Here’s a new twist on outsourcing: housing U.S. inmates in Mexican prisons.

This week, California Governor Arnold Schwarzenegger suggested that the state might outsource incarceration by opening prisons in Mexico in order to house jailed undocumented immigrants.

Sfgate.com reports the governor saying, “We pay them to build the prisons down in Mexico and then we have those undocumented immigrants be down there in a prison. … And all this, it would be half the cost to build the prisons and half the cost to run the prisons.”

Of the state’s 171,000 prisoners, approximately 19,000 are illegal immigrants. The state spends more than $8 billion a year on the prison system. Schwarzenegger predicted housing prisoners in Mexico instead of California would save the state $1 billion that could be spent on higher education.

The idea has a certain logic: Under the terms of the 1977 Prisoner Transfer Treaty between the United States and Mexico, United States prisoners in Mexican jails and Mexican prisoners in United States jails may choose to serve their sentences in their home countries.

But there’s a definite taint of “let’s send the illegals back where they came from” anti-immigrant sentiment in the governor’s comment. Beyond that, it’s just a very odd idea. When one breaks the law within a given set of borders, it makes sense to be punished within the limits of that same country. Each country has its own philosophy of crime and punishment. Mexico tends to have longer waits for sentencing, for instance, but shorter prison terms.

And though there’s no yelp.com for prisons around the world, it’s pretty clear that Mexican prisons aren’t known to be models of modern and humane incarceration.

An analysis of Mexican prison conditions (drawing from The Library of Congress Country Studies and the CIA World Factbook) concludes that “overcrowding of prisons is chronic. Mistreatment of prisoners, the lack of trained guards, and inadequate sanitary facilities compound the problem. The United States Department of State’s country reports on human rights practices for 1992 and 1993 state that an entrenched system of corruption undermines prison authority and contributes to abuses. Authority frequently is exercised by prisoners, displacing prison officials. Violent confrontations, often linked to drug trafficking, are common between rival prison groups.

In fact, just this week, a prison riot in the Mexican state of Durango left 23 inmates dead.

Female inmates in Mexican prisons are allowed to have their children under 5 live with them in prison. Photo: Caroline Bennett

Not that Mexico suffers in every prison-related comparison. The U.S. enjoys the dubious distinction of having the highest incarceration rate in the world. And Mexico has some prison policies that are more humane than those in the U.S. For example, women inmates are allowed to have their children under 5 live with them in prison. The Huffington Post recently published a photo essay on Mexican Prison Life: Babies Behind Bars.

Even if the prisons in Mexico were built and run by the U.S., Schwarzenegger ’s idea would still be problematic. Donald Specter, director of the Prison Law Office, said it “would be like the state of California having a separate island of its own government in Mexico. It just seems like that would be impossible.”

The not-so-sweet spot where privatization meets outsourcing

Schwarzenegger’s suggestion sits at the intersection of privatization and outsourcing. Earlier this month, our my-governor-can-beat-up-your-governor called for allowing private companies to compete with state-run prisons, which he claims would save billions of dollars.

And beyond privatization, it seems that in this era of free trade in a global economy, everything’s on the table for possible outsourcing: manufacturing, telephone help centers, retirement, medical care, and now, imprisonment.

What’s next—the outsourcing of education? Maybe public school would be more viable if you only had to pay teachers a few dollars an hour. And how about outsourcing funeral services? We could send our loved ones abroad for cut-rate embalming, Fed Ex them back to the local cemetery, then hire illegal immigrants to help us mourn.

Alex Leff recently reported in the Global Post that Americans are coming to Costa Rica for stem cell treatments, which in the U.S. are often prohibitively expensive, if they are available at all. Treatments not yet approved in the U.S. can often be had at hospitals and clinics abroad, from China to Costa Rica.

Some stem cell scientists in the U.S. say these treatments offer false hope to patients desperate enough to take a chance on techniques that have not been scientifically proven.

