A growing number of Americans (500,000 last year) are traveling to countries like India, Thailand, Costa Rica and Malaysia for medical care. Perhaps they are put at ease by the number of U.S.-trained doctors abroad and an increasing number of hospitals that are certified by U.S. insurance companies - Blue Cross Blue Shield Association includes an India hospital in its network of participating hospitals; California insurer Health Net contracts with clinics in Mexico; and West Virginia's Legislature is considering a bill that would encourage state employees to have non-emergency surgeries performed abroad. Medical tourism in recent years has expanded from primarily plastic surgery to include more medically necessary procedures like heart bypasses and orthopedic surgeries.

A recent episode of the television show Boston Legal featured the story of an HMO patient who was sent to India for a heart bypass. At the center of the plot was the fact that the patient had no choice about where she was treated. This is of course fictional, but I wonder if this might not become something to worry about for people who worry about things that might happen in the future.