11.20.07

Medical Tourism

Posted in Politics, Current Events at 4:56 am by diantus

Recently it came to my attention that there the terrible and growing problems with the private healthcare the in the United States are finally reaching the breaking point. If you need more proof in this all you need to do is look at the growing industry of medical tourism.

Medical tourism is mostly indulged by members of the middle class; those people, especially amongst the self-employed, who cannot reasonably afford health insurance. Premiums are getting increasingly expensive, and trying to afford preventative care without it is usually unreasonable. In order to deal with the outrageous costs of medical care, a lot of people are now leaving America for exotic destinations like Thailand, India, Mexico, and China. In these countries, it is possible to get top of the line medical services for a fraction of the costs that you would face in the United States.

Of course, this is just a symptom of a wide ranging set of problems in the United States. The private insurance system is a bloated and inefficient machine that forces both huge administrative overheads, massive premiums for doctors and patients, and overpriced and redundant diagnostic techniques. Furthermore, the industry is supported by massive government subsidies, which demonstrate the overall unsustainable nature of the entire private system.

Nevertheless, medical tourism has potentially wide-ranging effects in the American domestic market as well. When more and more people start heading abroad, doctors and nurses in the states will find themselves increasingly outsourced - just the latest in a long string of tragedies from poor economic management in the United States. Moreover, the grotesquely inflated price ceilings in US hospitals require constant influxes of money and resources. If these margins should suddenly fall, the fallout would likely lead to a severe shrinkage of the medical infrastructure in the US, but is unlikely to lead to a real depression of prices, since the government would be forced to prop the older system up to prevent a total collapse.

The outsourcing of American medical needs will also have serious ramifications in the developing countries that receive rich western patients. The sudden influx of western money will like have the effects of pushing the prices of medical care up overseas. The immediate logic is to go get your liposuction now, but moreover to be warned that if the premiums overseas rise too much, then medical care will be increasingly difficult to afford for the natives of those countries. The political ramifications for this are potentially very serious, but given the level of government regulation in the rest of the world’s health care systems, the prices will likely be kept to reasonable levels, with certain liberties and taxes being placed on western medical tourists to help pay for the costs of keeping medical talent.

Of course, we could just deal with the situation as it is, let the problem grow until such time as the system collapses and forces us to adopt a new model. It would be very difficult, and bring about an accelerated growth in inequality and further limit the upward mobility of middle and lower class Americans. This is the most likely outcome unless the lawmakers in the United States are will to admit that the medical system needs to be severely reigned in. When even the relatively well-to-do are forced to leave the country to receive critical medical care, there is a serious problem. This isn’t simply a matter of supporting private medical insurance companies (I fail to see any meaningful difference between this and a state-control enterprise), but actually earnestly streamlining and reforming America’s heath care system. This means dismantling lobbying organizations, likely forcing doctors to take paycuts (though reducing the role of insurance companies would likely decrease the costs associated with working in the medical industry in the US and offset many changes to the market for doctors), and disrupting the simply massive medical bureaucracy that also adds huge costs to the spiraling prices of medical care in the US.

There are ways to make things better for the American people, even if it hurts vested interests of the insurance firms. Sometimes you need to realize that existing models simply aren’t performing, and when you need to take a vacation to Bangkok to get treatment, there is a bigger problem at hand.

11.15.07

Shuffling through history

Posted in Politics, Governance at 2:54 am by diantus

There has always been this idea that prickles the back of almost every American’s mind that progress is inevitable. We have always held to the inexorable march of history, and that somehow we were its vanguard. History as progress is a common theme in literature, art, even entertainments. But I must say, what has always captivated me about the study of history is how much the same we are.

For example, when we come to understand that Julius Ceasar was killed by a jealous nobility that was attacking his politics in part, but his populism in practice we can see the parallels between political manipulations by any society’s elite echoed across history of all peoples. Take for example the fall of Japan’s emperor to the Tokugawa shogunate. While the office remained, the power was put into the hands of those that wanted it more, but remained safely away from the people.

This theme is common in all of our history - this reshuffling of elite structures of power. It happens periodically in our own history through events like the most recent republican revolution (which thankfully overplayed its hand and is ending not at all too soon), or the usurpation of the Articles of Confederation in 1787 in favor of the Constitution. None of these changes stemmed from the will of popular sentiment, instead they come from already entrenched powers seeking to stabilize the political situation in their favor.

My point here is this: the is no inexplicable march forward. Some of the toys change, but we can be simply amazed at the sophistication of societies that did not nearly possess our level of technical ability. But the truth is this: machines don’t matter, people do. America possess a virtual infinity of gadgets and devices that either chew up our natural environment and make even the most pristine parts of our country uninhabitable, or that no one can actually use because the skills simply aren’t there in the general public. In the end, what really matters is quality of life; the ability to get ahead and to have a sense of purpose is what really matters.

Regrettably, the history of the twentieth and twenty-first centuries increasingly seem like the acceleration of the politics of domination. All technology has really done is to speed up this tendency to move from one center to the next. The United States is looking increasingly shaky through its economic problems and increasing desperate military overstretch (though for those of us living abroad, a swiftly plummeting dollar is AWESOME!), and Japan has been forced to reduce the amount of tuna it imports for fear of endangering the species. The rest of the world is getting this technology, understanding it, and clawing at the specialness of the developed world. They are doing it faster, with less regard for the future than Europe had, and the coming reshuffle is going to be very uncomfortable.

This means that America MUST stabilize its domestic situation. We have to make life better for people living in our own country and start to correct the massive imbalances in power, education, and opportunity that exist there. The future is no longer about the United States guiding the rest of the world. If the country is to survive and maintain and shred of its former dignity, it must, like Europe before it, learn to coexist with the rest of the world. We need to become leaders in the social and environmental arenas - those places that really affect all of us. Simply remaining a military giant means that our resources will be ground away as the insurgencies get harder and harder.

We must remember the most important lessons of colonialism in ages past. First, there was no mass media to tell the world what you were doing, and second, the tribal federations of Africa and the Americas didn’t have ready access to AK-47s and TOWs. If we don’t find a new way to be global leaders, we’ll only manage to kill a lot of people - including ourselves. The sort of leadership we need now begins at home.