Fixing Health Care

Health Reform

Click image to browse other health reform articles (90+ from different perspectives).

By Wayne Caswell, Modern Health Talk founder

An NPR story this week described a Congressional Budget Office report that tied health care to recent and future increases in the federal deficit, suggesting that the Affordable Care Act was a start but that we need much more to rein in health care costs by 2020, due to the aging baby boomers.

“A fairly accurate summary of the federal budget is that the U.S. does not have a deficit problem — it has a health care problem,” said Harvard economist and health policy specialist David Cutler.

I responded with my own ideas on reducing health care costs.

13 ways to reign in health care

1.  First, understand the economic benefits of a healthy and productive workforce, and realize that Americans spend twice as much on health care but still live sicker and die younger, per the World Health Organization. 

2.  Next, know the opposition and that the immensely powerful medical industrial complex, motivated by profit, spends twice as much as the military industrial complex on lobbying to protect its $2.8 trillion in revenues. That same profit motive is why patients are seen as paying customers, and providers work to keep them … paying … by managing disease and treating symptoms, meaning we have a Sick Care system, not a Health Care system.

3.  Campaign Finance Reform is one way to minimize the corrupting influence of wealthy special interests, including that of the medical industrial complex, and many of the suggestions here won’t happen without dampening that political influence.

4.  Invest in public health, wellness and prevention, since that’s far more effective than free market capitalism when it comes to health care. That’s why so many people call for a single-payer system like Medicare-for-All.

5.  Find ways to exploit the different public and private incentives. Private companies measure investment success in business terms such as ROI, payback period, and profit, and over relatively short timeframes (quarterly earning report). Public entities measure investment success differently, usually in social terms such as unemployment rate, graduation rate, population health, etc., and over much longer time periods, so they can justify more strategic investments. (See

6.  Understand the politics of government subsidies (e.g. corn for high fructose corn syrup and oil & gas exploration w/o adequate environmental protection) and how they affect population health.

7.  Understand the connection between poverty and the health of the nation, and how public health officials have seen differences in average lifespan of more than 20 years between affluent and low-income neighborhoods on opposite sides of the same town.

8.  Modify the curriculum of medical schools with an eye on wellness to include integrative medicine, including chiropractic, acupuncture, yoga, nutrition, exercise, stress reduction and sleep.

9.  Promote competition among payers & providers (ACA is a good start), and enable consumers to shop for the best health care value through transparency of cost and quality.

10.  Change licensure and regulatory rules to allow telehealth video consultations across state lines (and international borders), and encourage consumers to seek out medical tourism when it results in better quality at less cost by pressuring payers to cover it. (See infographic below)

11.  Encourage home health care and new delivery models as alternatives to institutional care by covering the necessary devices and home modifications. Austin, TX is taking a lead role by requiring new homes to be ADA compliant.

12.  Fund X-Prize like competitions and promote best practices in areas such as remote sensor monitoring and big data analytics.

13.  Fund medical and basic science research in universities and through grants in the technologies that will define the future of health care. (See Moore’s Law and the Future of Healthcare.)

What did I miss? Add your own ideas in comments below.

About Wayne Caswell

Wayne Caswell With decades of experience as a technologist, futurist and marketer with IBM, Dell, Siemens and his own consulting firm, Wayne knows the positive effect digital technologies can have on society and the challenges of adopting them. He introduced IBM to the Digital Home market before retiring when the company got out of consumer markets.

After IBM, Wayne established CAZITech Consulting, held leadership roles in industry groups developing Wireless and Home Gateway standards, volunteered with the FCC Consumer Advisory Committee, successfully lobbied the Texas legislature to protect the rights of municipalities to install public Wi-Fi networks, co-founded a nonprofit homeowner advocacy to enact new consumer protection laws and abolish an abusive state agency, and founded Modern Health Talk. Here’s why.

Wayne is a long-time advocate for BIG Broadband and fiber-to-the-home, because of its role in telemedicine, telework, distance learning, e-commerce, and e-government. His full BIO and portfolio is at


Medical Tourism: Crossing Borders for Health Care

Medical Tourism


Infographic transcript follows for electronic screen readers…

EDITOR: Infographic and transcript brought to you by See also:

Why Would 8 million people cross borders for healthcare?
Including 1/300 in the U.S.?

