Going Outside the US for Healthcare

We hear about people going out of the US to get prostate treatment, heart bypass and joint replacements -- and getting their US insurance companies to pay.

Now the City of Myrtle Beach, South Carolina, had an employee who was in Thailand anyway get a colonoscopy there. A colonoscopy locally costs $3,500. In Thailand, it is $700. Quality of care was good, the employee reports.

The City is now considering sending employees who need angioplasty surgery to Thailand. The procedure costs "up to $50,000" in the US and $15,000 in Thailand. A report in The State newspaper says it will save the City money to pay for the employee to go to Thailand, have the procedure, spend a few days in Thailand, and return to work.

For most hospital CEOs, marketers and doctors in the US, the issue of their patients choosing to go outside of the US for treatment isn't on their memo pads. Most see it as an aberration, something that won't have an impact on their patient base. Some hospitals, however, are setting up operations overseas where the costs are lower for their patients and others who wish to leave the US for treatment.

Some treatments, like the high intensity focused ultrasound (HIFU) procedure for prostate cancer, are now in clinical trials in the US, but promising enough that US physicians are taking their patients abroad, to Canada, Mexico and the Bahamas, for the $25,000 treatment. This is an outpatient procedure, walk in and walk out.

Let me know if you have had experience in getting treatment outside of the US. Tell us about it.

South West England

My wife and I lived in South West England while I was a Leverhulme Fellow at the University of Exeter in Devonshire.

This part of England consists of the counties of Somerset, Gloucestershire, Wiltshire, Dorset, Devon, and Cornwall. The South West also includes the port City of Bristol,in between Somerset and Gloucestershire. Bristol is on the River Avon which pours into the River Severn. One of the great men of this area was Isambard Kingdom Brunel, the builder of the first iron ocean-going ship, the SS Great Britain, launched in 1843, carrying many British to live in Australia. The ship is on display in Bristol.

Since we were based in Exeter, we traveled often in Cornwall and to the Isles of Scilly to the west of Exeter and to Dorset and Somerset to the east. These counties are tourist destinations for the English and Europeans and have their share of sheep and cows. The counties of Wiltshire and Gloucestershire, being close to London, are more urbanized.

The economic development office for this part of England, the South West of England Regional Development Agency (SWRDA) is divided into seven sub-regions: Cornwall, Devon, Somerset, Dorset, Wiltshire, South West England (containing Bristol), and Gloucestershire.

The South West is looking for knowledge-based, high tech companies. I know it's a great place to live, with excellent transportation to get around Europe or around the world. I'm looking for comments on companies that may have looked at South West England to get their feedback on this area.

Fear of Foreigners

I'm a member of a national organization that has about 1,000 members. I sent an email to a staffer and asked how many members were from outside of the US. She wrote back that there were 7 non-US members, 5 in Canada, 1 in the Bahamas, and 1 in Puerto Rico.

I went to the organization's blog site and asked a question: Should the organization actively recruit members from outside the US? Although there isn't much activity on this blog, it took several weeks for the blog moderator to read my blog. But when she did, she called me on the phone and said that I must remove my question. She said that it was up to the Board and the executive director to make such decisions and that the members should not discuss the issue. I complied and removed the offending question.

I haven't been back to contribute to the blog site since. And when my membership comes up for renewal, I'll decline to renew. There are other such organizations that I can join that have open minds and actively seek members from the US and abroad.

Curiously, the parent organization to the one that didn't like my question had learned of my interest in global issues from other sources and asked me to send them more information and references to be a part of a speaker's bureau they operated. They said they didn't have any speakers on global issues.

So here is an organization with one its offspring fearing international relationships and the parent willing to promote international relationships.

The fear of foreigners, of course, is evident in some of our political leaders who really feel that foreigners like the ones who flew into the World Trade Center are trying to get into the US to kill more Americans. That may be true, but all foreigners are treated by the immigration people in the US, on Congress' direction, as if they have bad intentions toward US buildings and people living in the US. On a recent trip from Australia to Hawaii, a video was shown by Qantas Airlines alerting non-US citizens that they would be photographed and fingerprinted upon arrival and that certain nationalities would need a valid visa or they would be denied entry.

I talked with one Australian immigration officer who said he never intended to visit the US as long as all non-US citizens were presumed to be criminals.

