Re: [OPE-L] Abstraction

From: Rakesh Bhandari (bhandari@BERKELEY.EDU)
Date: Wed Jun 13 2007 - 01:32:50 EDT


>I don't think any number of unskilled labour hours can perform the
>work of a skilled surgeon, but for that reason I don't think that the
>hours worked by surgeons etc count as expenditures of labour power,
>defined as the group of skills common to all human labour: surgery is
>the expenditure of a skill that is not shared across people to a
>higher or lesser degree.

You may be right but...


Whether uninsured or fully covered, Americans 
getting surgery abroad save big bucks
Posted 11/2/2006 10:22 AM ET
By Margie Mason, The Associated Press
NEW DELHI, India - Greg Goodell flew from Iowa to 
India to have his arteries unclogged. Rick Thues 
made the trip from California for a new hip. John 
Terhune ventured from Indiana for a hip-and-knee 
combo.
Combined, all three saved about $140,000, 
including the cost of travel and hotels, by 
having their surgeries last month in New Delhi 
instead of America - where the health care system 
had simply failed them.
All in their 50s and fully employed, these men 
are among the estimated 500,000 Americans who are 
taking their health into their own hands by 
choosing medical care abroad. Many are stuck in a 
growing gap of uninsured or underinsured who are 
too young for Medicare and left with only losing 
health care options: siphoning their retirement, 
living in pain or possibly dying.
"Our share of the American dream has been lost in 
the past five years," said Thues, 53, a computer 
consultant from Orange, Calif. "Look at what 
we've outsourced - I'm even outsourcing my own 
health for God sakes."
He is fully covered under his wife's insurance 
and could have had total hip replacement back 
home for about $5,000 out of his own pocket. But 
it's not the newest procedure available and would 
have severely limited his mobility, kept him from 
his passion of skydiving, and possibly sent him 
back to the hospital in 10 years with more 
problems. Thues lobbied to undergo hip 
resurfacing, a new, less invasive technique 
approved in the U.S. this year. But he was denied.
So, he and his wife, Paula, hopped on a plane to 
Delhi and visited Dr. S.K.S. Marya, chief surgeon 
at the Max Super Speciality Hospital's Institute 
of Orthopedics & Joint Replacement, who has 
performed some 150 hip resurfacing operations 
over the past two years for about $7,000 each.
Within a few days, Thues was up walking and 
already talking about his next jump from a plane 
in six months - the whole trip including the 
surgery, airfares, lodging and a trip to the Taj 
Mahal totaled about $12,000, none of which was 
covered by his insurance.
"I was so let down by my HMO. The whole idea that 
they denied me because they could," he said while 
recovering at his hotel near the airport in New 
Delhi. "I've paid thousands of dollars in 
premiums over the years. It's their job to look 
after me."
Greg Goodell, 57, from Shenandoah, Iowa, ended up 
at the same Indian hospital as Thues. In August 
while bicycling, he felt a strange tightening in 
his chest and realized something was wrong. But 
the self-employed finishing painter was uninsured 
and knew the price of an angiogram test alone, 
quoted at $4,000 to $29,000 by nearby hospitals, 
could have put a big dent in the family's savings.
With a wife and five kids to consider, he said he 
put his faith in God and had an angioplasty with 
two stents inserted in India for about $10,000.
"When you first start, you're not sure. You 
think, 'Wow that's a long ways away.' But when 
you're faced with the other option, you want to 
check it out," he said two days after being 
discharged. "We felt comfortable. We didn't 
really have any red flags ever."
But Goodell did encounter a few downsides of 
traveling. He and his wife, Kriss, both 
experienced bouts of diarrhea during the trip and 
their luggage was lost for three days. Goodell 
also had a slight mishap while walking near 
Delhi's congested roads: He sliced his head open 
on a metal sign, resulting in six stitches.
Still, he said the setbacks were minor, given 
that his heart was fixed without breaking the 
bank. The couple's whole trip ran about $16,500.
Uninsured Indianapolis chiropractor John Terhune, 
57, didn't need any persuasion. He underwent hip 
resurfacing surgery in his left leg a year and a 
half ago in the southern Indian city of Chennai 
and was so pleased with the results, he came back 
to have the right hip done by Dr. Marya in New 
Delhi. And he got a partial replacement for his 
left knee to boot.
Both surgeries totaled less than $12,000 - about 
85% off the U.S. price tag - plus another $3,000 
for travel and accommodation.
"There's just no decision to it. I mean, the 
writing's on the wall," he said from his hospital 
bed. "I would still come over here for 
resurfacing if I were insured."
Copyright 2006 The Associated Press. All rights 
reserved. This material may not be published, 
broadcast, rewritten or redistributed.


