Medical Tourism / Our May cover story -- on Silicon Valley startup Ning and its CEO, Gina Bianchini -- attracted plenty of interest, but it was a thornier subject that drew the broadest range of comment: the outsourcing of health care (" Medical Leave  "). We heard from doctors, patients, and people in health-related businesses. A few worried what would happen if surgery in Thailand went wrong or whether insurers would force us to travel for treatment. But the most common theme was the dysfunction of our own medical system. There were complaints, smart analyses -- and one tongue-in-cheek suggestion that we meet for a drink and solve the country's health-care snafus in one sitting.
Globalizing Health Care
My world has been health care and medical equipment for almost 20 years. Hospitals and doctors overcharge because they know the insurance companies will pay 35 cents on the dollar. Doctors and hospitals are not making any more money in 2008 than they did in 2000 on average, and in some cases less, but insurance-company CEOs are some of the highest paid in the United States. And all big insurance companies have a cash reserve.
Washington Crossing, Pennsylvania
I have worked in the health-care supply chain for my entire life and only wish that every surgeon and hospital executive in this country would read "Medical Leave." Although there are many problems at the root of the cost of health care in this country, I believe that lack of supply-chain control is at least in the top five of contributing issues. Imagine an assembly line with 100 people working on it. Now imagine that 25% of them are attaching the same parts, and that each person could change the type, source, and number of parts attached. Finally, imagine that you had little control over how much you actually got paid for the end product. This is the health-care supply chain in the United States. Certainly, lower salaries and streamlining of paperwork help keep down costs in other countries, but I suspect those facilities also have a much stronger handle on their cost of goods and services.
I am in the middle of reading The World Is Flat, by Thomas Friedman, and I was struck by the connection between what he says in the book and what is apparently happening right now with medicine. As a practicing pediatrician in Las Vegas, I am amazed at the challenges I face in getting paid by the insurance companies and the degree to which it takes me away from providing care to my patients. I too am distressed by the state of affairs in America's medical system, but I feel confused as to which direction things are heading. I do use an electronic medical record in my office and have a Web site to which I refer patients all the time. Even though they use it, I feel there is much more that can be done. I surely don't want to go the way of the dinosaur.
Dr. Lisa Glasser
Las Vegas, Nevada
Mr. Lindsay's article was definitely an eye-opener. To see domestic insurance companies and municipalities beginning to outsource medical services is a clear indictment of the American health-care system. The current one rewards hospitals and doctors who seek surgeries over preventive or holistic care, and provides incentives to allow repeated mistakes in patient care. There is a glaring omission in the piece, however: What happens when things go awry? Say what you will about the American system -- at least it allows for a patient to have legal recourse. What happens in Thailand if the young surgeon accidentally pierces or slices something that leaves the patient paralyzed or wearing a colostomy bag? Does the patient get an apology and a coupon for 10% off her next surgery?
East Stroudsburg, Pennsylvania
Caught in a Viral Loop
Ning has a great thing going ("Ning's Infinite Ambition ," May). But I was surprised that I had never even heard the phrases "viral expansion loop" or "Power Law Curve." I thought I was more in touch than that. Guess I need to double up on my reading.
I get calls every month from someone looking for a "Facebook in a box" application. I usually recommend Ning if it's not necessary to own the data. Great article, especially the dissection of the business model.
Sackville, New Brunswick
As CEO of a company in the private-label social-media-platform space, I thought it would have been helpful to focus more on monetization, repeat users, and how Ning's managers plan to make money. My guess is they will create a huge advertising network across all Ning's communities.
I think givewell's heart is in the right place ("When the Giving Gets Tough ," May), but the mission is best acccomplished by local eyes. In Houston, the Greater Houston Community Foundation set up a free, comprehensive online resource designed to make the connection between funders, donors, and nonprofits easier, more strategic, and user-friendly.
The purpose of most competitions is to get the "great idea," so the winner generally has a great idea ("The Power of the Prize ," May). Converting it into a winning solution is something most have still not worked out.
New Delhi, India
Google in Africa
Kenyan telecoms' infrastructure leaves a lot to be desired ("Google's Surfing Safari ," May). One downpour and half of Nairobi's phone lines will be out of order. So the hotly anticipated undersea cable is not going to help Kenyans access the Internet at home unless the basic infrastructure is updated, too.