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The shifting geopolitics of medicine

There was a time when every aspiring medical student around the world dreamed of passing the necessary exams to obtain a residency position in the US, and for good reason. The money was better. The last twenty years have seen a progressive deterioration in the working conditions of the medical profession, with an all out assault by the insurance companies on hard working doctors, who to all intents and purposes have become indentured slaves. The US has the highest educational fees for medical school in the world, the highest medical malpractice crisis and the predictably dwindling autonomy associated with the implementation of the Affordable Healthcare Act. Large numbers of physicians in their fifties are retiring early simply due to the fact they are unable to maintain the business, and to make matters worse the public view the profession as greedy money hungry disease profiteers.

The US medical profession has no one but itself to blame for this ignominious end, which has been in the works for the last twenty years, thanks in large part to the bribes paid by the insurance companies to both state and federal governments, in exchange for the introduction of draconian laws that heavily penalize physicians should they unknowingly step the wrong side of these many legal lines. It is almost unheard of in any other country that most physicians will require the legal services of self appointed healthcare law attorneys to guide them through the morass of pointless regulations.

American healthcare has become the monster it tried so hard for many years to avoid, and as a consequence many of its best and brightest talent are leaving for the shores of nations with reasonable healthcare policies that discourage frivolous medical malpractice lawsuits, and encourage the fair reimbursement of clinical services. However the most relevant force in this migration is the search for the respect that physicians once received in the US. This non-tangible element of the contract between society and the profession counts for more than the dollars and large shiny hospitals that have come to represent the waste associated with US healthcare.

The ACA miserably failed to address the medical malpractice crisis, most likely because most of the individuals drafting the document were lawyers, who no doubt had many colleagues on the medical trial bar, and how could they in their conscience cut into the gross salaries their friends made, even if it improved the overall healthcare system.

The global healthcare market has watched the deterioration of the US model over the last twenty years learning from their mistakes and committed to not repeating them. One example of a healthcare model that is gaining ground in both its efficiency and high quality care is the one that belongs to the emerging superpower of India, whose entrepreneurs have spent the last two decades scouring the globe for inefficient systems with the promise that their state of the art hospitals can provide higher quality care at a fraction of the price. This savvy business move has paid significant dividends and established India as the model against which all other countries are now comparing their medical tourism configurations. The Indians realized early on that there was an excessive amount of waste in the western world that was unscientifically based on a number of theories centered on the internal processes of the operating room. In addition due to the high volume and lack of medical litigation Indian surgeons became far more proficient than their western counterparts in the technical completion of both simple and complex procedures, which consequently allowed them to offer their services at a much more competitive price point without compromising quality.

The rest of the world is just beginning to wake up to the fact that healthcare is now a global business, and the parochial rules of protectionism are fading into the distant mist to be replaced by young forward thinking healthcare entrepreneurs. This group of young Turks are technologically informed and have developed systems that are able to deliver both surgical and non-surgical care to patients anywhere in the world without the constraints of local medical boards. Their guiding forces are the same forces that select the best companies in the markets of every other industry, and should a medical service fall below par then one can be assured that the company involved will not survive, in contrast to the relatively inefficient centralized healthcare systems of old, where many mistakes were conveniently swept under the carpet.

The future for the global healthcare sector looks optimistic and as technology is adopted by what used to be called ‘third world’ countries the market for product sales will grow exponentially. Africa, India, the Middle East and South America are enormous markets that dwarf the US and so it is no coincidence that numerous US companies are desperately attempting to enter these lucrative arenas hoping to ride the economic wave as the tide turns against the once profitable US market. The implementation of the ACA has without question some redeemable features and an abundance of good intent, but intent never paid the bills and one of the first casualties of these historical pieces of legislation is the curtailment of innovation. However one should not fret that the world of medicine is going to come to a screeching halt, for the baton has been quickly picked up by both the Chinese and the Indians, who because of their visionary risk taking entrepreneurs are poised to head the global healthcare pack into the 22nd century.

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