these results at the latter, I find them hard to believe at the former. I'm paywalled away from this for the next two weeks, so if you want the facts, that's where I'd look: what sort of private healthcare.
Edit: To illustrate, another commenter has a link to an news story that says mortality is lower after the Indian procedure - http://m.theaustralian.com.au/archive/business-old/the-henry...
Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense...
Is that connected to the extra funding that older people get?
What happens if we compare mortality in people under 65?
Do centres that do more surgery have better outcomes? The answer to this is already a resounding yes. There isn't any doubt about that, it's been shown over and over again for multiple different surgeries within developed countries. Surgeons knows this, and so do health insurance companies. But of course this has to be asymptotic. Doing 1000000 CABGs doesn't make you 1000 times better than the surgeon that does 1000. So I doubt there is any real difference between the surgical skill in Shetty's centre and top institutions in the US. It's an untestable question in any case. The important point is that the care overall seems grossly non-inferior to the US, not that the US is inferior.
The problem is they would become proficient at treating the wrong things. Medical conditions vary greatly by geography. Polio is still alive in the third world, Russia is fighting drug resistant TB, and up thread there is a mention of a surgery performed at a 1000x rate in India compared to the US(Once a decade vs once a day). All the while what affects Americans would be glossed over because it doesn't infect the rest of the world at the same rates.
Also, the 16 hour/day rule is only for interns, IIRC. Resident shifts can go up to 30(?) hours.
As a Indian (who comes from relatively simple background), I don't need a study to tell me that general/govt. hospitals that provide PHC are overcrowded, lack necessary support staff, lack necessary equipment.
What the bloomberg article is talking about is, another class of hospitals and medical staff. Narayan Hridayala, Fortis etc employ pretty good doctors.
I doubt that, any general statement can be made about - "doctors trained in India are less qualified than US", because it depends on lot of factors.
EDIT: Added "may be?"
Within the US, the cost of heart surgery is highly variable, but if I were to go international, i would go south/central America over India any dry.
Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of satisfaction is incredibly low.
This is why "healthcare tourism" exists and is dominated by American patients.
Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by Americans includes the ability to identify & access those pockets of excellence; those areas in general may not enjoy such inexpensive quality as the norm, nor have easy access to excellent outliers.
BTW: Americans (I speak as one) are a chronically dissatisfied bunch. Having remarkable access to excellence in all things, we bitch & moan about how it isn't oh so slightly better. Yeah we complain about the cost of healthcare, and at the same time demand the absolute very best, quick to sue the pants off any doctor whose work fails perfection standards by any statistically normal degree when something could have been done better regardless of extreme cost. I suggest caring little about opinion polls where objective statistics are available.
There is no evidence that this is the case. Note that the vast majority of the cost is due to the massive complexity of the system: every party involved - and there are many - wants their cut, and they don't necessarily contribute to the well-being of the patient or the efficiency of the process.
if you had an operation with a 10% chance of failure for $5000, would you take it?
What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer.
what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your life.
what if you could cut it down to 4.75% for $100000? Don't you deserve the best? I mean this is your LIFE. In anything else this would be a silly investment, but your life? You can't take chances. It's a bizzare choice, but really the only rational one in your situation, you have to survive.
So the thinking goes, we are incapable of negotiating for our own lives. To the point where it blinds us, by choosing that expense you doom the ones who can not afford it.
What free market are you talking about? Medicare effectively controls the prices of medical procedures (since insurance companies reimburse non-Medicare recipients on the basis of tables the government puts out). It also controls the number of doctors (it does this by limiting the number of residency slots - see the Balanced Budget Act of 1997). The FDA regulates everything from the development and testing to packaging and marketing of drugs, medical devices and related products. Due to federal regulations, physicians are not permitted to discuss prices with one another. There are countless regulations that manipulate health insurance. And don't forget the 1943 IRS ruling that permanently established the link between health insurance and your employer.
And this is all stuff that's mostly decades before Obamacare. That just scratches the surface. For example, I didn't even mention HMOs, which were created under Nixon via another set of regulations intended to control costs for things Johnson had done.
A free market in health care? If there's one thing American health care has not had in the last 50 years, it's a free market. Sure, it has been slightly freer than in other countries, but that's not saying much.
Do I?
