Debunking Republican Healthcare Myths: "People Come To U.S. For Care!"

 

Thumbnail photos: Photo #1043976/PxHere; Kristopher Radder - Official U.S. Navy Page/Flickr

 

A Republican healthcare argument that you'll sometimes hear is that many people travel to the United States for care; this, they argue, proves that our healthcare system is great, and some say that people come here because we have the best doctors and medical facilities in the world. As we will see here, there is no good evidence available to justify reaching these conclusions, and there are many flaws in this argument.

While many do come to the United States for care, a much larger number of people leave the United States for care. Medical tourism takes place to and from many different countries for many different reasons, and the complex reality of the situation is nothing like the crude, one-sided picture that conservatives paint for us.

We heard this argument being made by Donald Trump during one of the 2016 presidential debates—on one of those exceedingly rate occasions where they actually asked a question relevant to public policy:

 

"She wants to go to a single-payer plan, which would be a disaster, somewhat similar to Canada. Have you ever noticed, the Canadians, when they need a big operation, when something happens, they come into the United States in many cases because their system is so slow, it's catastrophic, in certain ways."

 

This is just a side point, but notice that Trump here uses the hyperbolic language that he's constantly using: things he dislikes or disagrees with are always a "disaster," a "catastrophe," a "nightmare," whereas things he supports or likes are always "incredible," "the best you've ever seen," or "amazing."

Frankly I think he uses this kind of exaggerated language to compensate for his extreme ignorance. Since he's too uninformed to provide thoughtful, evidence-driven arguments on whatever the subject may be, there's nothing else he can do except puff his flabby chest out like this. It's like the poker bluff of political conversation.

At the very least, we can say that over-using these words causes them to lose their force. If we describe longer wait times for surgery as a catastrophe, what language will he use the next time something truly catastrophic happens, whether there's a giant earthquake or he's unable to go golfing for a whole week? He will be at a complete loss for words, and the only way he'll have left to convey the gravity of the situation will be to hold a press conference where he just stammers incoherently while pissing his pants—much like me when I talk to women!

Stefan Molyneux made a similar argument in a video of his, and he even provided a personal anecdote:

 

"The idea that I'm somehow benefiting from Canada's healthcare system, ohhh, that's just a shame that some people try to take that approach. A couple of years ago I had a growing lump in my neck that was found by my dentist, and I won't go into all of the ins and outs, but basically, I was in the Canadian healthcare system, and it took forever to get ultrasound, took forever to get a diagnosis.

. . . I ended up having to go to America to have an operation, which left me with this little scar here, 'cause they went up and took out the lump. It did turn out to be cancerous; it was lymphoma. So I went through treatment up here in Canada. But, yeah: Socialist medicine, it nearly killed me. And I did have to flee to America. And thanks again to those listeners who helped pay for the air fare and the operation."

 

I don't even believe him when he says that his motive for traveling to the U.S. was to circumvent wait times; the specialist that he got assigned to in Canada was probably just a black guy or something! (By the way, before all "Molyneux isn't a racist" people flood the comments section, that was just a joke. So chill the fuck out, and you can get back to watching your "Blacks Have Low IQ" videos in no time!)

There's something very important to note about the people who travel to the United States for care: Many of them do so only when they have lots of money that allows them to do this. In Molyneux's case, he actually had to resort to crowdfunding both his travel and operation! As he put it, "thanks again to those listeners who helped pay for the air fare and the operation."

Needless to say, many people don't have the luxury of being able to appeal to such a large and generous audience, nor do they have tens of thousands of dollars set aside for unexpected travel and medical treatment. So rather than being a testament to the quality of the United States healthcare system, this is moreso an illustration that having lots of money grants you certain priviliges that the less fortunate simply don't have access to.

"Hey, I had to start a GoFundMe campaign just to pay my medical bills. Isn't the United States phenomenal?" Yeah, dude: We are truly the envy of the world. Now if you'll excuse me, I need to get back to working my third job just to pay off the hospital bill for a single aspirin that I was given!