For many in the US, there is a problem with foreigners as members of an organization, just as some organizations in our history had a fear of having blacks in the organization. The biggest issue is that the communication between those in the US and those in other countries is effectively blocked and we do not have an opportunity to learn from one another things that would benefit both Americans and foreigners.

There is one organization, called Rotary International that advocates world friendships to achieve world peace. This organization was started in Chicago at the turn of the 20th Century by a lawyer, Paul Harris, and has millions of members and thousands of meetings all over the world every day of the work week.

I can go to Sofia, Paris, Auckland, Tokyo, Quito, Warsaw, Moscow, or virtually any city of any size and find a welcoming group of fellow Rotarians willing to have breakfast, lunch or dinner with me. Members can talk about any topic without fear of reprimand from the head office. It is an open forum. We take "banners", like little flags, with us from our home club and exchange it at another club for their banner. Then when we return to our home club, we present the other club's banner to our members.

Rotarians give millions of dollars to help people in developing countries drill water wells for washing or for irrigating their crops. One Rotary group in Cornwall, England has "shelter boxes" that contain a tent, water containers, cooking implements and other items that can be used in these temporary shelters for people who have lost their homes due to wind, fire, landslides, or flooding.

Rotary has existed and thrives after over 100 years of promoting international exchange and world peace. Rotary will still be around long after the organization I mentioned in the beginning of this blog.

International Health Care

American healthcare is sophisticated in that we have the latest technology, a variety of new drugs, and medical professionals that are dedicated, highly trained, and respected all over the world. However, our total healthcare system, in terms of outcomes, is not ranked as the world's best. In fact, some say it is rated as about the 25th best in the world.

We have the technology and the people that could make us the best in the world, but the system, when all the pieces of the puzzle are put together to show the big picture, doesn't produce the best outcomes for the people who seek care from the American health care system.

We have nearly 50 million people who, for one reason or another, can't afford, can't get, or just don't have health insurance. Having some kind of insurance, whether it is commercial, Medicare, Medicaid, military, veterans, or something else, is the golden key that opens the door to preventive care, procedures on demand, being able to see a primary care or specialty physician on demand, and getting needed medications and durable medical equipment.

Anyone, whether a citizen, resident or visitor in the USA, can get seen for care to stabilize health problems at any hospital emergency department, regardless of whether the person has insurance or cash to pay for the service. That doesn't mean they won't be billed for the service. It does mean that they will get the immediate care they need to stop the bleeding, mend the bones, or otherwise intervene when a health problem arises.

If you ask people in the US which country has the best health care, most are likely to say that country is the USA. However, when we look at infant mortality rates and other indicators of health care quality, the USA is not the best in the world. And, the USA is one of the highest cost systems. We spend more than other countries on health care, but don't get the best outcomes.

That's why many are looking at other national health care programs, such as those of France, Sweden, the United Kingdom, and our neighbor to the north, Canada, where we see higher levels of preventive care, lower expenditure on health care per capita, and more access for everyone to the total healthcare system. What we also see are best practices that we can import to the USA.

That's why I am starting a wiki on international healthcare, based on the Joint Commission web called WikiHealthCare. The address of the international healthcare wiki is at WikiHealthCareGlobal.com. The wiki is in its infancy, basically many pages that are awaiting contributors to fill in the blanks. I'm inviting contributors to report on any country in the world to provide information on what the country's healthcare system is like and what best practices and quality indicators there are in that system. Best practices can be in clinical services as well as in support services, such as marketing, public relations, planning and administration.

Anyone can read the wiki web site and anyone who registers can contribute information to the site. You can contribute.

Lawmaking in Washington DC

After a full day visiting my congressional delegation offices in Washington DC, which I do once each year, I marveled at how simple it is to schedule 10-minute appointments with either the representative or senator. During this day, I met with 4 congressmen and with 4 aides to my congressmen.

Access to the buildings, Cannon, Longworth and Rayburn for the representatives and Russell for the senators, is very easy, requiring only going through a metal detector and passing cell phones and cameras through the imaging machine, much easier than the experience of going through a TSA checkpoint at an airport. With a pass, I took the train underneath the Capitol to get from the House office buildings to the Russell office building.

I attended a House Armed Services Committee hearing and thanks to Representive Joe Wilson shook hands with the Chief of Staff of the US Army, General George W. Casey, and the Secretary of the Army, Pete Geren.

