The U.S. Senate Committee on Aging spent some time Tuesday morning considering the subject of medical tourism. Thousands of Americans each year are finding travel abroad a reasonable alternative to the high cost of getting well at home.

Private health insurance offers Americans access to some of the world's best medical care … but millions of Americans, mostly working class people, can't afford coverage. As a result, some travel abroad for surgery and other care, paying a fraction of what it would cost here in the United States.

One of them is Howard Staab. Two years ago, he discovered he needed heart valve surgery. He didn't have health insurance. His partner, Maggi Ann Grace, told the Senate committee they got a cost estimate from a hospital near their home in North Carolina.

"The hospital bill alone was estimated at $100,000," she said. "The valve itself, the surgeon, cardiologist, anesthesiologist, radiologist, and pathologist - all billed separately - would bring the total closer to $200,000 - if there were no complications."

Instead, after considering their options, they flew to India, where Staab had a mitral valve replacement. The cost, including travel and all expenses for the both of them, was less than $7,000. Their doctor, [Naresh Trehan] at the Escorts Heart Institute in New Delhi, had spent years teaching and in practice in New York, and Staab says, compared with his experience in American hospitals, his hospitalization in India was superior.

"In the promptness, in the degree of expertise, the experience of the surgeons and staff. We had typically one to two nurses around the clock, push-button was answered within seconds. They offered and administered baths and massages, and changed the bedding daily. It was truly excellent care," Stabb said in an interview.

Not all the stories have a happy ending, however. In some cases, the result of medical tourism can be "disastrous outcomes" - that's the phrase used by Dr. Bruce Cunningham, who heads the American Society of Plastic Surgeons. "I'm personally well aware of cases which are reported in the media and which confront myself and my colleagues and other physicians of patients returning to this country with disfigurement and nearly fatal infections associated with unaccredited hospitals and unlicensed providers. Patients simply cannot make informed decisions about medical care or establish a proper patient-physician relationship from a travel brochure."

The plastic surgeons represented by Dr. Cunningham's organization might see surgeons in India or Thailand or Mexico as business competitors. Financial considerations, as well as medical quality, are a key part of this health care debate. And not just for patients and doctors.

Except for the very poor and the elderly, most Americans who have heath insurance get it through their jobs, so the cost of health care is also a concern for employers.

Blue Ridge Paper Products is a small manufacturing company. It has been employee-owned since 1999, and with a workforce of mostly men in their 40s and older, health care costs were getting out of hand. The company is unionized, and American unions have been among the strongest opponents of outsourcing. But company benefits director Bonnie Blackley said workers were enthusiastic at a presentation that explained a new health plan that would pay for medical treatments abroad.

"You could tell every slide that they showed, more and more people were going, 'Oh my gosh, we never knew about this.' We really had some excitement there," she recalled. "'This sounds like a good deal, sounds like excellent health care. It's affordable. This will save our company a lot of money.'"

But in the end, American patients and their families want the assurance that a foreign facility will be offering them or their loved ones the best possible care. As long ago as 1997, the Joint Committee on Accreditation of Healthcare Organizations, which certifies the quality of U.S. hospitals, set up an international affiliate. JCI, as it is known, certifies hospitals in about 25 countries, with highly credentialed doctors.

"Many of these hospitals offer board-certified surgeons who trained at U.S. teaching hospitals," said Arnold Milstein of the Pacific Business Group on Health, which represents large employers who spend a lot of money on health care for their workers. His group found that select accredited hospitals in India, Thailand and Mexico provided quality surgical care at costs 60 - 85 % lower than in U.S. hospitals. At the same time, he stressed that sending patients abroad is not the answer to the high cost of medical care in the United States. "The out-migration of Americans for surgical care is a symptom, not a solution," Milstein concluded.

The American healthcare system delivers high quality for those who can afford it, or those who have good insurance. For the rest, a hospital stay in Thailand or India, followed by recuperation at a five-star resort, is starting to look like just what the doctor ordered.