Let's look at one final example of this argument, made by user "V.V." on one of my videos in a comment which is a treasure trove of idiotic arguments. As he put it,

 

"if American healthcare is soooo bad, can someone tell me why ppl around the world come to America for Surgery or Long term treatment when they can afford out of pocket costs."

 

Key phrase here: "...when they can afford out of pocket costs." Healthcare in the United States is so ridiculously expensive compared to the rest of the world that many people are obviously unable to do this.

This argument breaks down for a more important reason, however. People from other countries sometimes do travel to the United States to receive care; yet people from these countries also travel to other countries to receive care. What's more, people in the United States also travel to other countries to receive care! This is a general activity that's known as "medical tourism," and the things that motivate people to do this are wide-ranging. Let's take a look at the numbers and the driving factors behind this medical tourism.

In the case of patients traveling to the United States, one key motivation—as conservatives will be sure to let you know—is to receive care in a more timely manner. As we read on the creatively-titled website USNews.com,

 

"[The Fraser Institute] said difficulties in obtaining timely medical care at home is, increasingly, leading Canadians to seek it abroad."

 

Another motive is described on Wikipedia—and here we're talking about patients coming not just from Canada, but from all around the world:

 

"The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care."

 

I can tell you what doesn't motivate medical tourism to the United States: the desire to save money. But hey, if you're lookin' to burn a fuckin' hole in your wallet, come on over! Or maybe I'm wrong about this? Maybe some subset of U.S. medical tourists do come here out of some combination of masochism and thrill-seeking? Perhaps they just want to feel the adrenaline rush of virtually bankrupting themselves after spending only a few days in the hospital? What an experience!

So what kind of numbers are we talking about here? Based on how conservatives frame the subject, you would expect people to be practically trampling one another to come here for care! As the US International Trade Commission writes in a 2015 report,

 

"About 0.5% of all air travelers entering the United States annually—between 100,000 and 200,000 people—list health treatment as a reason for visiting (this data excludes travelers from Canada and Mexico, the majority of whom travel to the United States overland)."

 

How many Canadians, specifically, travel to the U.S. for care? I can't find precise statistics, although I can tell you that the number is very likely to be less than 60,000. As The Fraser Institute writes in a 2017 report,

 

"In 2016, an estimated 63,459 Canadians received non-emergency medical treatment outside Canada"

 

And this is the number of Canadians that traveled to any country for medical care—not just the United States. Let's generously say that 50,000 Canadians come to the U.S. every year for medical care.

How many Mexican medical tourists are there each year? I can't find clear statistics on that question, but for the sake of analysis, let's come up with what I think is a reasonable estimate: Statista.com shows that, in 2017, there were 19 million visitors from Mexico to the U.S. According to that USITC report, 0.5% of air travelers came to the U.S. for health treatment. 0.5% of 19 million is 95,000.

Adding all of these numbers together, we find that 200,000 worldwide plus 50,000 from Canada and 95,000 from Mexico yields a grand total of 345,000 people that travel to the U.S. each year for medical treatment. My goodness: That is a lot of people right there. That's right around the number of people who voted illegally in 2016–times 345,000! If I was a mindless partisan who only cared about making his own position look good, I could stop right here and say: "See? Look at all these people that come to the United States for care. That proves it: The U.S. healthcare system is phenomenal."

But if you want to honestly evaluate this question, you have to look at all of the numbers, and when you do, you find that the conservative position crumbles before your eyes. Here is the key fact that a right-winger will never tell you—even if you tie him to a chair and torture him by forcing him to listen to Bernie Sanders speeches: When it comes to medical tourism, way more people leave the United States and go to other countries than come from other countries to the United States! As Fred Hansen writes in The Institute of Public Affairs Review,

 

". . . the number of Americans traveling abroad for healthcare . . . is up from 500,000 in 2006 to 750,000 in 2007."

 

In recent years, these numbers have doubled. As PatientsBeyondBorders writes,

 

"We estimate some 1,400,000 Americans will travel outside the US for medical care this year (2017)."

