1) “YET…”
this is a highly questionable assumption.

2) “If patient satisfaction in other countries is better than in the US (and I don’t think the two articles you cited prove that assertion),”
-my point actually was that patient satisfaction is no worse in other countries. this is a major detail. if a more “socialized” system sucked as much as the critics say, why are there patient satisfactions often better than in the US?

your explanation for this further proves my point (or what would of been my point had i responded earlier). our system routinely ignores a large chunk of the population while spending twice as much as some other countries for poorer total outcomes in a lot of measures.

“On the other hand, countries with socialized medicine make routine medical care more accessible and then ration expensive care, providing the most “good” for the funding spent.”
which is why my personal preference is for a government run “basic” plan with the option to purchase additional insurance on the side.

3) “My impression is that import and export of medical tourism in the US occurs for different reasons (and this is just conjecture on my part).”
- i think your conjecture is partially right and partially wrong. first, i am aware of very few countries that disallow a person to pay for faster care. when i was lived in canada this is what i occasionally did mainly because the $50 cost of a PCP appointment was trivial to my worrying parents. second, the people who come over here tend to be wealthier than average. these people can (and do) go anywhere they percieve they will get the best treatment. third, i think you are grossly underestimating the lengths of waits in the US. some studies have pegged the average wait time for certain US doctor visits. elective ortho surgery (IIRC) has a 4-6 wk wait, the neuro group i was training under has a 3 month wait. fourth, i would hardly consider open heart surgery “mundane”. The renowned CT surgeons i worked under for a while can attest to the fact that the US, india and several european countries have very similar outcomes for CABGs at a fraction of the price. fifth, i am uncomfortable with the ethics in the belief that only those who can afford it should get care. and as long as we live in a democracy, that is important.

Ummm… because last time I checked the U.S. wasn’t a socialist country

Great post whitecoat. I agree completely.

YET…

If patient satisfaction in other countries is better than in the US (and I don’t think the two articles you cited prove that assertion), my belief is that the difference lies in the perverse entitlement system we have in the US.
A majority of citizens require routine medical care while only a small minority routinely require very specialized care.
In the United States, there is no entitlement to “routine care.” Therefore, when a majority of the public is unable to obtain routine care, it gives the system low grades. Instead, the United States creates an entitlement to “emergency care” through federal EMTALA laws. We then spend inordinate amounts of money on the unhealthy few, leaving those who need routine care (including children) without.
On the other hand, countries with socialized medicine make routine medical care more accessible and then ration expensive care, providing the most “good” for the funding spent.

My impression is that import and export of medical tourism in the US occurs for different reasons (and this is just conjecture on my part). Sick people with money come to the US for expensive and timely treatment because they cannot get the same treatment in their system in a timely manner, or they just can’t get the treatment in their system at all. US patients (who have significant wealth compared to the patients in most other countries) with more mundane medical problems go to other countries where they can receive the same treatment for less money.
Perfect example of market forces at work.
If you have a unique product, you will receive more money for it until another entity can reliably replicate it. If you have a common product, then you must either create a niche (luxury hospitals) or you must lower your price point.

but i’d point out two things.

1) patient satisfaction in other countries are greater than or equal to that of the US. i’ve yet to see a comparison ranking the US higher. here’s one about taiwan, here’s one between several different countries, and the new physician magazine had a good article on it a couple of issues ago.

and 2) medical toursim (as you’ve pointed out here) works both ways. plenty of people leave the US to get medical care in other countries.

as an aside, why is the comparison always made to canada? it’s not known to be a particularly good example of a national health care system. oh, never mind, i just answered my own question.

“Convert to a “loser pays” tort system…Most other countries in the world use some form of a “loser pays” system (are there any that don’t?) Why is it that the United States is so far behind the curve?”

Most other countries in the world also have a “socialized” system of healthcare. I’ve yet to see you argue for that though. Why is the US so far behind the curve?

It is amusing that the sovereign immunity might be the method that universal coverage leads to better medical care. Of course, the way things are going, eventually everyone will work for the government. 100% taxation? I don’t need the whole $700 billion right now. I’ll take it on the installment plan.