The political rhetoric surrounding the current efforts in Congress to extend the State Health Insurance Program provides a glimpse of what is sure to be a major domestic issue in the presidential campaign. The nation’s healthcare industry is almost certainly going to join the war in Iraq and immigration as the most debated issues in the up-coming election.

Thursday, President Bush vowed to veto a Democratic plan to expand a health insurance program intended for poor children. The current program is set to expire Sept. 30 and the president had proposed to extend the program and add about $5 billion to it. However, the administration is dead set against any expansion of the program. In his veto threat the president said that an expansion of the program was a step toward federalization of healthcare. It is not coincidental that his remarks followed on the heels of a recent question and answer discussion with the three leading Democratic presidential candidates held earlier in the week. All three, Sen. Hillary Clinton, former North Carolina Sen. John Edwards and Illinois Sen. Barack Obama, are proposing universal health coverage.

Heretofore in the universal coverage debate, one of the major non-philosophical objections to a national healthcare system was that in the U.S. we enjoy the best healthcare in the world. While that may still be as true as ever, it is becoming increasingly clear to most observers that it is also the most expensive healthcare.

In the September issue of the AARP Bulletin, the newsletter for the American Association of Retired People, there was a report that the soaring U.S. health costs are driving more Americans abroad for medical treatment. The story, “Traveling for Treatment” was not referring to the growing number of people in the north going to Canada for prescriptions and treatment or about the number of people in the southwest making a similar pilgrimage south to Mexico. There were stories of U.S. citizens taking serious trips abroad for major medical care. One testimonial was from a 61-year-old Florida man who was desperate for relief from excruciating back pain. He was worried that his insurance coverage would not cover treatment so he searched the Internet for options. He settled on having spinal stenosis surgery at a hospital in Thailand by a U.S.-trained doctor.

According to the article, the Florida man is one of an estimated 500,000 Americans treated abroad in 2006. “Medical tourism” has grown in recent years from an obscure phenomenon into a global industry. Professionals who are monitoring the trend say it is being driven by the soaring cost of U. S. healthcare and health insurance and is being fueled by the Internet, ease of travel, shorter wait times for appointments and greater international sharing of “best practices.”

But the major reason to make the journey is financial. The total bill for the Florida man’s back surgery was $4,618.03 the newsletter said. In the U.S. his out-of-pocket costs would have been at least $14,000. Even when one factors in the costs of travel and recovery time staying somewhere miles from home the savings are significant. That is the simple answer for many of the Americans considering an overseas alternative it’s the only way to get needed treatment without devastating their savings.

The article said that the trend is also being driven by some U.S. companies and insurers anxious to lower care costs. They are urging employees to consider being treated in one of the growing number of countries that cater to foreign patients. In addition to Thailand, those countries include India, Singapore, Hungary, South Africa, Dubai, Costa Rica and Brazil. Thailand, however, remains a top destination with one hospital alone, Bumrungrad, treating 64,000 Americans last year, an 11 percent increase over 2005. The hospital’s CEO said many of the patients they see belong to the “gap group,” people ages 45 to 64 who are either early retirees or workers who have lost employer benefits or are self-employed. They consider themselves relatively healthy and then suddenly they have to have a major operation and they are facing a $40,000 to $50,000 bill with no health insurance.

A global perspective has been prominent in the business and industrial world for many years. I guess it was only a question of time when the same economic factors that drove many businesses overseas would drive U.S. citizens abroad. The gap between the healthcare costs of medical procedures in the U.S. and countries like Thailand is huge. It is time to have a national debate.

Robert Brincefield is publisher of the Brownwood Bulletin. His column appears on Sunday. He may be reached by e-mail at