 

1.4 million versus 345,000. That is a ratio of over 4:1; that is to say, 4x more people leave the United States for care than come to the United States for care. Listen to right-wingers discuss the issue, and they frame it as if medical tourism is a one-directional phenomenon where people all across the world are clamoring to receive care in the United States. In reality, it's actually a bi-directional process that runs much more in the opposite direction.

If the right-wing logic is that having people come to the U.S. for care makes our healthcare system great, doesn't it logically follow that having people leave our country for care makes our system shitty? Since way people more leave our country for care than come to our country for care, isn't our system therefore much more shitty than it is great? Just applying their own logic here completely undermines their position.

I should also point out that this statistic of 1.4 million is counting only the Americans that physically left the country and went to another for healthcare. Millions of additional Americans take advantage of other countries' healthcare systems in additional ways. For example, as Fred Hansen continues,

 

"5.4 million Americans purchased drugs from other countries over the Internet last year."

 

And millions of Americans do this each year despite the fact that it isn't even legal!

Needless to say, Americans are traveling to other countries—or purchasing prescription drugs from them—largely because the cost of these things in the United States is outrageously high. As Horowitz & Rosensweig write in The Physician Executive,

 

"Low cost is the primary reason that patients from industrialized nations seek medical care in less developed countries. . . . Patients from the United States typically fit one of two profiles:

1. Working class adults who require elective surgery but have no health insurance or inadequate insurance benefits

2. Patients who desire procedures not covered by insurance such as cosmetic surgery, dental reconstruction, gender reassignment operations, or fertility treatment."

 

And as Hansen reveals, these price differences are significant:

 

"Services abroad are, on average, 80 per cent cheaper according to the founders of PlanetHospital. Their data show that heart surgery which costs more than $50,000 in the United States can be purchased for $20,000 in Singapore, for $12,000 in Thailand and between $3,000 and $10,000 in India.

Offering dental work at one-fifth of US prices and inexpensive drugs, Mexico is attracting the majority of American medical travellers. . . . Stomach surgery, eye exams and routine check-ups are among the major services that Americans are seeking in Mexico."

 

Now when you hear this, you might be imagining people traveling to some shithole third-world facility where the surgery room is illuminated by a single flickering light bulb and the doctors—who don't have a clue what they're doing—cut you open using rusty medical equipment. You wake up and you're like "Doctor, my head hurts!", and he just hands you a bottle of vodka. And you're like "But I'm only 12!", and he's like [in super Russian voice:] "It doesn't matter. Drink."

So you might imagine that care received in other countries is substandard; In reality, the quality is perfectly acceptable. As Horowitz & Rosensweig continue,

 

"These countries have large, modern medical facilities that are staffed by well-trained physicians who perform complex procedures."

 

What more could a man ask for?

Another example of these price differences are provided by Nian Hu on ThisIsInsider.com:

 

"Sarah May Grunwald is an American citizen living with severe Crohn's disease, a chronic illness that necessitates frequent hospitalization, surgeries, and medication. However, she said she had trouble receiving adequate healthcare in the US. She told INSIDER that her medical bills from the US have landed her deep in debt. And her monthly medication, which costs about $500 a month, is simply 'impossible to afford.'

Now that she is living in Italy, Grunwald said she is finding it easier to maintain her health. She said that she pays about five euros, roughly $5.79, every month for her medication. And the medical procedures that used to cost her thousands of dollars in the US, she said, now cost 'so little' that she cannot even recall the exact cost. She estimated that she pays 'under 20 euro' for every hospital visit."

 

So as we can see, trying to avoid paying the extremely high healthcare costs in the United States is one of the core reasons that people travel to other countries for care. It's not the only reason, however. Another reason is the very same reason than many Canadians travel to the U.S. for care: long wait times!

