Three months ago, Howard Staab learned that he suffered from a life-threatening condition and would have to undergo surgery at a cost of up to $200,000 -- an impossible sum for the 53-year-old carpenter from Durham, N.C., who has no health insurance. So he outsourced the job to India. Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital [of New Delhi], where doctors . . . replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.

-- Washington Post news story, Oct. 21

Good grief, why didn't someone think of this earlier! Forty-five million Americans lack health insurance, and covering every one of them would be costly. Why not outsource them all to India?

The Institute of Medicine, a component of the National Academy of Sciences, calculates that because so many Americans lack health insurance, as many as 18,000 of them die prematurely every year. Of course, this is a drop in the bucket compared with how many die from inadequate health care in really squalid places like . . . well, like parts of India. But now there are apparently lots of slick new hospitals in India, run by Western-trained doctors and catering to foreigners who, The Post reports, want "First World health care at Third World prices." Since we apparently can't -- won't? -- give our uninsured First World health care at the First World prices the rest of us pay, why not go for the Third World solution?

Think about it. President Bush has plans for covering somewhere between 2 million and 6 million of the uninsured at costs to the federal government variously estimated at $90 billion to $227 billion over 10 years. Sen. John Kerry has plans that could cover 25 million to 27 million at federal costs variously estimated at $650 billion to $1.5 trillion over 10 years. Now to the back of the envelope: If all those people could get the Third World deal that Howard Staab got -- a 95 percent discount, including travel and that Taj Mahal side trip -- Bush's plan would cost no more than $11 billion over 10 years and Kerry's would total just $75 billion. Either way, it's a steal (and need we point out, a fraction of the cost of the war in Iraq).

Opponents will immediately say this idea is impractical. I say, don't be health coverage girlie men! First, not all the uninsured would have to travel to India to get health care. For example, when an uninsured person first got the sniffles, he or she could pick up the phone and talk with someone at a call center in, say, Bangalore. An Indian nurse making $10 a day would listen (sympathetically, of course) and offer advice. Through the miracle of telemedicine, people needing to be "seen" could visit a walk-in center stateside and have a videoconference with a medical team in India. Prescriptions could be filled by the burgeoning Indian pharmaceutical industry -- now busily producing cheap generic knockoffs of patented Western drugs -- and sent directly to U.S. patients via international express mail. (That would also solve that pesky Canadian drug importation problem.)

For those uninsured in need of hands-on medical care, here's an idea: What if some of those failing U.S. airlines converted to running medical air shuttle services between, say, New York and New Delhi, or Boston and Bombay? Uncle Sam could hire them as private contractors, then pay them to ferry the uninsured back and forth. It would be less risky than putting up taxpayer money for more loan guarantees, and it might even create a few new jobs here at home. If we can farm out parts of the war in Iraq to private contractors, why not the far easier task of transporting the uninsured?

The more I think about this idea, the better I like it. Just imagine all the problems it would solve: No more overcrowded emergency rooms choked with uninsured patients. No more worries about a nursing shortage; by transferring our patients to India, we'd outsource nursing care there, too. Hospitals and doctors here would be freed up to do what makes most sense for them economically: treat well-insured patients at steep prices -- even to the point of giving them care that they probably don't need! Perform the most lucrative elective surgeries on relatively healthy patients, rather than giving high-cost care to the sickest loss leaders!

We all know the uninsured are a terrible problem, an embarrassment, really, for such a rich country as ours. Every other major industrialized nation has figured out how to provide health coverage to most, if not all, of its citizens. At last, here's a twist on globalization that could really work for everybody. So let's get started. Who says Americans can't take care of their own?

Author's e-mail:

sdentzer@newshour.org

Susan Dentzer is the health correspondent for "The NewsHour With Jim Lehrer" on PBS.