I’m hoping Dean Baker wrote this in a Swiftian modest proposal sort of way, but he’s actually raised this many times before, so I’ll take it seriously:

Just as people in the United States can benefit from buying cheaper steel or clothes produced in other countries – and those countries can benefit from selling these products to us – we can also gain from getting cheaper medical care in other countries.

However providers of medical care in the United States, drug companies, medical equipment suppliers, doctors and others who benefit from high prices, are far more powerful than steelworkers or textile workers. As a result, the trade deals we have been writing over the last three decades have not been designed to facilitate medical trade.

This is where Bill Gates and his fortune could make a huge difference. Suppose he established an insurance company that gave people the option of getting some of their health care in other countries. The potential savings would be enormous. For example, according to the International Federation of Health Plans the average cost of a hip replacement in the United States is $40,400. The average cost in Spain $7,700 and in Argentina just $3,400. For heart bypass surgery the average cost in the United States is $73,400 compared with $12,400 in Chile or $8,900 in Argentina.

The insurance could be structured so that people in need of these services could still get them in the United States and be covered as they would with other standard insurance policies. However they could also have the option of using high quality facilities in other countries and splitting the savings with the Bill Gates Insurance Company. To ensure that the population of the receiving country benefits as well, the insurer could pay 10 percent of the cost to support the training of additional doctors and other health care professionals in the country.

Imagine someone needing bypass surgery chose to get it in Chile. Their half of the $60,000 in savings would be enough to cover the airfare and hotel stay of several family members for several weeks and still leave tens of thousands of dollars to put in the bank. The same would be true for many other expensive procedures; patients would see an enormous dividend from escaping the wasteful U.S. health care system.

Baker then goes onto describe how this would lower costs in the U.S. I’ve discussed this before, but I’ll mention this again: this is a horrible idea.

This is what happens when everything is perceived as an economic problem. I would argue the greatest threat the U.S. healthcare system–not payment system–but the part that, you know, tries to make people healthy–is antibiotic resistance. If we lose the ability to reliably combat infection, especially in the subgroups that routinely need procedures (and are less able to cope with infections to begin with), this will result in thousands of needless deaths every year. Medical tourism is an excellent way to transfer multi-drug resistant organisms.

Bacteria don’t do budget negotations. They don’t change resistance patterns in response to an election. They just keep evolving resistance. I greatly respect Baker for his yeoman’s work on fighting Social Security and Medicare idiocy, but this is a really bad idea.

Disclosure: I am not an MD, nor are any family members. In addition, none of my research is funded by hospitals or drug companies.