
A Mexican Hospital, an American Surgeon, and a $5k Check - hvo
https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html
======
MrLeap
This is the most absurd escalation I've read regarding the US healthcare
system. What a laugh.

Since it's this bad, it alludes to vast untapped potential for more cost
saving measures that are both funny and embarrassing.

A quick google suggests prisoners have to pay 10-100$ copays in some states,
but otherwise receive care. I wonder if there's a topology of illnesses where
a financially optimal course of action to acquire treatment is to commit some
petty crime and receiving treatment in prison? After lost wages, and earnings
potential from your now tainted record, and all else. There might be!

Here's a business idea that might already exist, vocational-technical
elementary / pre-school for trying to lead your own children into and through
medschool. Doctors are so expensive you might as well make your own!

That one baby saving medicine that just got approved costs like 2 million
dollars, right? For anything ~ 200k+ that isn't literally holding your baby
hostage from imminent death, it's probably cheaper to get a degree in
chemistry and some lab equipment.

[https://www.vice.com/en_us/article/43pngb/how-to-make-
your-o...](https://www.vice.com/en_us/article/43pngb/how-to-make-your-own-
medicine-four-thieves-vinegar-collective)

It's crazy, but only in a crazy system can things like this approach rational.

Here's another idea. What if patients could rent hospital administration as a
service. Put payment for a procedure in escrow, sign all the malpractice
waivers and try to attract a doctor like tinder. I'll sign all malpractice
waivers if you'll just cut this cancer out of my gut. We can use my living
room! It's this or death anyways so fuck it! America WOO

~~~
gambiting
Americans need to raze their healthcare system down to the ground. None of the
bandaid fixes like getting the government to pay but still having private
companies dictating the prices. The whole system has to be torn down and
rebuilt from scratch, with the state the main owner of hospitals and provider
of healthcare. The kind of things that you read about the current system are
just absurd, but it's past the financial absurdity at this point, reading
about insurance companies literally deciding whether cancer treatment is
"strictly necessary" for weeks without approving it is not a healthcare
system, it's hell, it's barbarism.

~~~
clarkmoody
Healthcare has been a political football for decades, with massive
interventions by government up and down the stack of services.

Think about the market's provision of grocery stores: plenty of competition.
Most places they don't enjoy geographic monopolies like car dealerships do.
They manage to get one of the most vital goods to a huge population spread
across a huge area on time and at a great price, with local variations
anticipating the specific desires of local consumers. There is no central
coordinator or Department of Grocery Services. The market figures it out.

How can someone look at healthcare, with its absolutely absurd outcomes, and
not understand that it is precisely because of government interference that
nothing makes any sense? Costs keep rising unsustainably, which is the
opposite of the way markets work. Paperwork and administrative staff balloons
in proportion to patient care.

Once the state gets involved, now it becomes political. Do you think the
current political climate in the US should be further embedded into
healthcare? If the state controlled everything, then you'd get outcomes like
red/blue states losing/gaining funding depending on the results of the most
recent election. One could imagine more dystopian outcomes quite easily.

~~~
erentz
I had to go to the ER yesterday. I was taken to the closest ER. You bring up
geographic monopolies without any irony and yet healthcare has huge and very
obvious geographical monopolies.

At the ER I was made to sign something on the way in in a state in which I
couldn’t really tell what I was signing. I was given various drugs and sent
through a CT scan. I had no idea what was going on. I certainly was in no
position, with symptoms of a life threatening condition on top of being
incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans
can you guys transfer me there!”

Healthcare is entirely different from buying groceries. It does not and will
never operate like a typical market for typical commodity items.

~~~
refurb
Emergency medicine is a small fraction of all medicinal needs.

A lot of medicinal procedures allow time for determining what the most cost
effective offering is.

~~~
lostlogin
But is the ideal system one with several hospitals per city, duplicating
expensive resources or one big centre with centralised resources?

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paulsutter
Why are people so surprised? This is a great story and everyone should do it.
The US system is gridlocked regulatory capture by scammers scamming scammers.
Anything to route around it is a great idea.

In Japan I had no insurance, but my shoulder bothered me so I walked in to see
my doctor the next morning (no appointment, $100), he scheduled an MRI for the
next day ($300), and two days later I paid extra to talk to the
radiologist($75) to see the damage up close. By the time I saw the surgeon the
next week, I already knew I should do physical therapy instead of surgery. In
the US this would have taken many weeks and thousands of dollars.

Meanwhile, back in Seattle, a doctor said "take this paper to the emergency
desk to get a scan". Bad idea, that cost me $5500 and 8 hours of imprisonment.
I couldn't leave after the scan, I waited hours longer for the doctor on duty
to give a diagnosis (for a scan?), and of course she billed me separately for
that.

