 Free-marketers like to talk about health-care reform in terms of empowering consumers to spend their dollars in more efficient ways -- for example, by letting them see what different doctors and hospitals charge for the same procedure, and how their results vary. Paying more doesn't guarantee getting better health care; in fact, there may be no relationship at all. Just look at the United States, which spends far more than any other country on health care but still trails in some key indicators.
But the wide variation in the cost of health care also creates opportunities for those willing to travel in search of a better deal. And now, the nation's largest health insurer, WellPoint, is starting to pay their way.
WellPoint is conducting a pilot with Serigraph Inc., a specialty graphics company with operations in Wisconsin, Mexico and Asia, that gives U.S. employees the option to travel to India to have surgery on a non-emergency basis, said WellPoint's Paul McBride, vice president of health care management and services. McBride was speaking at a panel on health-care economics at the Milken Institute's Global Conference today in Beverly Hills. The India option makes sense for Serigraph, McBride said, given that a number of its employees come from that country. The cost of care is about 80% lower, largely because of dramatically lower charges for labor, drugs and medical devices, McBride said. Yet he contended that the results of the care were at least as good.
One conference attendee -- Dr. Sally Andriamiarisoa, vice president of advancement at Riverside Community Health Foundation -- questioned the morality of the arrangement, arguing that the U.S. shouldn't be consuming other countries' scarce health resources. Andiamiarisoa, who is from the Indian Ocean island nation of Mauritius, said the practice wasn't fair to countries that, to conserve their meager health-care dollars, do much more to promote wellness than the United States does.
But the globalizing health-care industry is already positioning itself to take advantage of the national differences in treatment costs. McBride said Apollo Hospitals, India's largest health-care delivery system, is actively seeking deals with insurers in higher-cost countries to attract patients from overseas. He couldn't say whether Apollo was trying to fill excess capacity or simply increase profit margins.
There has long been a global market for cosmetic surgery, with patients traveling far and wide for deals on liposuction, gastric bypasses and dental work. What's different now, McBride said, is that traveling for medical care is starting to move into mainstream insurance coverage. WellPoint, which is looking to expand its pilot program, is focusing on cardiac and joint-replacement surgeries that require about a two-week hospital stay. The choice to travel will be the patient's, and he or she they won't have to go to India, McBride said; there may be significant savings available from hospitals within the U.S.
The Times editorial board puts paid to teacher tenure. Tenure, the board says, protects the few bad apples among teachers and a better system is needed. Teachers deserve meaningful job protection. Senior teachers should feel safe from administrators who could save money by hiring lower-paid beginners and from parents who can turn vindictive when they don't get their way. Instead of sheltering weak instructors, though, teacher contracts should specify fair and effective ways of assessing their performances -- and ushering them out the door.
 Over on the Op-Ed page, columnist Patt Morrison also takes on education and says the looming budget cuts, along with the impending departure of Supt. David L. Brewer, make the Los Angeles Unified School District ripe for an extreme overhaul in every way. W. Scott Thompson assesses Thailand's remarkable King Bhumibol Adulyadej and Rosa Brooks writes that the indictment of Illinois Gov. Rod R. Blagojevich is a warning for victorious Democrats to avoid feeling too smug.
For every Larry Craig, there's an Eliot Spitzer; for every Ted Stevens, there's a Rod Blagojevich.
Back over in the editorial stack, the board presses Pakistan's President Asif Ali Zardari to not only punish the perpetrators of the Mumbai attacks, but to make and a serious effort to shut down their networks, weed out their supporters and disable their allied charity, Jamaat ud-Dawa. Lastly, criminal prosecution of a Colorado man who ranted online against an ex-girlfriend was probably good cause for a civil lawsuit, but criminal prosecution, the board says, is an "afront to the 1st Amendment," and Colorado's law permitting it should be declared unconstitutional.
* Photo by Hoang Dinh Nam AFP / Getty Images)
Read on »
 In Tuesday's Letters to the editor, readers react to this Patt Morrison Op-Ed about taxing marijuana.
As with all stories about pot, most of the mail we received argued in favor of legalizing the drug, including this letter from former prosecutor James Anthony, of Oakland: Patt Morrison says legalizing marijuana wouldn't necessarily eliminate pot-related crime because there still might be a black market -- as there is with legal alcohol and tobacco. Though that may be true, without question the majority of the criminal market would disappear.
What consumer wouldn't be willing to pay a slight premium for the convenience of purchasing marijuana from a safe and regulated facility instead of running the risk of being hurt or killed in an illegal drug deal on the streets?
As a former Oakland community prosecutor, I certainly would never argue that marijuana is completely benign or that more people should use it. But what I do know is that the most dangerous thing about marijuana is that it's illegal.
Public safety will be improved immensely when we bankrupt most of the criminals who control marijuana cultivation and profits.
More on gay marriage, terror training in Pakistan, and new columnist Hector Tobar's return to the United States, too.
Marijuana leaf photographed by Karen Tapia of the Los Angeles Times.