In an article for The Fiscal Times, Beth Braverman describes this, as well as an additional motive. (By the way, what kind of a last name is "Braverman"? What kind of weirdly insecure caveman would make that his last name? "Me...braver man!" Ok, buddy: Whatever you say!)

 

"In addition to traveling in order to save money, some medical tourists plan trips because they want to have a treatment that’s not approved in the United States or because they’ll have a shorter wait by going abroad."

 

So as we can see, there are several reasons that people leave the U.S. for care, although our expensive healthcare system is the primary reason.

Listen to conservatives talk about the issue, and the impression you get is that everybody around the world is pushing and shoving to get into the United States—and the United States alone—to nibble off a piece of our healthcare pie. Just take another look at this right-winger's YouTube comment. Marvel at the stupidity:

 

"if American healthcare is soooo bad, can someone tell me why ppl around the world come to America for Surgery or Long term treatment when they can afford out of pocket costs."

 

Here is one of the key things that's missing from the right-wing portrayal of this issue: people travel to other countries for medical care, as well. When it comes to medical tourism, we can summarize the situation as follows: People from a bunch of different countries are traveling to receive care in a bunch of different countries for a bunch of different reasons. As Wikipedia writes,

 

"Popular medical travel . . . destinations include: Canada, Cuba, Costa Rica, Ecuador, India, Israel, Jordan, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States."

 

There's a report published every two years called The Medical Tourism Index—the full version of which costs $2500! Jesus Christ, that's more expensive than two Band-Aids at a U.S. hospital!

Here, in this report, they basically weigh several factors and rank different countries around the world in terms of their overall medical tourism standing. According to their 2016 report, the top 5 countries are: Canada, the U.K., Israel, Singapore, and India. Ask a right-winger to predict which country would be number one, and they wouldn't even hesitate to say "the United States." They'd probably even start awkwardly chanting "USA! USA!...", and you'd be like "What the fuck, man?: This conversation is weird."

Not only does the U.S. not crack the top 5, but of the 41 countries around the world considered in these rankings—and of the 9 countries specifically within the Americas considered in these rankings—the U.S. wasn't even a contender!

You can also find a variety of articles which feature "Top 10 Medical Tourism Destination" lists, and while articles like this always strike me as a bit clickbaity and not the most rigorous things in the world, we will briefly consider two such rankings.

One, from Medical Tourism Magazine, provides the following Top 10 list: India, Brazil, Malaysia, Thailand, Turkey, Mexico, Costa Rica, Taiwan, South Korea and Singapore. Another article, from NomadCapitalist.com, has a very similar list: #1 is Malaysia, followed by Singapore, Thailand, India, Turkey, Czech Republic, Costa Rica, Panama, Mexico, and Brazil.

Why is the United States not in either of these lists? Clearly because the authors of these articles are communists who hate America! What's that? The author of one of these articles is Andrew Henderson, offshore tax-reduction expert? More like Mao Zedong's biggest fanboy!

One possibility worth considering is that the Medical Tourism Index report, as well as these two articles, are written from the perspective of: Which countries are the best medical tourism destinations from the perspective of people in the United States who might be traveling there. This is a real possibility, and perhaps this explains the United States not being included in the lists.

With that said, MedicalTourism.com provides the following statistical data which makes absolutely clear that the United States is not unique in having people travel there to receive care:

 

"Data from the Council for International Promotion of Costa Rica Medicine (PROMED) shows that in 2012, Costa Rica attracted nearly 50,000 medical tourists (mostly from the U.S. and Canada) and each one spent an average of $7,000.

. . . Tourism Research Australia from the Australian Government reported that more than 10,000 medical tourism patients flew into the continent in 2013 . . . In 2012 . . . 2,530,000 international patients traveled to Thailand for treatment, the top five nationalities were; Japan, U.S., UK, GCC and Australia. . . . The Korea Health Industry Development Institute reported in 2012 that 159,464 patients from 188 countries visited Korea in 2012, 32,503 of those patients were Chinese.

. . . A 2012 report from the Taiwan Ministry of Health and Welfare found that more than 60,000 patients traveled to Taiwan for healthcare the previous year, with 50 percent of patients coming from mainland China."