~~~
com2kid
> In the US this would have taken many weeks and thousands of dollars.

The many weeks part is not true, the $ part is pretty much random and unknown.

Every time I've gotten injured, it has been a next day appointment, or I just
walk into urgent care, and an MRI/Xray scheduled a day or two later.

The imaging clinic my doctor uses provides a complete price sheet before any
services are given, saying exactly:

1\. How much the overall bill is

2\. How much they will be billing and reimbursed from the health insurance
company

3\. What the patient's total will be

> Meanwhile, back in Seattle,

I'm also in Seattle, find a better clinic! (Also ERs are overkill for 99% of
things, sucks if you get injured after Urgent Care hours though...)

~~~
paulsutter
It wasn't an injury. I was at Swedish for a routine checkup and the doctor
handed me a piece of paper and said "take this to the emergency desk, they can
get you a scan". I had no intention of being checked into the ER and no idea I
was about to be imprisoned for 8 hours.

It wasn't a big deal for me to be robbed like that, but for most working
people a surprise unnecessary $5500 bill would be a real problem, so it's
infuriating.

~~~
Reelin
> imprisoned for 8 hours

You mentioned this twice, but unless you left out some _major_ details you
were never actually imprisoned. If you demand to leave it's almost always a
felony to stop you.

~~~
paulsutter
They kept telling me I could not leave. If I knew how long it would take I
would have called my lawyer to confirm, but it was always, “Just 20 more
minutes and the doctor will be here”

It was especially frustrating because I’d been asked to show up to the morning
appointment fasted, and of course there was no food in the ER, but I guess it
was more important to run up the tab.

I’d prefer a Mexican hospital any day.

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koolba
This is a crazy story. All that’s missing is a connecting flight through
Canada on the return to pickup some prescription drugs.

~~~
Scoundreller
Probably still cheaper in Mexico.

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maximente
> Mr. Stackpole said only a limited number of Americans were willing — even
> with a financial incentive — to travel abroad, because most perceive the
> care won’t be as good.

this meme that the US has the best and brightest in _everything_ and nobody
else holds a candle is both hilarious and depressing. it is now costing people
their lives and creating financial ruin, but it seems that US health parasites
are still pumping it.

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aaron425
It's incredible that medical tourism can allow people to be treated by a Mayo
& Brigham and Women's trained physician at a fraction of the cost, and that
the physician actually makes more. I suppose much of the expense here is what
American facilities normally charge, though I wonder if the stated prices in
the article are before any negotiations between the providers and payors.

~~~
teej
Don’t mistake “more than what the doctor would make from Medicare” as anything
close to what they make normally. Medicare pays pennies on the dollar.

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epmaybe
This is a misleading article.

If the patient truly qualified for outpatient total knee replacement
(orthopedic surgeon was out of Cancun in less than 24hrs per the article), the
cost of this procedure would have been around _$11,677_ in the US at an
ambulatory surgical center. Per the article, the cost of the procedure in
Cancun was..."but at Galenia, it is only _$12,000_ ". I will definitely give
credit where it is due, as the inpatient cost in Mexico would be far cheaper
than in the US.

Disclaimer: I am a medical student, so please keep my biases in mind. I have
no skin in the game, and I totally get that prices in the US are abhorrently
high. Please read the following articles to gain a better understanding:

[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3....](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89)
[https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144](https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144)

Source: [https://www.eurekalert.org/pub_releases/2019-03/hfss-
nir0313...](https://www.eurekalert.org/pub_releases/2019-03/hfss-
nir031319.php)

~~~
classics2
You’re mental if you think you can get a knee replacement for $12k in the us.
People who make one trip to the Ed here, with insurance, for something simple
like an infection end up with bills over $20k for little more than what ends
up being an ultrasound, A lab test and a script for antibiotics.

~~~
Scoundreller
$15.5k at Surgery Centre Oklahoma for a total knee replacement:

[https://surgerycenterok.com/](https://surgerycenterok.com/)

EDs don’t have competition like outpatient surgical centres do.

~~~
epmaybe
I don't think he read my comment in full, where I specifically mentioned that
it would only cost that much at an ambulatory surgical center, linked to a
source, and accepted that it would definitely cost more in a hospital.