  More Americans Seeking Surgery Abroad
High Costs in U.S. Is Driving Some Patients to 
Seek Treatment in India and Elsewhere

WebMD Medical News
Reviewed by Louise Chang, MD


Oct. 18, 2006 -- Dismayed by high surgical costs 
in the U.S., increasing numbers of American 
patients are packing their bags to have necessary 
surgery performed in countries such as India, 
Thailand, and Singapore.
"This is not what is sometimes snootily referred 
to as 'medical tourism,' in which people go 
abroad for elective plastic surgery," says Mark 
D. Smith, MD, MBA, president and chief executive 
officer of the California HealthCare Foundation 
in Oakland.
Today's "medical refugees," the term Smith uses 
in an article published in the Oct. 19 issue of 
The New England Journal of Medicine, are going to 
foreign countries for lifesaving procedures such 
as coronary bypass surgery and heart valve 
replacement, and also life-enhancing procedures 
such as hip and knee replacementknee replacement.
"People are desperate," Smith tells WebMD. "This 
illustrates the growing unaffordability of the 
U.S. health care system, even to people who are 
by no means indigent."
The report by Smith and his colleague, Arnold 
Milstein, MD, MPH, documents the case of a 
self-employed carpenter who couldn't afford 
private health insurance and would have faced 
financial ruin if he had surgery in the U.S. It 
also shows how some insured workers are being 
steered toward receiving less-expensive 
procedures outside the U.S.
Indian Hospitals Booming
Vishal Bali, chief executive officer of the 
Wockhardt Hospitals Group in Mumbai, India, says 
there has been a 45% increase in the number of 
American patients seeking care at his 10 Indian 
hospitals during the past two years.
"Cost is a major factor," Bali tells WebMD. Some 
examples: Wockhardt Hospitals usually charge 
$6,000-$8,000 for coronary bypass surgery, $6,500 
for a joint replacement, and $6,500 for a hip 
resurfacing, which represent a small fraction of 
the typical costs at U.S. hospitals.
"Another major factor is what we call 'the Indian 
advantage,'" Bali says. "At some point, most 
American patients have been treated by an Indian 
physician in the United States and they have 
tremendous faith in Indian clinicians."
Partly because of the influx of foreign patients, 
not all of them American, Bali plans to open 10 
new hospitals in India during the next two to 
three years.
Safety Concerns May Be Overblown
"Our American patients don't just pack their bags 
and fly to India," Bali says. "They have multiple 
conversations with patient coordinators and 
clinicians, many of whom have been trained in the 
U.S. and have American board certifications."
All Wockhardt Hospitals are accredited by the 
international affiliate of the Joint Commission 
on Accreditation of Healthcare Organizations, the 
group which accredits U.S. hospitals, Bali says. 
More than 80 hospitals in India, Thailand, 
Singapore, China, Saudi Arabia, and other 
countries have received this accreditation, 
according to the new report.
"These institutions are reporting gross mortality 
rates of less than 1%," Smith says. "I'm unaware 
of any evidence that surgery at these 
institutions is less safe or of lower quality 
than that in the average American institution, 
and there's some reason to believe it may be 
better."
"The downside, however, is that if you are harmed 
in an Indian hospital, you have less legal 
recourse than if you harmed at an American 
hospital," Smith says.
To compete with less-expensive offshore 
hospitals, the U.S. hospitals should do more to 
reduce costs, improve efficiency, and increase 
quality, Smith says. "Regrettably, I fear that 
some people's response to the offshore trend may 
be to moan and groan and try to shut it down or 
engage in scaremongering about quality."
A Sign of Globalization
"This trend shows that the world is flattening," 
Smith says. "We're no longer just outsourcing 
back-office functions such as the reading of 
X-rays, medical transcription, and billing. Now 
it's the actual clinical care that can be 
outsourced."
The report concludes that the trend is a "symptom 
of, not a solution to" America's affordability 
crisis. "I'm not suggesting it'll ever be the 
main way people get surgery," Smith says. "But it 
certainly is a wake-up call. If the cost of 
surgery continues to go up, particularly in 
settings where there's no relationship between 
cost and quality, this trend will continue."
Bali believes the trend represents a sea change 
in global health care economics. "This is only 
the beginning," he says. "This trend is not going 
to reverse. It's as strong a trend as the 
outsourcing of information technology because it 
is advantageous for patients."
Although most of Wockhardt Hospitals' American 
patients are uninsured, Bali predicts that will 
change. "Insurance companies are looking at this 
trend, their own viability, and the need to save 
money," he says. "They're telling patients that 
there are international destinations where they 
can be treated, which may mean paying much lower 
premiums than they're paying to receive treatment 
in the U.S."
A Call for Reform
"The need for American citizens to go abroad for 
care -- and their willingness to do so - 
represents a crushing indictment of numerous 
myths about the U.S. health care system that have 
gained popular currency in recent years," says 
Peter Budetti, MD, JD, chairman of the department 
of health administration and policy at the 
University of Oklahoma Health Sciences Center. 
Budetti was not involved in the report.
Budetti says the report dispels the myths that 
"foreign systems of universal coverage are so 
flawed that people in those countries who can 
afford to do so flock to the U.S. for care; that 
our health care is the best in the world; that 
everyone in the U.S. will get the care they need 
whether they can afford to pay for it or not; 
and, most telling, that increased consumer 
cost-sharing will reduce cosmetic or other 
nonessential care, not medically necessary care.
"The profound irony of these myths is a sad 
commentary on the state of our health care 
coverage and delivery system," Budetti tells 
WebMD. "The understandable focus in the past 
decade or so on improving quality and promoting 
patient safety may have played a role in 
distracting us from paying sufficient attention 
to growing problems with access and equity. 
Perhaps the emerging sight of Middle America 
traveling thousands of miles for medical care 
will spur new attention to the need for universal 
coverage with adequate benefits in this country."

