<p>When Veronica Merrill decided to undergo stomach surgery for weight loss, she found two options: pay $12,000 at home in the United States, or have it done in Mexico for $4,000.</p>.<p>She packed her suitcase.</p>.<p>Her insurance would only cover the operation if she was morbidly obese and suffering from diabetes and hypertension.</p>.<p>This was not the case for the 50-year-old, who weighs 210 pounds (95 kilos) but aspires to slim down to 160 -- precisely because she wants to avoid ending up with those medical conditions.</p>.<p>"It's sad that I have to come to another country" for the procedure, said Merrill, who drives a school bus in rural Arizona and is highly critical of the US health system -- the most expensive in the world.</p>.<p>"We shouldn't have to do that. That's crazy. And we're the only ones (with this system), and that is depressing."</p>.<p>After researching medical tourism options, she saved up the money and contacted a specialist agency to organize her trip over the border to Tijuana, where weight-loss operations and dental treatments are popular.</p>.<p>Others travel to the Mexican city for treatment of cardiovascular conditions or cancer, orthopaedic work and fertility care, as well as to buy medications.</p>.<p>"If I only could have done it in the US... (but) I can't pay that much money," she told AFP. "I just want to be healthy."</p>.<p>Each year, an estimated 20 million "medical tourists" seek treatment around the world, according to Patients Beyond Borders.</p>.<p>About 1.9 million of those people are Americans.</p>.<p>Mexico and Colombia -- which many Americans associate more with drug trafficking than health care -- are among the most popular destinations, along with Costa Rica and the Dominican Republic.</p>.<p>They all offer lower costs and high-quality infrastructure.</p>.<p>Bernie Sanders and Elizabeth Warren, two prominent Democratic candidates for the 2020 presidential election, have proposed universal health coverage -- an idea that Merrill considers "logical."</p>.<p>For now, Merrill turned to a company called Medical Tourism Corporation to organize every detail of her trip -- including her flight from Phoenix to San Diego, the driver who took her across the border and a luxury hotel.</p>.<p>Altogether, the tickets, hotel and surgery -- at the Oasis of Hope hospital, right by the border -- cost her $3,880. She paid in cash.</p>.<p>"We do the coordination... (we) have a destination manager in those cities who would help a patient with the language, the local logistics and things like that," said Deepak Datta, who founded Medical Tourism Corporation 13 years ago.</p>.<p>The company sends 60-70 people abroad each month to countries around the world, mainly Mexico.</p>.<p>"I operate on two or more foreigners every day," said surgeon Luis Cazares, who removed 80 percent of Merrill's stomach.</p>.<p>He said his greatest flow of patients is during the tax refund season in the United States, after April.</p>.<p>According to Gerald Kominski, a professor of health policy at UCLA in Los Angeles, the US does "little to regulate prices, in contrast to all other high-income nations."</p>.<p>"Medical tourism from a high-income nation like the US is indicative of a problem with affordability, as opposed to quality," he added.</p>.<p>But even if "Medicare for All" were introduced as Sanders and Warren have urged, Americans likely would not stop seeking cheaper care abroad, says Medical Tourism Association CEO Jonathan Edelheit.</p>.<p>After President Barack Obama's health care reforms in 2010, which required all adults to have insurance plans whether through work or the government, medical tourism by Americans expanded, he said.</p>.<p>Some employers whose medical costs "almost doubled since Obamacare was in place" sent staff abroad, he said, citing a company that saved $20 million in five years by sending employees for orthopaedic and weight-loss operations outside the US.</p>.<p>Under universal care proposals, the US would likely end up with a system where, like in Canada and Europe, non-urgent procedures such as stomach operations require years on a waiting list.</p>.<p>"Wait times... will push people to go for medical tourism" to get treatment earlier, he predicted.</p>.<p>Indeed, many of the foreign patients at Oasis of Hope hospital are Canadian.</p>.<p>Europe is a sought-after destination for US medical tourists, though it does little to attract them, unlike emerging economies such as Singapore, Thailand and the Philippines.</p>.<p>The United States itself receives health tourists -- its highly advanced health care system appeals to patients with massive purchasing power from Arab and Asian countries.</p>.<p>But that is a luxury Merrill cannot afford.</p>