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chiph
As this grows in awareness and popularity, I can see US healthcare providers
lobbying to make it illegal. Which would be tough - what do you do, put heart
surgeons on the no-fly list?

~~~
armandososa
We have pretty good doctors down here too, why the need to fly one form the
USA other than prejudice?

~~~
eipipuz
As the article mentions, so you can sue if something goes wrong.

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dsfyu404ed
Seems like a win for the patient and the insurance company and clearly worth
the surgeon's while (or he wouldn't have gone). Personally I'd have no problem
signing up for a "everything over $x and we send you to Mexico" plan.

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pier25
I live in Mexico with my Mexican wife.

Earlier this year she had a minimally invasive heart valve replacement
(instead of opening all the chest they did via a smaller cut on the side). She
was walking out of the hospital 4 days after the surgery.

We paid about $6500 USD which included everything. The mechanical valve,
surgery, hospitalization, etc.

Some people pay a lot less than that since the price is according to a socio
economic background check the hospital makes.

~~~
Scoundreller
In the US, the valve would have cost that.

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codingdave
Having had a number of surgeries in my life, I do care that my surgeon is
well-trained. But I care even more about the anesthesiologist.

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noir_lord
How long until someone converts a cruise ship to a hospital ship and parks it
off the coast.

The US healthcare system just gets weirder and weirder, almost everything has
been tried except fixing it.

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wil421
In 2004 I was in Cancun and met a few people doing this kind of thing. It was
for plastic surgery type stuff that wasn’t covered by insurances. Not nose job
stuff more disfigurement or getting something unsightly fixed. 15 years later
they have a hospital catering to this. It was sketchy back then and I heard of
botched jobs with not so great surgeons.

Here we are 15 years later where they fly in surgeons and pay the patients.

Anyone want to build a system to connect hospitals overseas with insurance
companies/patients?

~~~
elliekelly
In Florida they have a boat that goes out to international water, drops
anchor, and lets everybody gamble for the day.[1] Perhaps we aren't too far
off from Norwegian Cruise Knee Surgery and Holland America Hip Replacements.

[1] [https://victorycasinocruises.com/day-cruise-central-
florida/](https://victorycasinocruises.com/day-cruise-central-florida/)

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BadassFractal
How does one find any hope in a system like this?

~~~
RhysU
Despite all the structural crazy, two self-interested parties agreed to a
mutually beneficial trade. That is, capitalism finds a way.

------
PunchTornado
Sometimes I'm thinking I'd love to work in USA. But reading this stories is
very scary. When you have an emergency situation, you shouldn't need to find
out if the doctor/hospital is on some network. One commenter on the article
complains she was charged 65k.. waw.

I'm glad for the nhs.

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mlindner
> Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or
> three times what he would have received from Medicare, the largest single
> payer of hospital costs in the United States. Private insurers often base
> their reimbursement rates on what Medicare pays.

This is what happens when most of the actual health care cost is going to fat
administrator paychecks.

~~~
Scoundreller
It's 25% in the US on administration. The low end is 12% in public health
systems. [https://www.nytimes.com/2018/07/16/upshot/costs-health-
care-...](https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html)

The more likely answer is: Everyone else is paid less and everything else
costs less.

The extra costs in the US will be some combination of total nonsense, marginal
(you should get _some_ compensation when errors cause you harm) and very real
(e.g. Replacing HVAC filters on schedule, having someone go through lab
results for the last month's infections and figure out which antibiotics to
use the next time when you can't wait for results).

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wtdata
> Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or
> three times what he would have received from Medicare

This illustrates perfectly the point I (and most everyone on Europe) tries to
get to Americans and often they - for some weird reason - refuse to
understand: healthcare can be cheaper and better to everyone (yes, this means
that universal healthcare can and is cheaper on the taxpayers in most of the
EU than for American taxpayers... with ours being universal), if you just
understand that the middle man you created by wanting the state out of it, is
getting most of the money.

It's really so simple to understand...

~~~
wtfrmyinitials
I’m not sure I understand your point. The surgery was done in a private
hospital and paid for by a private health insurance company. It certainly
points out that care in the U.S. is too expensive, but I’m not sure how it
indicates a single payer system is the best course of action. The doctor was
also paid 3x the Medicare rate which sounds like a good thing to me. Am I
missing something?

~~~
paulsutter
He literally said "healthcare can be cheaper and better", and this story
definitely proves that.