 

To focus only on medical travel to the U.S. is to look at only a tiny snapshot of a much larger picture. Different people in different countries have different reasons for seeking care elsewhere, and to omit these facts from your thinking and analysis is to present us with the most laughably one-dimensional portrayal of a very complex and multi-facted issue.

The existence of medical tourism makes clear that no country's healthcare system is perfect in every single area: Sometimes, the wait times are too long; other times, healthcare is way too expensive; and sometimes, the TV channels in the hospital room are terrible! By the way, that handjob you gave me? Worst I've ever had. "Sir, that was a sponge-bath. Now please leave."

Other times, a country's hospitals might not provide a certain type of medical technology. And sometimes, as Horowitz and Rosensweig point out, the procedure might not even be available in their country, either because it hasn't yet been approved or it's outright illegal.

As Donald Trump once said, "Who knew healthcare could be so complicated?" Clearly not the right-wingers who make this argument, that's for sure.

From what I can gather, medical tourism usually happens for very narrow reasons: "the wait time is too long"; "the cost is too high"; "my country doesn't currently offer this procedure." It's usually one very specific aspect of healthcare that motivates medical tourism, so it doesn't make sense to use medical tourism as proof of the overall superiority of that country's system. The most we can say is that it proves that country A does better than country B in this one specific area.

Now of course, the conservative, at this point, would argue that medical tourists come to the U.S. specifically because we provide some of the best-quality care in the world. Is this, in fact, the case?

I took a very close look at healthcare outcomes and quality in a previous project, and there—after looking at lots of data on the subject—I concluded that we pay much more in the United States to receive care of only an average quality and to receive only average outcomes. There is simply no empirical support for the claim that quality of care, overall, in the United States is significantly better than that of other countries.

Maybe you could condede that point about overall quality, but you might still try to argue that we do have some of the best medical technology, specialists, and facilities in the world—and it is for this reason that people travel to the U.S. for care? This is something that I didn't address in my project on healthcare quality, so let's take a look at how the United States compares to other countries in these particular areas.

The first thing to point out is that it's hard to even quantify these things and create such rankings. What specific criteria should we use to determine which are the best medical facilities in the world? The technology available? Patient survival and recovery rates? Patient satisfaction surveys? How shiny your scalpels are? All of these things, and others, combined? Should these different factors be equally weighed, or should others be more influential in the rankings than others? It seems that there will inevitably be some subjective component to these rankings, and that they will always be open to debate.

I don't know how people who make these assertions—that the U.S. has the world's best specialists and medical facilities—even come to this conclusion, because from what I could find doing research, there just aren't a lot of good-quality rankings of these things based upon a sound methodology. So on what grounds do people even make these claims?

I really think people are just talking completely out of their ass when they say things like "The United States has the best specialists in the world!" How the fuck do you know? Have you compared specialists in the United States against specialists in France or China—and every other country on the planet? How have you empirically demonstrated that the medical technology available in Singapore or South Korea is inferior to that that we have within the United States?

I think when people say shit like this, it's not actually backed up by facts and a reputable list of the rankings, but it's just something they blindly assume and baldly assert—and when they say it in front of an American audience, nobody questions it and most people just take it for granted. This looks to me much more like thoughtless, flag-waving jingoism than it does objective science.

I did a bunch of research and I just couldn't find good-quality rankings of the world's medical facilities or specialist doctors—and some of the worldwide rankings that I could find strike me as being much more clickbaity than they are actual rigorous attempts to provide reliable rankings on these questions.

BookiMed.com appears to have a pretty good ranking criteria for the world's cancer facilities—taking into consideration such things as success rates, staff experience, pricing and hospital conditions. But you take a look at the website and everything about it screams "We're trying to get you to book an appointment somewhere, presumably so we can make some money." That doesn't necessarily discount the validity of their rankings, but it does give the article a clickbaity vibe and, to me, makes it seem a lot less rigorous and professional.

