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Amanda, The problem with our medical care here in the US is that it’s based on an economic model that is a disaster. Quality has caved in to the adoption of directives here that remove the humanity from healthcare, employing hospitalists who do nothing other than provide the hospitals with more income. Putting all physicians in a particular discipline from the insurance companies point of view are all of equal education, knowledge, experience, compassion; “pick anyone from the list we sent you. They are all equal.” Primary care is about to disappear if reimbursement stays so much below the “specialists.” After all, it is the primary care physicians who provide them with the patients they see and charge inordinate amounts. In today’s Dallas newspaper, they talked about a man who had an aortic valve replaced and the total bill was over $95,000. That is where “medical tourism” has its place, again not because the care is better, but because it is cheaper. But don’t ever forget that the wealthy Indians, Thais, and others who have sufficient money, all want to come to the US, where cost is not a problem. In the Houston Medical Center, all signs from everything for hotels, transportation and all hospital directions are in English, Spanish, Arabic, and Chinese. Those folks wouldn’t stay in their home country for anything. So medical tourism is a way for the insurance companies to approve care overseas, ONLY BECAUSE IT WILL COST THEM LESS. Dr. Bob Kramer 214 676 5692 office 214 522 8040 fax drbobkramer@pol.net

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