This is much more effective communication of your views than sending an email or letter and you get contacts who can help get the kind of legislation you want.

Furthermore, once these visits are made, you can go home and get in touch with the local office of the representative or senator for follow-up.

Combine this with visits with the representatives and senators in your statehouse and you can be a part of the lawmaking process there.

This is what American democracy is, easy access to the lawmakers on a local and national level.

A very small fraction of our people in the US vote and an extremely small percentage ever meet face to face with their representatives and senators.

This is the exercise of power.

Lunch with Rod Stewart

I had lunch with Rod Stewart, his wife Penny and their son Alastair at the Gardens Restaurant at Royal Botanic Gardens in Sydney, New South Wales, Australia last Sunday. Well, we weren't at the same table. He was at the next table.

He had finished a concert the night before and was taking advantage of the clear skies, comfortable weather, and beautiful gardens for a stroll and a meal in this pleasant open-air restaurant.

The Cunard ships Queen Elizabeth 2 as well as the Queen Victoria berthed nearby, adding about 6000 people to the parks and quays near the bridge and the opera house.
This evening they will meet in the harbor, QE2’s final visit to the harbor and Queen Victoria’s first. QE2 turned 40 in 2008. Queen Victoria was launched in December 2007, only a few months old.

Legendary rocker Stewart just turned 63 in January. Alastair just turned 2 years in December. Penny will be 37 in mid-March.

No one rushed up to Stewart asking for an autograph, although some discretely took photos. Other than wearing sunglasses when outside the restaurant, Stewart was doing nothing to conceal his classic hairdo and familiar profile from his fans.

Even though Stewart has one of the highest status and recognition levels of any of the rock and roll stars, here he had a leisurely and pleasant meal with his family in public. He signed for the credit card bill after reviewing it carefully, picked up the food containers he and his wife had brought for his son’s lunch, and followed Penny, who carried Alastair in arms, from the restaurant. It was a nice way for an obviously happy family to spend Sunday afternoon.

While Stewart was not asking for the public’s attention at all, Cunard was literally tooting the deep-throated whistles of the two Queens, saying “Look at us. Book a cruise with us.” Local papers carried articles on the amenities aboard the Queen Victoria and the history of the QE2, including service as a troop transport during Britain’s personal war in the Falklands. I suppose Stewart would have appreciated someone acknowledging his presence and asking for an autograph. Perhaps some did as the family walked the paths in this garden with trees curiously full of flying foxes. But the Queens had the spotlight and got their attention all day and into the evening from many thousands making digital images.

Cruising in the South Pacific on Cunard Queen Victoria

What’s the difference between a “cruise” and a “crossing” on a ship?
When is a ship a “liner” and when is it a “cruiser”? The two questions are related.

Right now our ship, the Queen Victoria, is cruising on her maiden voyage around the world, going west, the long way around, from New York to Southampton, which will take about 90 days. This is a one-time trip. It’s a cruise, stopping at many ports along the way. In this instance, the ship is not a liner. It’s a cruse ship.

Let’s say a ship makes regularly scheduled trips between New York and Southampton. This is a “crossing” and the ship is then called a “liner”. Draw a line between point A and point B. A line goes between two points. The true liners, such as the Queen Mary and the Queen Elizabeth were expressly designed and built to go between England and America.

The Queen Elizabeth 2 was a hybrid, designed after jet travel became the most popular way to go from America to Europe. The QE2 was designed with the knowledge at Cunard that the ship could not be profitable simply doing transatlantic crossings. It had to make its money as a cruise ship in places like the Caribbean or the Mediterranean.

This was the last major ship built that looked like a transatlantic liner. The later ships, the Queen Mary 2 and the Queen Victoria, joined the look-alike ships built to be cruise ships on tranquil seas, not transatlantic ships on the high seas of the North Atlantic. They, like the other ships being built lost their long bows and began to look more like what they are, floating hotels, with balconies for nearly everyone.

Whereas the Queen Elisabeth 2, as its predecessors, was traveling under the slogan “Getting there is half the fun.”, the later ships were in themselves destinations that just happened to make short stops at cities.

On the world cruises, people can embark in Southampton and disembark in Southampton.
They don’t ever have to leave the ship. Some don’t. The ship is the adventure in itself. Being on board became all the fun. We are told that one woman still lives on the QE2 after 14 years.

