Seeking Medical Care Overseas, at Lower Cost

Monday, August 12, 2013

Elisabeth Rosenthal talks about the high cost of hip and knee replacement surgery in the U.S., and the growing popularity of having surgery overseas. Her New York Times series, Paying Till It Hurts, is about the cost of medical care in the US. Her most recent articles are "In Need of a New Hip, but Priced Out of the U.S." and "The Growing Popularity of Having Surgery Overseas." She's joined by Michael Shopenn, who was the subject of her article.


Elisabeth Rosenthal and Michael Shopenn

Comments [19]


John A: Maybe my comments were confusing to you, but please read them again. I agree that fullpayers pay more than insured. That's my whole point: THEY SHOULD. The reason an uninsured FullPayer is paying so much more is because they have skipped out on all the years of paying when they are healthy. The reality is that while an insured person reimburses less, they pay whether they are sick or not. Insurance premiums are collected during healthy and unhealthy years. So the healthy pay more than they use, and the unhealthy use more than they pay. In a perfect world these numbers balance somewhat.

The moochers, however, decide to skip the healthy years, and just want coverage when they are sick. Or they complain when they have to pay out of pocket some ridiculous huge number when they are sick. Well, that's just several years of healthy premiums all bunched up into one. The insured pay over time, over several years. The uninsured get the bill all at once. Don't complain to me about mooching off the system.

I agree that it is difficult to get insurance outside of work. As a self employed individual, I pay crazy premiums for my family. But I pay them. Because that's how the system works.

Anyone complaining that the uninsured pay too much sure wasn't complaining all those years they were healthy and paid NOTHING into the system. Stop complaining and participate.

Aug. 12 2013 05:23 PM
Lonnie Hanauer, MD from west orange

Ms. Rosenthal's article was so misleading as to make me, a 65 year NYT reader, worry about all of their critical articles. Close to the majority of hip replacements in the US are paid for by Medicare (and the majority of the balance by commercial insurance) which pays the surgeon $1400 , not $8000. Hospitals may bill $40,000 (an unfair practise) but insurance companies and Medicare will reimburse less than 1/4 of that. Devices are overpriced and MC may pay too much but far less than noted. Those with NO insurance and with finances are often billed a lot but they are a SMALL minority Obamacare should help that. I missed the first 2/3 of your discussion with her but her article was unfair and i hope you covered that.

Aug. 12 2013 02:10 PM
Dana from Brooklyn

I agree the overall cost is inflated, but the guest is overlooking some import parts of this system. A cost of 150-300 for a hip would just be the basic manufacturing cost; it misses the safety surveillance, regulatory, quality oversight of manufacturing, and innovation costs. Also, the reason manufacturers can sell joints more cheaply in Europe is that they depend on the US (and Japan) markets to cover all the other costs. A good question is whether the US should be subsidizing the medical costs of Europe and how we can change this system.

Aug. 12 2013 02:05 PM

Single-payer advocate Marcia Angell, M.D. on the Affordable Care Act:

"Obamacare is simply incapable of doing what it is supposed to do -- provide nearly universal care at an affordable and sustainable cost." -

Aug. 12 2013 02:00 PM

hjs -- your comment will probably become true.

Aug. 12 2013 01:59 PM

"Has your guest considered what you would do in the event of a complication?"

Due to unwashed hands of doctors and nurses (i doubt wearing scrubs in public helps either), a large percentage of patients in the US get sick simply because they went to the hospital. After years of fighting, hospitals are now required to release that percentage.

I wonder if your experts have comparable stats for foreign hospitals? Is there a place where they are clean?

Aug. 12 2013 01:58 PM
genejoke from Brooklyn

"I fully expect to need a new knee. I'm a jogger blah blah ..." Go pay for it yourself, lady.

Aug. 12 2013 01:57 PM
john from office

What about mal practice or if the product is defective. Who do you sue and can you sue??

Aug. 12 2013 01:55 PM
David from Fredericksburg, VA

@ John A
"Obtaining medical insurance outside of work was often impossible before the federally mandated exchanges, or did Shawn miss that?"

The exchanges still aren't up & I've been purchasing health insurance myself since 2007.

I agree it is very expensive - I have very little faith that Obamacare will fix this. I suspect the exchanges will either fail to save money or will pay something like medicare (or even medicaid) rates & therefore it will be very hard to find a participating doctor.

Aug. 12 2013 01:53 PM
David from Fredericksburg, VA

Prices should go down over time?

I'm sure glad houses cost half what they did in the 1960s!!

People aren't widgets, but this guest is a bit of an idjit!

Aug. 12 2013 01:50 PM

Maybe insurance companies should send us to Europe to save themselves money.

Aug. 12 2013 01:50 PM
John A

Shawn seems to have also missed the reporting of the NYT for decades, saying that prices for the insured in ths US are often 1/3rd what they are for fullpayers.

Aug. 12 2013 01:43 PM
Amy from Manhattan

Most people who need surgery couldn't afford "only" $13,600 to go to another country to have it done. What the hell are *they* supposed to do? How much will PPACA help w/this when it goes into full effect?

Aug. 12 2013 01:42 PM
John A

Obtaining medical insurance outside of work was often impossible before the federally mandated exchanges, or did Shawn miss that?

Aug. 12 2013 01:37 PM

Ask this guy where he's going to go if he has an issue. I'm not saying he will, but there is a 1% infection rate for even the best joint replacement.

The price for a joint depends on contracts that the hospital has with the manufacturer. So it's not $13,000 for a joint prosthesis.

The fact is the hospital needs to make money off people who can pay, because they give too much free care to those mooching off the system. It's not $100 for a Tylenol. It's the same price for everyone, but people dont have insurance so the hospital has to get the money from the guy who does.

Aug. 12 2013 01:36 PM
Me from Bergen

The surgeon's fees for a total knee replacement from Medicare: $1,697. Total hip replacement: $1588.

That is a 90 days global period too, so you get all your follow up for 3 months included there.

This is not a doctor problem. It is the hospital and the fact that healthy people mooch off the system until they need it, then they sign up and pay in.

Aug. 12 2013 01:31 PM
Shawn from Bergen County

THIS! This is why medical care is expensive. This guy sums it up.

Healthy for years, so he doesn't need real health insurance. So he doesn't pay in. And he saved money without having good insurance.

So then he needs it. So he signs up JUST when he needs it. And this is why we have a problem. Everyone should have insurance. The healthy pay for the unhealthy.

5 bucks says this guy is a liberal who feels that we should redistribute the money from the rich to the poor. Yet the money from the healthy to unhealthy? No thanks for him!

Aug. 12 2013 01:27 PM

I am certain I will get medical care overseas at some point as I am often shocked by the high cost of medical care in the US even though I have good insurance. I would probably go to India or Thailand or Singapore for care. It would be helpful if there were reliable ways to research the quality of care in other countries.

Aug. 12 2013 01:27 PM
meesh ess from queens

for the cost, dental work in the US is THE WORST!

believe it or not, i got a root canal done in an eastern european country for $100... WITHOUT ANESTHESIA OF ANY KIND! it's been about 6 years since and ZERO issues!

compare that to about $1,000 (min) and endless nightmare stories of US root canal disasters!

Aug. 12 2013 12:25 PM

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