That said, according to them, the #1 cancer facility in the world is the Asklepios Medical Center in Germany. The home country of the top 10 cancer facilities are as follows: Germany, Thailand, Italy, Spain, Israel, Turkey, Germany again, India, Turkey again, and South Korea. Conspicuously absent from these rankings is the United States.

But again, I don't know how much currency we should put behind these rankings. Notice that the number one cancer facility in the world, according to them, is in Germany. Then, later in the article, they say the #1 facility in Germany is another cancer facility. That's a pretty glaring contradiction right there. (Perhaps this is an example of that famous German humor I've heard so much about?)

On top of that, the article is just poorly and awkwardly written in places: we read that "IBM Watson is a supercomputer based on using the artificial intelligence. This revolutionary technology contains the data of thousands researches"; "There are all conditions for comfortable stay at the hospital: children feel like at home here."

Maybe that just means the author's first language isn't English, and maybe the ranking methodology, at the end of the day, is still sound, but I have a hard time saying that we should completely trust these rankings. And believe it or not, this, sadly, is the single best worldwide medical-facility ranking criteria that I could find.

Another list, courtesy of TopMastersInHealthcare.com, ranks the 30 most technologically advanced hospitals in the world. Now obviously this is a pretty narrow criteria—because all they're focusing on is technology, in particular—but pickings are slim, so this is what we have to work with. We'll just look at the top 10 hospitals: Starting at number one, these are located in the United States, India, the U.S., Turkey, the U.S., Thailand, the U.S., Lebanon, Singapore, and Germany. So 4 out of the top 10 are located in the United States. Impressive!

In another article, they also rank the most technologically advanced cancer facilities in the world, and of the top 10, the top 6 are in the United States, with number 7 being in Canada, number 8 also being in the U.S., number 9 being in the U.K., and number 10 being in Spain. Now before conservatives start cumming in their pants and declaring victory, they provide a crucial caveat at the start of their article: many countries around the world are going to be underrepresented in these rankings not because they perform poorly in these areas, but because the researchers' information-gathering process had a clear bias in favor of English-speaking countries:

 

"In an effort to preserve the international aspect of this ranking, we intentionally sought to include hospitals from many regions outside of North America. Unfortunately, language barriers, a lack of web presence, poor translations, and/or limited access to information can – and did – impede this process."

 

So when the people doing the research admit to us that non-English speaking countries are at a severe disadvantage, is it any wonder that the United States ranks so highly? These rankings have clearly been heavily biased in favor of English speaking countries, so we simply can't describe them as reliable and informative.

Another article, on HealthCareGlobal.com is entitled "Top 10 Hospitals In The World," but clearly not a lot of thought and effort went into this article. The content doesn't even reflect the title; the title implies that there would be a top 10 ranking of the world's best hospitals, but instead, the anonymous author basically provides the top 1 hospital in 10 separate niche areas of healthcare.

In general, we're told that the best in the world is John Hopkins Hospital in the U.S. Here we also learn that the world's largest hospital is in South Africa. Neat! The best children's hospital is apparently in the U.K., but the indecisive author walks back his classification by merely calling it "one of the world’s leading children’s hospitals."

The pattern repeats itself when we're told that the world's best hospital for medical training is in the U.S. In his two-sentence description of this hospital, however, he writes that it is "Arguably one of the best medical schools in the world." He doesn't say "Here is the criteria that I used to arrive at this conclusion"; instead, we're simply told that "Harvard Med is famed for its levels of research and primary care." Oh, it's "famed" for these things? Well, holy fuck!: that is convincing enough for me.

Stormy Daniels might be famed for sucking cock, but that doesn't mean she gives the world's best blowjob. In order to figure out who actually does, we'd need to run a very large-scale comparison with a sound methodology—and in the interest of furthering scientific inquiry, I am willing to take one for the team and subject myself to this debauchery. "Get your dick sucked for science"—now that's an initiative that'll get some clipboard signatures!