This change, from transatlantic liners to cruisers, changed the mix of passengers, from business people and professionals going between New York and Southampton as a means of opulent transportation to something to do for the well-heeled elderly and an escape from the workplace for younger people who could spend a week or two drinking Margaritas and watching beautiful sunsets and sunrises, going to shore if they pleased.

Thanks to John G. Langley, Q.C., the chairman of the Cunard Steamship Society, for giving freely of his knowledge to those of us who are just learning about the evolution of ships from sail to coal-burning steamers to diesel electric generators. Had it not been for the successful transition from transatlantic ships for the very rich to cruise ships for the common man, there would be no passenger ships on the seas today.

Aboard the Cunard Queen Victoria at Pago Pago

American Samoa historically has been significant as a place for refueling ships.

Today the Queen Victoria, the newest ship in the Cunard fleet, docked for the first time in American Samoa’s capital, Pago Pago (pronounced “pango pango”) for 9 hours to allow 1,900 passengers and some crew off the ship after 5 days at sea.

Margaret Meade, Robert Lewis Stevenson and Somerset Maugham found this island, Tutuila, and its people inspirational for their writings.

We went ashore to see what these people may have seen in the city of Pago Pago, with its 4,000 inhabitants. We found a friendly people, ready to say hello and welcome us. A tuna cannery is the major industry. We got a beer at Sadie Thompson’s and a chocolate shake at a café, Island Java, near the docks. It was easy to pick out the passengers from the locals.

The opulence of the ship contrasts with the simple shops and houses in this city. One street runs the length of the town with shops obviously catering to the townspeople rather than to the rare ship’s passengers that visit this port. We are told that only one or two ships such as ours dock here each month.

This island still looks like paradise, with its coconut heavy palms and bright flowers growing in the bushes. But the people and the plastic bottles that litter the streets and beaches do not fit our image of an idyllic people, picking bananas, mangoes, and coconuts off the trees. Obviously, there are improvements to be made here as in any of the world’s cities.

Crossing the Equator on the Cunard Queen Victoria

Those who cross the equator at the 180 degree longitude are called, we are told, golden shell backs. At 180 degrees longitude, the distance east or west is equal, on a great circle route of navigation, to Greenwich, England, the point of the 0 degree longitude.

We were pollywogs who practiced for our initiation, which included “kissing the fish”, the day prior to our crossing the zero degree latitude at about 170 degrees longitude.

Unlike the sailors of the 18th and 19th centuries who knew when the reached the equator but were unsure as to the longitude, our ship’s global positioning system, let the captain sound the ship’s whistle, knowing both longitude and latitude, as we crossed the line.

After passing the zero degree latitude and passing from winter in the northern hemisphere to summer in the southern hemisphere, we became “shell backs”, those duly initiated as having crossed the equator by sea.

Prior to our crossing the equator, we wasted a great deal of the ship’s supply of water watching the direction of the water draining in our sink. It drained clockwise. After crossing the equator, we noted that the water continued to drain clockwise, thereby debunking the myth that water drains clockwise or counterclockwise in the northern hemisphere and the other direction in the southern hemisphere.

The Coriolis effect that helps explain the direction of rotation of winds such as cyclones in each hemisphere does not apply to the direction of water emptying our bathtubs and sinks.

We have confirmed that it is true that after passing the equator on a southerly heading, the temperature does increase and it is summertime in the South Pacific. We wore coats on deck in the northern hemisphere and we wore shorts and t-shirts on deck in the southern hemisphere.

Mr. Wizard, the American TV teacher in the 1950s, would be proud of us in conducting our experiments relative to the equator. What, we wonder, are the other facts and myths involving crossing the equator?

American Way of Life

Americans may not be liked in some countries in this world, but we are not only liked but highly respected and sought after as "experts" in countries that want to bring the best in America to their country.

One such country is Poland, a huge, flat, but beautiful country with 39 million people. Whether you're in Warsaw or Krakow or Poznan, you'll find friends.

Part of the reason is that the second largest Polish city is Chicago, with over a million Poles. The Consulate of the Republic of Poland in Chicago actively bridges relations between Poland and America.

By the way, what is the second largest city in Poland? No, it isn't Krakow. It is Lodz, with about 750,000 population. Lodz, which means "boat", is pronounced something like "wootch".