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SOURCES: Mark D. Smith, MD, president and chief 
executive officer, California HealthCare 
Foundation, Oakland. Vishal Bali, chief executive 
officer, Wockhardt Hospitals Group, Mumbai, 
India. Peter P. Budetti, MD, JD, Edward E. and 
Helen T. Bartlett Foundation Professor of Public 
Health; chairman, department of health 
administration and policy, College of Public 
Health, University of Oklahoma Health Sciences 
Center, Oklahoma City. Milstein, A and Smith, M. 
The New England Journal of Medicine, Oct. 19, 
2006; pp 1637-1640.

 2006 WebMD, Inc. All rights reserved.






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>On the other hand, it is arguable that an
>amateur plumber can do plumbing work but at the cost of a lot of
>hours finding out the regulations, planning the work, and doing the
>job slowly (the ratio might perhaps be 8 to 1, so nearly everyone
>hires a plumber, not to mention those jobs where the work has to be
>inspected and by regulation must be done by a qualified plumber - so
>bricklaying might be a better example)
>
>>Marx says that commodities are commensurate in the market, but there
>>is no way to
>>get behind the market to get a handle on the abstract labor
>>measures.  How many
>>hours of abstract labor does a surgeon represent.  Can 20 or 50
>>unskilled labor
>>perform the same procedure?
>>  --
>>Michael Perelman
>>Economics Department
>>California State University
>>Chico, CA 95929
>>
>>Tel. 530-898-5321
>>E-Mail michael at ecst.csuchico.edu
>>michaelperelman.wordpress.com
>
>
>--
>Associate Professor Ian Hunt,
>Dept  of Philosophy, School of Humanities,
>Director, Centre for Applied Philosophy,
>Flinders University of SA,
>Humanities Building,
>Bedford Park, SA, 5042,
>Ph: (08) 8201 2054 Fax: (08) 8201 2784


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