Elsewhere in this thread is a post about a surgeon greatly improving the lives of those who cannot afford it by buying a used laparoscopic tool and creatively applying it. I've had laparoscopic surgery; thanks to the high price I & others pay, the laparoscopic instruments used may have replaced the very same one that Indian doctor is using. Far from "dooming the ones who cannot afford it", the system which regularly replaces top-end tools makes entirely acceptable equipment very affordable to regions which can't pay top-end prices.
Disallow me from paying an extra $50,000 to get that extra 0.75% survival odds, and the surgeon very well may not buy that next-generation laparoscopic tool and, as a consequence, sell the still-perfectly-good used one at low cost ... making it possible for another doctor to increase the survival rate for his patients by 5%.
The healthcare market cannot chose to capture deadweight losses. People would view health care professionals treating rich and poor with different medical standards as an abomination. There is no Healthcare basic edition, Home basic, Home premium, Professional, Ultimate. If you raise the general cost of a heart surgery from $50K to $55K, and lower the mortatilty rate from 5% to 4.5%. Does the amount of people you save with that 0.5% worth the amount of people who can't make it to 55K, but could make it to 50K?
Are you sure these numbers are in your favor? Well, I mean, yes of course they're in your favor, I mean everyone, as a whole.
Yes, your very life is subject to the costs of diminishing returns. We can't guarantee everyone the very best because it costs too much, and we can't force people to spend less on their life than they can afford and choose to spend because it's not yours to distribute. Tough choices aren't easy.
I'm glad you're well. How much would it be worth if you'd had to sell your house and/or declare bankruptcy, while knowing that similar-quality treatment was available for 1/20th the price in India and elsewhere?
Not just being snarky. Since leaving corporate America (and the healthcare plan) to start my own thing, I think about healthcare costs a lot. For starters, the lack of transparency or price-competitive marketplace, for such an expensive purchase, is mind-blowing.
Yes, health care costs a lot. Miracles are expensive.
Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't care how much it costs. You don't shop around. This enables doctors and hospitals to charge more. American healthcare is very cost efficient where the care is not covered by insurance, for example plastic surgery, lasik etc.
Your stated areas where american healthcare is efficient are optional, cosmetic surgey, lasik etc...
Not to say insurance doesnt play a part, just saying you havent presented a solid logical arguement.
It's also worth noting that healthcare costs in most of the developed world, while lower than the US system, continue to increase substantially.
However, what you are saying raises the question of how on earth a system can be constructed where people shop around for health care.
Any ideas?
In reality I think many healthcare entrepreneurs either get caught in the existing framework (and dependent on it), or find the regulatory and other hurdles too hard here.
That said, I still think there is a LOT of room to improve cost efficiency here, and the right entrepreneur could do it. It's been done in other stagnant segments of the economy... I would like to see an Elon Musk-type entrepreneur open efficient hospitals here like this guy is doing in India.
The opportunity is in helping Americans get real healthcare outside their borders. Take a glance Uber's way. You'll know you've got it right when there's serious talk about making it illegal to travel abroad to obtain medical care. For the safety of the people and the necessary good of the lowly American doctors, of course.
This sounds like a terrible law. Where can I look for more information on this?
That excess capacity tends to be filled up with old and poor people on government health programs, and people needlessly hospitalized are likely to get more sick as a direct result of their unnecessary hospitalizations.
Top it off with his worst payers were not the insurance companies but government based.
Government regulation, from deciding what insurance must cover for all people to not being able to shop across state lines was very much responsible for the rapid increase in healthcare. It didn't help much when we got sold out by Washington under the guise of Affordable Care to the drug, insurance, and hospital, companies. ACA was payoff for campaign contributions, that is why no one read the damn bill.
I'm not sure if you've heard the story but there is an American inventor by the name of Thomas Shaw. He invented the first safe, retractable syringe that was more reliable than any existing solution. Companies tried copying his design and managed only to produce sub-par copies, it's an interesting read. http://www.washingtonmonthly.com/features/2010/1007.blake.ht...
Perhaps you are correct, but I doubt this assertion. U.S. graduate schools are generally the best in the world, I am not sure why that should be any different for medical schools
That's what we should be asking IMO.
Liability might be a problem, but it only accounts for 2% of medical expenditures in the US, so I wouldn't expect it to be insurmountably difficult to insure the procedures to "US standards."