<p>When Veronica Merrill decided to undergo stomach surgery for weight loss, she found two options: pay $12,000 at home in the United States, or have it done in Mexico for $4,000.</p>.<p>She packed her suitcase.</p>.<p>Her insurance would only cover the operation if she was morbidly obese and suffering from diabetes and hypertension.</p>.<p>This was not the case for the 50-year-old, who weighs 210 pounds (95 kilos) but aspires to slim down to 160 -- precisely because she wants to avoid ending up with those medical conditions.</p>.<p>"It's sad that I have to come to another country" for the procedure, said Merrill, who drives a school bus in rural Arizona and is highly critical of the US health system -- the most expensive in the world.</p>.<p>"We shouldn't have to do that. That's crazy. And we're the only ones (with this system), and that is depressing."</p>.<p>After researching medical tourism options, she saved up the money and contacted a specialist agency to organize her trip over the border to Tijuana, where weight-loss operations and dental treatments are popular.</p>.<p>Others travel to the Mexican city for treatment of cardiovascular conditions or cancer, orthopaedic work and fertility care, as well as to buy medications.</p>.<p>"If I only could have done it in the US... (but) I can't pay that much money," she told AFP. "I just want to be healthy."</p>.<p>Each year, an estimated 20 million "medical tourists" seek treatment around the world, according to Patients Beyond Borders.</p>.<p>About 1.9 million of those people are Americans.</p>.<p>Mexico and Colombia -- which many Americans associate more with drug trafficking than health care -- are among the most popular destinations, along with Costa Rica and the Dominican Republic.</p>.<p>They all offer lower costs and high-quality infrastructure.</p>.<p>Bernie Sanders and Elizabeth Warren, two prominent Democratic candidates for the 2020 presidential election, have proposed universal health coverage -- an idea that Merrill considers "logical."</p>.<p>For now, Merrill turned to a company called Medical Tourism Corporation to organize every detail of her trip -- including her flight from Phoenix to San Diego, the driver who took her across the border and a luxury hotel.</p>.<p>Altogether, the tickets, hotel and surgery -- at the Oasis of Hope hospital, right by the border -- cost her $3,880. She paid in cash.</p>.<p>"We do the coordination... (we) have a destination manager in those cities who would help a patient with the language, the local logistics and things like that," said Deepak Datta, who founded Medical Tourism Corporation 13 years ago.</p>.<p>The company sends 60-70 people abroad each month to countries around the world, mainly Mexico.</p>.<p>"I operate on two or more foreigners every day," said surgeon Luis Cazares, who removed 80 percent of Merrill's stomach.</p>.<p>He said his greatest flow of patients is during the tax refund season in the United States, after April.</p>.<p>According to Gerald Kominski, a professor of health policy at UCLA in Los Angeles, the US does "little to regulate prices, in contrast to all other high-income nations."</p>.<p>"Medical tourism from a high-income nation like the US is indicative of a problem with affordability, as opposed to quality," he added.</p>.<p>But even if "Medicare for All" were introduced as Sanders and Warren have urged, Americans likely would not stop seeking cheaper care abroad, says Medical Tourism Association CEO Jonathan Edelheit.</p>.<p>After President Barack Obama's health care reforms in 2010, which required all adults to have insurance plans whether through work or the government, medical tourism by Americans expanded, he said.</p>.<p>Some employers whose medical costs "almost doubled since Obamacare was in place" sent staff abroad, he said, citing a company that saved $20 million in five years by sending employees for orthopaedic and weight-loss operations outside the US.</p>.<p>Under universal care proposals, the US would likely end up with a system where, like in Canada and Europe, non-urgent procedures such as stomach operations require years on a waiting list.</p>.<p>"Wait times... will push people to go for medical tourism" to get treatment earlier, he predicted.</p>.<p>Indeed, many of the foreign patients at Oasis of Hope hospital are Canadian.</p>.<p>Europe is a sought-after destination for US medical tourists, though it does little to attract them, unlike emerging economies such as Singapore, Thailand and the Philippines.</p>.<p>The United States itself receives health tourists -- its highly advanced health care system appeals to patients with massive purchasing power from Arab and Asian countries.</p>.<p>But that is a luxury Merrill cannot afford.</p>