 David Klinghoffer reminds readers that the "invisible world" of spirits and supernatural phenomena reamins very real to many Americans and bucks the trend toward "a pallid rationalism."
"It may be that such pallidness helps explain why Americans turn to florid paranormal beliefs, as opposed to traditional supernatural ideas. Indeed, U.S. polling data from Gallup, reported by Baylor University researchers, shows that belief in the occult is more common among non- or infrequent churchgoers or those belonging to a liberal Protestant denomination than it is among frequent churchgoers and conservative evangelicals."
Editorial writer Jon Healey finds himself in the middle of the Chargers-Raiders game, and perhaps the next phase of entertainment and communications as well, thanks to 3ality Digital of Burbank, RealD of Beverly Hills, the National Football League and a pair of polarized glasses. 3-D didn't make the game a better matchup, but it made it compelling. Rather than popping images off the screen and into viewers' laps, the 3ality Digital crew used the technology mainly to push the action deeper into the screen. The result was more clarity, more ability to pick out details in crowded scenes and to follow individual players through clumps of bodies.
But Healey wonders whether the experience will be enough to get the public to pay more for the experience if, in the end (for example), the Chargers are still the Chargers and can't perform well on the field.
The editorial board also urges the Screen Actors' Guild and Hollywood Studios to keep bargaining, and it takes a look at Mexico's deadly drug war.
The Humane Society chief economist Jennifer Fearing warns against Gov. Arnold Schwarzenegger's plan to balance the state budget in part on a tax on veterinary services, and Times columnist Gregory Rodriguez calls on the public to not fixate on video images of terrorism. lest the perpetrators gain even more from their violence.
Illustration: Ellen Weinstein/LAT
Read on »
 In Friday's Letters to the editor, two takes on Monday's Column One about halting efforts by the Catholic Church to commemorate its members abused by clergy.
Newport Beach's Joelle Casteix, Southwest Regional Director of the Survivors Network of those Abused by Priests, writes: When reading about the four or five memorials to the Catholic Church's ongoing clergy sex-abuse crisis, I was reminded of the old adage: "Actions speak louder than words."
Here in L.A., victims weren't consulted when Cardinal Roger Mahony was contemplating a chapel in tribute to abuse victims. Victims weren't notified or invited when the chapel was opened. And we weren't asked or notified when the chapel was rededicated to another purpose.
It reminds me of another Mahony action pattern: when victims, parents and Catholics aren't notified when dangerous men are purposely put in their neighborhoods, schools or parishes.
Mahony loves to talk about healing. But his talk rings hollow when his unilateral, self-serving actions exacerbate wounds instead of relieving them.
But Dave Pierre, of Downey, thinks the Church is the real victim: Monuments are being built "to provide solace" to victims of abuse by clergy of the Catholic Church. Meanwhile, the author of a 2004 report commissioned by the U.S. Department of Education has reportedly stated that "the physical sexual abuse of students in schools is likely more than 100 times the abuse by priests."
If she is proved correct, will the L.A. Unified School District put up a monument at the Belmont Learning Center for its victims of abuse by teachers? Or does our media and culture only care about abuse by Catholic priests? Do we really care about sexual abuse at all, or just the vocation of the abuser?
The Times revisits the terror attacks in Mumbai, featuring letters responding to this Op-Ed and this editorial, and airs views on the reshuffling of police personnel on the Westside. Also, readers question Dan Neil's Op-Ed arguing for the nationalization of General Motors and President Bush's proposed rule permitting doctors to refuse delivering treatment they find morally objectionable. Writes Donna Handy of Santa Barbara: When it comes to women's reproductive health issues, everybody has a conscience and moral rules: President Bush, nurses, doctors, pharmacists, Catholic bishops, the Pope, the Taliban and Health and Human Services Secretary Mike Leavitt. But when it comes to a prescription for Viagra or Cialis, anything goes.
I would just love to find one pharmacist in the U.S. who would refuse to fill a prescription for Viagra or Cialis for a single guy.
2007 photo of Los Angeles' Cathedral of our Lady of the Angels by Michael Robinson Chavez/Los Angeles Times.
 So long, farewell, auf wiedersehen good-bye! The board shows the door to a handful of overpaid and incompetent executives. First up are the head honchos of the Big Three automakers, writing:
Today, the biggest challenges for the Big Three are their top executives' insularity and sense of self-importance, the public's perception that their products are inferior and the recession that's sapping demand for cars. The first two could be addressed by sweeping out the current management...
Next to get the hook is Los Angeles Unified School District Supt. David L. Brewer. In an earlier editorial the board asked him to resign. Now it's begging. His supporters, the board says, should put aside racial politics and the retired admiral should give back some of the $381,000 he's paid even though Senior Deputy Supt. Ramon C. Cortines is the one really in command. Lastly, the board chides George Bush for coming whisper close to an admission on ABC News that the invasion of Iraq was a mistake but then dodged making an apology. Looks like he'll leave office with those words unspoken.