This might be objectively true (which you could reasonably determine through some combination of standardize testing and surgery complications/outcomes), but if you ask 100 people on the street in US whether they would prefer to see a US MD or an Indian MD for their heart surgery, I bet 97 or higher would prefer the US MD. The tiny remainder would probably show no preference.
Their is a brand power of a US medical education, which is especially strong for US patients.
I am not sure it is true anymore. If you compare cost of living in a good infrastructure or similar lifestyle you will find India is expensive. I am sure many will disagree but just go ahead and look at cost of decent housing in any Indian metro. We too have crap doctors in India like anywhere else, may be they don't sound too expensive when you go by USD conversion.
... and even a few years of college tuition or a small mortgage ...
First off, this article is comparing the cheapest clinic in India, with the most expensive and most revered Heart center (Cleveland Clinic) in the world. NH is basically like getting your heart surgery done at a non air conditioned WalMart. There are no patient rooms. There is a patient room. A giant room with beds lined up civil war style. The food is akin to gruel, ETC... Of course there is going to be a significant cost difference. This is like comparing staying at a Hostile and getting dinner in the soup line with Staying a night at the Hilton and ordering a New York steak dinner for room service, of course there is going to be a significant cost difference. Leave it to a reporter to compare the cheapest abroad to the most expensive here (a bit of stretching to make the store line a bit more catchy).
Second, the reported cost is false. "NH maintains its costs low, savings that are then transferred to the patient. NH's cost of open heart surgery is USD $2,000. The hospital charges $2,400 to the patient, compared to $5,500 charged at an average private hospital in India." http://healthmarketinnovations.org/program/narayana-hrudayal...
Third, the per capita income in India is $1,000 nominal dollars, in the U.S., it's $50,000.
So the average adjusted open heart surgery in India is actually $275,000 when converting to USD and comparing using the average per capita income. (Narayana Hrudayalaya's "discounted hospitals" only charge $120,000)
I know that the average income does not fairly reflect the true cost differential because India has a disproportionately large population of people living in abject poverty. It does make the cost difference margin quite a bit less though.
If you are wondering just how places in countries like this can operate more cheaply though? I will tell you. US laws. In America the law states that hospitals have to care for anyone even non citizens. It also puts stringent regulations on hospitals. Regulations that do not exist in India. These Regulations are very expensive to comply with.
Narayana Hrudayalaya's establishments are not hospitals, they are not for emergency care. They do not treat non-paying clientele. In America, our medical costs balloon out of control for many reasons, one of the larger ones being the care of non-paying patients. Emergency rooms and therefore hospitals cannot turn away patients for any reason. They must admit illegals and uninsured (even for long term care). They cannot recoup money from these individuals so the paying customers get to flip the bill so the hospital can remain in business.
Just try going to an emergency room in India as an illegal alien. You will be promptly jailed and deported. Try going without insurance or means of payment... Good luck with that (same MO as all these countries where these "cheap procedures" can be had)
There are some countries where these procedures are still cheaper than in the US and they cannot legally turn away illegals and uninsured. They have a slightly different formula. The government flips the bill (subsidizes the hospitals) thus allowing them to compete cheaply (which keeps the costs low).
It's comparisons like these that really make you sick to your stomach. You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start. The lobbyist super groups, hospitals being paid kickbacks for using an exclusive medical equipment provider, the money hungry mentality of US medical corporations is more than obvious.
I think when your medical system becomes so expensive it's cheaper for people to fly out of the country, pay for accommodation and even some spending money to get the same level of care, if not higher than that of your own country, regardless of cost of living differences and other nation specific costs that's absolutely ridiculous. By the sounds of it, India is going to be the new global superpower if more and more people fly there to pay for medical treatment it benefits their economy in the end (given how a substantial chunk of the population is below the poverty line, this might not be such a bad thing).
A doctor trained in India is no less qualified than a doctor trained in the US. So expertise or training is no excuse either. In-fact I've found Indian trained specialists to be more thorough, careful, understanding and compassionate in comparison to that of Australian trained medical professionals (I'm from Australia). When was the last time you saw or heard of a poor American medical specialist or surgeon?
The question is: Will America ever change their ways? Or will quality medical care only be reserved for those who can afford decent medical insurance or have jobs that provide fair medical benefits?
One thing is for certain, this is submission is going to garner a lot of responses from both sides of the fence if past submissions along these lines are anything to go by.