Last week I wrote an article outlining my opinion on Medical Tourism within workers’ compensation, and why I believed it would never really work for our industry. I had intended to write that as a “one off”; to speak my piece and move on, not really planning to address it again. However, follow up comments and responses, both in my blog and on LinkedIn, have compelled me to revisit the topic.

While almost all feedback has been quite positive to my message, the gentleman who has been the most fervent proponent of the concept left a lengthy comment on my blog, implying I am stupid and directly calling me a “despicable person”. He then wrote an article generally lambasting opponents of medical tourism in comp, with one section particularly critical of those who believe in “American Exceptionalism”.

I have no intention of taking this discussion to a personal level. I am a firm believer that debate is best accomplished when you “challenge the concept, and not the individual.” Therefore I would like to address the content of the response, specifically the part concerning American Exceptionalism.

If you read my original article, found here, you will find I used humor and absurdity to make a serious point. You will also see that I am actually not very critical of medical services or facilities available in these medical tourist destinations. I was extremely critical, however, of the concept that we could compel, cajole, or otherwise force injured workers to potentially distant, strange and exotic locales solely for the benefit of saving the insurance company and employer money. The issue really was not “quality of care” (although there are serious considerations, particularly for recovery and follow up treatment); the issue was the process of that remote care when directed under the exclusive remedy umbrella of workers’ compensation.

That said, I will now move on to counter the criticisms of American Exceptionalism by unabashedly embracing it. I do believe we have been, and still are, an exceptional nation in the world. We are by no means a perfect country, but our free and open society has accomplished tremendous things in its relatively short history. I am proud of our heritage as that shining city on the hill that has drawn legions of immigrants to our shore, looking for opportunity and the better life it offers. I lament the apologist mentality that now grips many, including leadership in this country. Anyone who suggests that we have not had profound influence across the globe in our short 238 year lifespan doesn’t properly comprehend history. It doesn’t matter if you dislike the influence that we have wielded, the influence itself is undeniable.

And that is exceptional, my friends.

The United States has been a leader and innovator for the world in many areas; including equality, human rights, manufacturing processes and regulatory oversight. And while most of Europe and some other countries have equal and at times superior methods and results, we should note that the medical tourism crowd isn’t talking about sending workers to France, Canada or Sweden. Those and other developed countries are not on the medical tourist travel brochure.

And if we are being truly honest about things, we have to admit things are different in other parts of the world. Medical tourism boosters will admonish us that “the economy is going global, so we had better get on board.” There is no doubt that, in an economic sense, geographical borders are becoming blurred and far less defined. But from an anthropological sense, factoring in customs, heritage, and regional views and attitudes, it has not changed much at all.

Russian Omsk Cheese workers bathing in production milk

These aren’t Wisconsinite’s splashing around in a giant tub. No, this disgusting image, which has been all the rage in the news this week, shows naked Russian cheese factory workers bathing in milk that is on its way to be made into cheese and consumed by humans. There are also videos of these men, in shorts and bare chested, handling and tossing the cheese in what appears to be highly unsanitary conditions.

Or we could look to Pakistan, where a 9 month old baby boy was charged last week with attempted murder, because he is accused of being with his family during a rock throwing incident. Not to worry, though, he is out on bail (seriously, 9 months old, and he is out on bail!), and has a lawyer, so the system is working well for him.

In the last two years, almost 1,500 Bangladesh factory workers have been killed in fires and structural collapses due to that country’s terribly lax building and regulatory standards.

These examples have nothing to do with medical tourism, but they highlight social mores and standards that are vastly different than our own, and display a blatant disregard for the value of human life. These things matter, and both societal standards and process controls must be considered when we are talking about sending people, at our behest, to medical facilities removed from our culture and control. Advocates point to excellent facilities in Mexico, Costa Rica, Colombia and India as examples of where workers’ could be sent. I ask you however, if those travel floodgates were to open in a competitive global economy, could Pakistan or Bangladesh be far behind? Ponder the implications of that for a moment….

The medical tourism cabal and their carnival barkers are right about one thing. Our medical fee for services system is broken, and neither the injured worker nor their employer is being served well by it today. We must do better, and we can. I believe the answers lie here at home in the form of preventative care and outcome based medicine. It exists in ownership of process and a nationwide commitment to return to function. The answers are not easy to define, or simple to achieve, but as exceptional Americans we can meet these challenges. For workers’ compensation, the answer is right here, at home. It is not in Costa Rica, Bangladesh or Turkishmaninacanstan.

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