Over in Op-Ed territory, Patt Morrison flirts with the idea of balancing the California budget by taxing marijuana until the folks at Rand rain on that parade by predicting all sorts of unpleasant social costs of legalizing the nation's biggest cash crop. Robert Epstein, a visiting scholar at UC San Diego, struggles to explain to his horrified wife (and everybody else) that he's not really against gay marriage, per se, but in favor of legitimizing all sorts of consentual, "non-exploitative" relationships. And columnist Rosa Brooks bids goodbye to the worst of all Bushisms, the "war on terror," Terror is an emotion, and terrorism is a tactic. You can't make "war" against it. Even if meant as a mere metaphor, "the war on terror" foolishly enhanced the terrorist's status as prime boogeyman...."
Also, have a look at letters to the editor, in which readers weigh in on the effort to oust Brewer, gun rights and the healthcare debate.
Cartoon: Jim Margulies
Tuesday's Letters to the editor marks the first of what's likely to be several days of reader reaction to last week's terror incidents in Mumbai, India.
Readers take University of Chicago professor Martha Nussbaum to task for her Op-Ed contextualizing the attacks. Writes A. Subramanyam, of Los Angeles: The problem with Martha Nussbaum’s article is that it seems to distract attention from the horrendous events in Mumbai. It also fails to emphasize the differences between Hindu and Muslim terrorism.
Stories of Hindu mobs massacring Christians and Muslims may well be true, but Hindu militants are not nearly organized or prevalent enough to threaten most of the civilized world. I don’t see any evidence of a Hindu jihad that spreads an ideology of hate, under which it is OK to spray machine-gun fire into a railway station or a restaurant, or fly planes full of innocents into buildings full of innocents.
Isolated incidents of Hindu extremism do not add up to a global problem. The threats posed to the world from Muslim terrorism are an order of magnitude greater. Any reasonable debate on terrorism must recognize this problem.
John Taylor of La Habra doesn't see the need to differentiate among faiths: All the faces of terrorism in India have just one face -— the face of the 800-pound gorilla in the room that everyone ignores: religious violence. As long as every religion claims there is an absolute truth, the gorilla will continue its rampage.
Religious violence will end when religions no longer control moral standards while demanding the murder of heretics. There really is only one kind of terrorism, and it continues to rape and murder in the name of God.
Letters responding to this news story and this Op-Ed about veterans' benefits, to Black Friday killings at Wal-Mart and Toys "R" Us, and a post-Thanksgiving smorgasbord, too.
*Nov. 29 photo of violence in Mumbai by Harish Tyagi/EPA.
 Lots in letters over the Labor Day weekend: Barack Obama, Sarah Palin, medical marijuana, the plight of the gay Republican, India's kids...and cows.
Catherine McCallum, of Monrovia, responds Saturday to the Paul Roberts op-ed "The cost of steak." Higher prices for meat, she argues, would only benefit American consumers: [Roberts] expresses concern about the rising meat prices that will accompany the return to more traditional methods of raising meat animals, but he neglects to mention the benefit: with higher prices, people will eat less meat.
...I say, let those prices soar and pass the hummus. We'll all be better off.
And on Sunday, Los Angeles' Allan Hatch can't resist riffing on the discovery that cows, like compasses, point north: Did the scientists ever consider that the cows may lay down facing north because they don't want the sun in their eyes? If they did the study below the equator, would the cows be facing south?
*Photo: Karen Bleier/AFP/Getty Images
 The Times was ahead of its time three years ago, when an editorial predicting the imminent demise of the SUV included a list of useful suggestions on what people could do with the gas-guzzling behemoths now that nobody wanted to drive them anymore (sample: Sink them offshore as artificial reefs). Reports of the SUV's demise were premature, but then gas prices started their astonishing climb. If the SUV hasn't quite flatlined, it's got a roomful of worried auto makers gathered around its bed while their stock analysts are calling for a priest. Unfortunately, though, the steel-and-rubber corpses aren't going to get a decent burial as artificial reefs. They're going to end up spreading pollution and inflating gasoline prices in the developing world.
Reuters is reporting that General Motors is in talks with Indian auto maker Mahindra & Mahindra, as well as other companies in Russia and China, about unloading its disastrous Hummer brand. In places like China where gasoline is subsidized, it's not unreasonable to think the nouveau riche might appreciate a tank-sized symbol of excess like the Hummer. But what happens to carbon emissions and oil prices when a big percentage of the 2.45 billion people in China and India start driving? Especially if they're driving 15-mile-per-gallon monstrosities? It's little wonder that speculators are excited about oil futures, because even as high prices prompt Americans to conserve gas and reduce demand, newly wealthy populations in Russia and China are shielded from rising prices by the government and have less reason to cut back. Hence GM might find a buyer for a brand that nobody in the industrialized world would touch.
There may have once been a time when what was good for GM was good for the country. But if selling Hummer to China or an Indian manufacturer is good for GM, it's bad for everybody on Earth. Better to turn those old Hummers into planter boxes, or, as The Times suggested in 2005, make them into "hot tubs with comfortable seating."
*Photo: Carolyn Kaster / Associated Press
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