20% of Americans struggle to pay medical bills
3 out of 5 bankruptcies are due to medical bills.

That’s 1.7 million Americans
Or 248,002 in California
113,524 in Illinois
and 99,780 in Florida alone.

Who could save…
India: 65-90%
Malaysia: 65-80%
Thailand: 50-70%
Turkey: 50-65%
Mexico: 40-65%
Costa Rica: 40-65%
Taiwan: 40-55%
Singapore: 30-45%
Korea: 30-45%
Brazil: 25-40%

Over U.S. prices for the same medical procedures.

Things to Balance

High Wait Times
High Costs
High Quality Care in Many Nations
Low Cost of International Travel

But what about…

1980: $1029
2012: $926
…And it’s set to fall farther

Often it goes like this:
Flight -> Pre-procedure care nursing -> Procedure ->Post-procedure care nursing -> Flight home.

And there are so many options:
Argentina, Brunei, Cuba, Colombia, Costa Rica, Honk Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, Saudi Arabia, UAE, South Korea, Tunisia, Ukraine

And specialties

1.) Cosmetic Surgery
Most cosmetic surgery is not covered by insurance.
Most popular destinations:
Rio de Janeiro, Brazil
Chang-Gung Memrial Hospital in Taoyuan, Taiwan
For Americans:
Costa Rica

2.) Dentistry
Nearly half of Americans have no dental coverage.
Most popular locations:
Right across borders:
Americans –> Mexico, Costa Rica
Europeans –> Hungary
Asians –> Thailand

Top Hospitals:
Bumrungrad in Bangkok, Thailand
and Hospital San Jose Tec de Monterrey in Mexico.

3.) Cardiovascular
Cardiovascular disease is the number one killer in Europe, and 16.7 million die yearly worldwide from CVD. This leaves experienced CVD doctors worldwide to cater to medical tourists.
Most popular locations:
Mexico, India, Malaysia, Taiwan, Singapore, Turkey, Thailand, Korea.
Top Destinations:
Wockhardt Heart Hospitals in Bangalore, Mumbai, and Nagpur India.

4.) Orthopedics
More than 20% of Americans have arthritis, with 2/3 under 65. With better prostheses, and prices up to 80% lower than in the states, orthopedic surgery is a good reason to be a medical tourist.
Most Popular Destinations:
Bangkok, Thailand
San Jose, Costa Rica
Bangelore and New Delhi, India
Seoul, South Korea
Mayo Clinic, Minnesota
Monterrey, Mexico
Dubai, UAE

5.) Cancer
Cancer is the second leading killer in the developed world, and treatment is often prohibitively expensive.
Top Destinations:
Turkey, Singapore
Other Destinations:
Seoul, South Korea
Sao Paulo, Brazil
San Jose, Costa Rica
Delhi, Bangalore, Mumbai, India
Petah Tikva, Israel
Monterrey, Mexico

6.) Reproductive
One in six couples fall under the “infertile” designation, but reproductive healthcare can be prohibitively expensive.
Top Destinations:
Barbados, Israel
Other Destinations:
Mumbai, New Delhi, India
Bangkok, Thailand
Dubai, UAE

7.) Weight Loss
2.5 million people die of obesity associated deaths yearly, and the annual healthcare bill is massive. Bariatric surgeries cost $20-$25,000 in the U.S., but half that abroad.
Top Destinations:
Sao Paulo, Brazil
San Jose, Costa Rica
Mumbai, New Delhi, Bangalore, India
Monterrey, Mexico
Bangkok, Thailand

Joint Commission International (JCI) accreditation for hospitals and individual doctors is a good indicator of developed world quality healthcare, wherever it is.


  1. Wikipedia, Medical Tourism
  2. Patients Beyond Borders Stats
  3. Nerd Wallet On Medical Expenses
  4. Patients Without Borders, Dentistry
  5. Patients Without Borders, Cosmetic Surgery
  6. Patients Without Borders, Cardiovascular
  7. Patients Without Borders, Oncology
  8. Patients Without Borders, Fertility and Reproductive Health
  9. Patients Without Borders, Weight Loss Surgery