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New Knees for Old

? Brad Setser (almost) throws in the towel |


| Downward productivity revision coming ?

August 01, 2006

New Knees for Old

Michael Mandel

First, an apology to my readers (if any are left by now). It's been almost a month since my last post, as my spare time and attention has been absorbed by my wife's second knee replacement operation--the right one was done 18 months ago, this time it was the left.

She's still young (tell her I said so!), and expects to go back to dance classes after she recovers. And apparently she's not alone. According to a July 31, 2006 article in the Baltimore Sun

By 2030, the number of knee replacements in the United States is expected to jump 673 percent to 3.48 million, according to a study presented at the American Academy of Orthopaedic Surgeons' annual meeting in March.

Hip replacements are expected to grow 174 percent to 572,000.

"Prior generations lived with a little limp. But baby boomers are the first generation to try to stay active on an aging frame," said Dr. Nicholas DiNubile, an orthopedic surgeon in Philadelphia who has seen the number of patients in their 50s and younger swell in recent years.

A little limp. A little limp. Pre-knee surgery, my wife didn't have a little was more like a knee that would buckle at random moments. Airports were completely unmanageable.

The question, though, is whether all these knee replacements will be done in the U.S. or somewhere else, like India, at a much lower cost.

11:29 AM


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Having knee issues myself, I sympathize with your wife and I wish her a quick and successful recovery.

I turn to your question of medical globalisation. I believe that if the medical industry cartel of providers and insurers continues in the United States we will see a few people crossing borders to get medical care, but most will be unable to do so and our health care crisis will accelerate. Our medical costs are outrageous. "In 2003, the United States spent $5,635 per capita, or almost two and a half times the amount spent by Canada, France, the United Kingdom or other industrialized countries."(1) The result? "The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance."(2) The government needs to end this cartel which is accelerating prices at three times the rate of inflation and could be crushing our economy. While I support a single-payer health care system(3) which eliminates the insurance companies at the center of this cartel, there are many ways we could end this situation and I'm sure others have other solutions worth discussing. I anticipate that you would argue that competition from overseas providers would eventually drive down costs here. However, I find it unlikely that most people would be willing, or able, to fly to India for a surgery. It makes much more sense to have the health care provided here and the inconvenience levels provide a barrier-to-entry that I think insurmountable by foreign providers. To fix our health care system, we need to eliminate the health care cartel.

(1) Dr. G.F.Anderson, Johns Hopkins Univ,

(2) World Health Organization report,


Posted by: Brandon W at August 2, 2006 09:58 AM

Hi Brandon,

Thanks for the good word. Here's an interesting price list comparing british prices to indian prices, for various medical procedures. I haven't been able to find a comparable U.S. site yet.

Posted by: Mike Mandel at August 2, 2006 10:03 AM

A primary reason we spend more per capita on health care is that we can afford to, and the health care is there, avaiable to be bought. For the most part there's not some government overlord explicitly denying care to needy patients; banning commercials for new drugs in order to keep the population from learning about them (because, you know, that increases demand); and/or creating a lack of available care in the first place.

Not that a lot of things don't need fixing -- I just like to point that out. My current pet peeve is that I'd love to have an HSA account, but none is available through my company's policy. So I'm missing this opportunity while I'm young & healthy to rack up savings in that type of account. There is a lot of insurance companies and policies, yet there's not sufficient retail competition for health care insurance and that's one example. (Certainly one reason I immensely dislike the single payer idea -- that's worst case.)

Competition at every step is good. When my UK colleague was visiting, he was totally nonplussed to see an Emergercy Room facility advertising on a billboard, and asked why they did that? I was surprised at his confusion over such a mundane thing -- and he was equally surprised to learn that people had a choice of where to go for emergency care.

Anyway he was quite taken with the idea and felt that that must lead to better care than he gets in the UK.

Posted by: Kevin at August 3, 2006 04:35 PM


I thought you might like to see this article:

Posted by: Brandon W at August 4, 2006 02:02 PM

Since my knee must remain attached to my body during the procedure, and the rest of me is unwilling to travel to India for the operation, I see a continued need for local talent on some level. That aspect of the process aside, there is tremendous opportunity to globalize my knee. The instruments and replacement parts could come from one country, while the diagnosis software could be written in another. The processing of the claim and administrative function could occur in a third. I don't know what portion of our health care costs must stay local, but I suspect a significant portion can and will be sent abroad to a lower cost provider. - pjw

Posted by: Patrick J. Walker at August 4, 2006 03:52 PM

I've seen a lot of Americans wearing dark glasses in dark hotel lobbies in Costa Rica. They go there for cheap plastic surgery. If you'll travel to fix your face, I don't see why knees are any different. A north-south flight to the same time zone is a lot less taxing than a schlep to India.

Posted by: steve baker at August 6, 2006 09:48 PM


A knee is major surgery, and a much bigger deal than plastic surgery. That probably restricts the number of places that are acceptable.

Posted by: Mike Mandel at August 7, 2006 03:14 PM


I noticed a term on a yahoo article this morning that I had never heard before, "Medical Vacations." Here is the link:

Perhaps knee surgury in Mumbai is not far off for many Americans. - pjw

Posted by: Patrick J. Walker at August 9, 2006 08:47 AM

Medical tourism, medical vacation...appeals to those who don't have good health insurance coverage, but do have enough money to travel.

Posted by: Mike Mandel at August 9, 2006 10:28 AM

That is the question, is the healthcare system going to be able to cope with the increase of needed knees and hip replacements surgery? the same broblem is faced in Europe where patients are having to travel abroad for affordable medical and surgical treatment.

Posted by: knee replacement at August 17, 2006 03:13 PM

Here's to a speedy recovery for your wife.

Posted by: Dr. Frank Pedlow at September 15, 2006 12:21 PM

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