The real quality information on hospital ranking in this HealthCareGlobal article actually comes from the comments section: "very good . . . gogogogo . . . yes good." I couldn't have said it any better myself.

I'm sorry, but none of these worldwide rankings that I've come across strike me as being based upon a sound methodology, and none of them are actual scientific publications. The one that actually has the best ranking criteria is the one from BookiMed.com—because they actually took into consideration many key variables—and 0 of their top 10 cancer facilities are located in the U.S.

Trying to rank the world's best doctors or specialists is even more futile than this, because the ranking would arguably be even more subjective. Not surprisingly, I wasn't able to find any studies which rank the world's best doctors in certain fields, and the best thing you'll be able to find are websites like RateMDs.com which are basically the Yelp of doctors.

It should go without saying that websites like this are untrustworthy indicators of physician skill and knowledge. Perhaps one physician's office more heavily encourages its patients to leave reviews—and it is for this reason that they show up higher in the website's rankings?

Perhaps a grumpy, anti-social doctor gets poor reviews even if, at the end of the day, he's a medical genious? Conversely, perhaps people leave a 5-star review simply because the doctor was very friendly and charismatic—even if, when it comes to the medical science itself, he's a bumbling fuck-up? "Ah, so you hurt your wrist playing basketball, huh? I get this all the time and I know exactly what to do: We need to amputate immediately. Here, bite down on this dirty rag and I'll start sawing."

On top of all these sources of bias that are not relevant to medical expertise, websites like this are obviously built around the English language, so even if the ratings were accurate measures of medical proficiency alone, they're just not going to be informative on the question of "Who are the best medical specialists in the world?"

So whenever you hear people say things like "The United States has the best doctors and medical facilities in the world," understand—and please point out to them—that they are talking completely out of their ass, because there simply are not any rigorous, worldwide rankings that are informative on these particular questions.

Let's be clear about what I'm not saying: I'm not saying that the United States doesn't have great medical facilities and great doctors; what I'm saying is that there is insufficient evidence to justify the claim that we have the best medical facilities and the best doctors in the entire world.

There might be strong opinions within the medical community on which facilities are the best for certain treatments, and certain facilities might have great reputations, but until you can point me to some hard data on these questions, I'm going to have a very hard time believing that United States has uniquely talented specialists, or uniquely innovative medical technology, that no other country in the world can compare to.

Yes, I will concede that there are some great medical facilities in the United States with great technology that people travel to receive care in. The problem for me is that when conservatives point this out, they're failing to take into consideration the great medical facilities in other countries that people travel to visit. The U.S. has some great medical facilities, but so does Australia and so does Singapore; we might have some cutting-edge medical technology in the United States, but so does the U.K. and so does China.

So the conservative thinking on this subject is plagued by selection bias: counting the hits and ignoring the misses. They will shine a spotlight on the medical tourists seeking great facilities and technology within the U.S., but they pay no attention to the medical tourists seeking the exact same thing within other countries. They're paying attention only to the people who support their position and they're ignoring the people who contradict their position.

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Another way to think about this issue is by imagining a normal distribution: In any given country, the average level of specialist expertise will fall somewhere along this spectrum. Yet in every single country, there will be a small percentage of specialists who are on the extreme end of the spectrum—meaning that they're among the most knowledgeable and talented in the world.

So we could say that, yes, the United States has some of the best specialists in the world—but so does every other country, because every country has at least some small number of specialists that are on the tail end of the distribution. Thus, a characteristic that every country has can't be used as proof of the unique superiority of one particular country.

But even if we conceded that specialists and medical facilities in the United States are significantly superior to those of other countries—a claim that I've seen no empirical support for—this doesn't necessarily mean that our healthcare system as a whole is superior; it just means that—in this one very narrow area of, say, bone cancer care—we happen to excel. You could theoretically have the world's best heart surgeons, for example, yet your health care could be unaffordable to millions of citizens. You could also have great heart surgeons but terrible brain surgeons, and your physical therapists could also be trash.

