I have to admit I have skipped an occasional write-up when you were hitting the medical issues, but I really thought some about today's idea of thai and indian clinics opening in mexico. my doc, a good guy, suggested a colonoscopy a couple of years ago. I'd had one 12 years before and said ok. off I went and $5000 later i was deemed fit for society - no shit! I was stunned; my doc was too.

Recently I saw where the same procedure is done in india for about $700. Ironically, the doc who did me here in maine was indian. we used to get all our drugs in mex. I think you are onto something. a local supermkt is offering outsourcing to singapore of knees and hips as an alternative in its health insur. plan, and i think humana is doing something similar in the southern u.s. Something does have to give. My only caveat would be the Asian surgeon in a prison where I worked. He had the nastiest post-op infections--but then he only operated when drunk.

I am always amazed on how the american health system and other economic systems operate. We all know that junk food, alcohol, cigarette smoking, lack of exercise and just plain complacency, etc... are the core of all health problems in America but we don't do anything to "prevent" them.

What would happen if local and federal agencies just prohibit companies to expend and sell items that are just bad for your health? I am sure that many would scream and cry because their "american freedom" is being co-opted, that they should do what they please with their bodies and brains. I see that freedom to do what we want has been corrupted and distorted for monetary gain. It is so much cheaper to prevent than to cure but then there is no money to be made in that effort. Some companies knowingly keep poisoning the american people just to keep their money making systems rolling.

It is truly immoral to use the name of the "american people " slogan only in times of support and elections. After that is business as usual. I think this great country is being destroyed from within.

Outsourcing medical care would shock the system a bit, but I don't think you'll ever have enough of it to make a difference. And like I said, it's a stopgap that only exists until India is rich enough to keep its own doctors busy. Sometimes stopgaps are the best you can do, but as you point out, Medicare will eventually become a crisis unless medical inflation is tamed.

The question I have is this: Shouldn't you be able to offer a 1980 standard of care for the same price (in real dollars) today? No one thought medical care was horrible back then, and primary care is probably not that changed in the last 30 years. In fact, I think that before HMOs started to crack the whip, doctors had more freedom, less paperwork, and spent more time with their patients than they do now.

The drugs they used then (even the name-brand ones) would all be generics now, and should be cheaper to produce. So should all the medical equipment. It can't have become more expensive to build an X-ray machine in that time! So offering that exact same standard of care should cost less in real dollars than it did then, and much less than it costs now. And many people would be happy with it.

There are hints of that in the system now, from cheap drugs at Wal-Mart to cheap eyeglasses at these mall places. I wonder why retail medicine cannot go down that route. Just fee for service, cheap doc-in-the-box places. If you want more attention, with lots of tests and a specialist, then you'd have to pay. But as we both know, the vast majority of effective health care is primary care, and it should be a lot cheaper.

If we had cheap primary care and more expensive specialists, I think a lot of this debate would resolve itself. People would not think they've been abandoned by the system -- they can see a doctor. But when the diagnosis of cancer or heart disease comes, they would have to face the fact that another $100K might or might not get them a few years of life. If you want that, get insurance. We could even subsidize insurance for poor people, provided there's enough money. But all the routine stuff is cash only.

I'm not advocating a government program, because they'd mess it up. They'd require the clinic have a huge staff, make them liable for errors, and insist insurance cover everything from the first dollar. What I'm wondering is what legal barriers keep the simple retail system I'm thinking of from being tried.

As for diabetics, there's either going to have to be some innovation in treatment, or else people are going to be managing on their own. There aren't enough doctors to supervise millions of chronically ill patients. Just as there aren't enough to treat Alzheimer's in the boomer generation, when it comes to that.

I liked your article on our national medical problems. Here are a few comments.

Back in the early nineties Senator Phil Gramm made a very astute comment. "If there was Grocery Insurance, food would be very expensive and everyone's dog would eat very well."

Several years ago a billboard appeared in Canada. It said "If you have a cold and you go to the doctor, it lasts about seven days. If you don't go to the doctor, it lasts about a week."

Perhaps insurance by itself is a major factor in our medical expenses? Possibly a little more market influence would help. Walmart hospitals? Less government influence by the AMA? You commented on outsourcing, and I think that appears to be one of our few hopes.

To my way of thinking, the medical-industrial complex is far more evil than a corporation such as Haliburton. Since folks have no choice, they have to use it and suffer large numbers of malpractice deaths and bankruptcies. It's not like buying a car.

Generic meds are far cheaper than the latest versions and often nearly as effective. Patents expire 20 years after application is made. Folks weren't dropping like flies in 1988 because of ineffective meds. This tells me there is hope for less expensive drugs in the near future.