Bitter congressional debate has begun regarding President Barack Obama's plans to overhaul U.S. health care. There are many things about our current system that doctors find challenging, but one in particular poses a serious threat to our medical industry. As with other sectors of the economy, it comes from abroad: medical tourism.

Mainly, this means surgical tourism -- patients going abroad for surgical care. Our initial response to this phenomenon, which began in earnest in 1998, was reminiscent of our response to competition in our manufacturing industries: We denigrated the upstarts. Their products were poor, outcomes unsatisfactory; there were many complications, surgeons were poorly trained, facilities were inadequate -- with dated imaging equipment and the like.

Times have changed. Surgeons abroad are now well-trained -- in fact, we trained many of them. Hard data is difficult to come by, but based on my experience in surgical education, I would estimate that upwards of 50 percent of the doctors involved in surgical tourism had at least some training in the United States.

I have visited some of their overseas facilities, which boast the latest medical technology. The clinics are first-class, and various levels of accommodation are available, from moderate to luxurious. Staffs are caring, schedules are tight, and a variety of tests can be accomplished within 24 hours, not spread over weeks as they are in this country. Most importantly, results have improved dramatically and the outcomes in most foreign medical centers rival those in the United States.

The trickle of patients has become, while not a flood, a rising stream. Thailand and Singapore now say that a major thrust of their economic development programs is to get patients from other countries to come to their countries for health care.

The estimates of patients leaving the United States for care vary widely. A study in the May 2008 McKinsey Quarterly estimates the annual figure at 60,000 to 85,000; the Deloitte Center for Health Solutions puts the number at 750,000.

Since 1997, when the United States and Western Europe reigned as the centers of medical excellence, rising medical costs have spurred the emergence of alternatives. Thailand and India have become legitimate medical destinations. Discretionary surgery, such as cosmetic surgery, has especially seen a dramatic increase abroad. The Joint Commission International has accredited more than 220 foreign facilities to date.

Helping to drive this phenomenon have been the inexorable increases in U.S. health-care costs at a rate far exceeding inflation, with health insurance companies paying a smaller percentage of the medical bills and patients paying more. Employee contributions to family health-coverage premiums are rising twice as fast as family income. Non-insured services are increasing, and out-of-pocket health-care expenses are rising. The burden is shifting from insurance companies to the individual.

Expanding on the analogy with our shrinking manufacturing industries, where there is an adversarial relationship between workers and management, similarly, there is an adversarial relationship among U.S. physicians, hospitals, patients, employers and health insurers. In Thailand and India, there is much greater cooperation among all the players in their health-care systems.

Why would someone travel 10,000 miles to get medical treatment from a doctor they don't know at a hospital whose name they can't pronounce?

One-stop shopping. Fully integrated hospital medical staff. Immediate access. No technology or quality gap. Competitive prices. A focus on service.

Consider the cost of a heart-valve replacement in the United States: $230,000. In India, the same procedure, all costs included, runs $9,500; in Thailand, $10,500; in Singapore, $13,000.

A knee replacement in the United States costs up to $58,000. In India, it's about $8,500; in Thailand, $10,000; in Singapore, $13,000.

Surgical tourism does come with problems. At medical conferences, one hears of two basic hurdles before the floodgates really open. First is the care of patients who have serious complications and need follow up. Who cares for them? How are they compensated? Second, what about professional liability? What kind of medical malpractice systems do other countries have?

So, can we bring down the costs of U.S. health care?

Of course. Electronic medical records may help, but different systems must be able to communicate with each other; at present, they cannot. Health insurers must reduce their overhead. Academic medical centers must curb excessive tests ordered by inadequately supervised students and staff. "Defensive medicine" -- excessive ordering of tests to protect against rampant malpractice suits -- must be decreased by tort reform (which would save up to $160 billion a year).

Unless physicians, surgeons, hospital administrators and health insurers get together to control costs, I fear that the health-care industry in the United States will rapidly continue down the same path as our indigenous manufacturing industries. If we do not take this issue seriously, if we keep repeating the old, inaccurate mantras about the lack of quality medical care abroad, we will lose our competitive advantage. Not only will fewer foreign patients come here for medical treatment, more of us will go elsewhere.