The point is that people traveling to a country to receive specialized care doesn't necessarily mean that the healthcare system as a whole is fantastic, and it doesn't even mean that the quality of care received, in all areas, is fantastic; it just means that in certain, very specific areas, that country does better than their home country.

Things are much more complicated than right-wingers make them out to be when they make this argument, and I just want to make clear that you can only draw so much of a conclusion from medical tourism statistics, and there is much more to healthcare analysis than this. Let's not make the mistake of saying that medical tourists demonstrate the general quality of care provided or the overall desirability of a healthcare system.

Here's another very important thing to consider about medical tourism: Because our healthcare system is so profit-driven compared to other countries, medical facilities in the United States almost certainly more-aggressively advertise their services to the rest of the world. Thus, even if we had more medical tourists than these other countries, rather than this reflecting the genuinely superior quality of our facilities, it could simply be the product of more people being marketed to and persuaded to come to these facilities to spend their money.

By analogy, of all companies, McDonald's sells the most hamburgers worldwide, but nobody would argue that the quality of their burgers are the best in the world. They're simply such a large company that their advertising budget is comparable to a small country's GDP. (With all that capital they have, maybe McDonald's should just start its own country? They could even have their own military where everybody dresses up like Ronald McDonald? Not the most effective urban camouflage, but it would be quite a menacing sight to see—not to mention a great opportunity to get the brand across! They could even engage in biological warfare by forcing the enemy to eat their food!)

I have a couple more small points to make on this subject. (I couldn't really figure out a good way to smoothly integrate them earlier without disrupting the flow of things, so fuck it!: I'm just gonna tack them on at the end here.)

One point is this: medical tourism isn't exclusively people paying out of their own pockets for travel and care; oftentimes, their physician recommends it and their insurance might pay for it. As Beth Braverman writes,

 

". . . a growing number of Americans (and their employers) are finding it more cost efficient to fly across the globe for certain medical procedures. The savings are so great — and the quality high enough — that a handful of American insurance companies are now encouraging the practice and covering the travel and treatment costs."

 
 

"Big insurers are already adding global low-cost providers to their health plan networks. Blue Shield of California, for instance, allows enrolees of its health plan to have access to cheaper physicians across the Mexican border. Blue Cross of South Carolina allows treatment at the Bumrungrad International Hospital in Thailand."

 

So medical tourism might appropriately be viewed as part of the globalization of healthcare. I'm not really sure how this is relevant to the specific argument here, but hey, fuck you: You learned something new today, so you're welcome.

The final point I'll make is that many of the problems that motivate medical tourism can actually be resolved within a country's healthcare system; it's not like a country is forever doomed to have the drawbacks that it has. If you lack a certain type of medical technology in your hospitals, you can adopt this technology. If a certain groundbreaking new treatment is only available in one country, other countries can also start offering this treatment. So rather than medical tourism being a sign that we should seek to emulate every aspect of that country's healthcare system, it could simply be a sign that we should try to emulate them in the one specific area where they're outperforming us.

So what are the key conclusions that we can reach on this subject? There are many flaws in the commonly-made conservative argument that our healthcare system is great because people travel here to receive care. Yes, many do travel to the U.S. for care, but many travel to other countries, as well, for many different reasons. Furthermore, way more people leave the United States for care than come here for care.

On top of that, medical tourism doesn't reflect the general quality of a country's healthcare system all around the board; instead, it's moreso proof that they do well in one particular area. So there's not much of a big-picture healthcare conclusion that we draw from medical tourism, and even if we could, the net outflow of medical tourists from the U.S. make clear that our conclusion would reflect negatively upon this country—not positively.

Finally, contrary to what conservatives claim, medical tourism to the United States doesn't prove that we have the best doctors or facilities in the world, and there simply aren't any reliable rankings on which medical specialists or facilities are the best in the world. While I'm sure we do have some very great doctors and facilities, there's no reason to believe that other countries don't as well. For these many reasons, this argument does not stand up to scrutiny.