Costa Rican doctors like Dr. Fabio Solano, who directs the stem cell institute at San Jose’s CIMA Hospital, disagree. Solano says they’re providing medical tourists with groundbreaking (and affordable) treatments. Dr. Solano estimates that his team has treated as many as 400 patients with procedures that involve stem cells.

Costa Rica is known for its high-quality medical care.  More and more medical tourists come here for surgery and other treatments that they can’t afford back home.

And despite the naysayers, success stories about stem cell treatments in Costa Rica abound, from 8-year-old Kenneth Kelley receiving stem cell treatment for autism to Trish Stressman seeking treatment for her chest-down paralysis, to Jennifer Blankenship, who received treatment for her multiple sclerosis (MS).

But many doctors urge caution. Dr. Jack Kessler, an expert in stem cell research at Northwestern University’s Feinberg School of Medicine in Chicago, warns, “The lay press is unfortunately replete with many overstatements and misconceptions about what can be accomplished in the short term by stem cell biology,”

FDA says don’t go abroad for treatment, but are they tarring all non-U.S. facilities with the same brush?

CNN reports that the International Society of Stem Cell Researchers and the FDA discourage Americans from traveling overseas for stem cell therapy. Clinics are operating worldwide–in China, Russia, Mexico, and Costa Rica, among other places.

I fear ISSCR and the FDA may be tarring too many countries, hospitals, and procedures with the same brush. I have personal experience of Costa Rican (private) hospitals and can attest to their quality. As for providing treatments not allowed in the U.S., I’m not an expert, but have read a bit about the lengthy (and sometimes arbitrary) review process that new drugs and procedures must go through in the U.S.

There’s also the issue of stem cell research and treatment being a political hot potato in the U.S., which has probably set medical advances back years, if not decades. It wasn’t until March of this year that President Obama issued an executive order that lifted Bush-era restrictions on federal funding for stem cell research.

Stem cell research is also a political issue in Catholic Costa Rica, where researchers are not allowed to work with human embryos (even in vitro fertilization is against the law). Doctors and researchers in Costa Rica have supposedly done an end run around that prohibition by working with “adult” stem cells (derived from tissue including body fat and umbilical blood or tissue).

About stem cell treatment

Wikipedia defines stem cell treatments as “a type of cell therapy that introduce new cells into damaged tissue in order to treat a disease or injury. Many medical researchers believe that stem cell treatments have the potential to change the face of human disease and alleviate suffering. The ability of stem cells to self-renew and give rise to subsequent generations that can differentiate offers a large potential to culture tissues that can replace diseased and damaged tissues in the body, without the risk of rejection and side effects.”

This year’s Medical Tourism Congress (Oct. 26 – 28 in Los Angeles) features Costa Rica in its portrait of the growing trend of going overseas for affordable care.

The focus on Costa Rica’s medical system doesn’t surprise me. I lived there, and ended up having major surgery in the capital city of San Jose. No hospital stay is fun, but I received very competent care, and the bill didn’t push me to the brink of bankruptcy (the biggest cause of bankruptcy in the U.S. is said to be unpaid medical bills.)

In the Medical Tourism Conference video, we see Bob (his last name is not provided) from Orlando, Florida, as he flies to San Jose, Costa Rica, to have a double knee replacement at Clinica Biblica, one of the top rated facilities in a country. Bob consults with English-speaking doctors, jokes that this is the first time the doctor was waiting for him, and sings the praises of Costa Rican medical care. He even fits in a visit to the rainforest aerial tram at Braulio Carillo National Park.

The video says Bob’s double knee surgery would have cost $100,000 in the U.S., and that it cost him about $20,000 in Costa Rica.

The video has that marketing vibe, where you wonder if they’re telling you the full story. But it happens to be true that Costa Rica’s not a bad place to go for medical care. No system is perfect, but I’ve had surgery (lucky me!) in both the U.S. and Costa Rica, and felt I received good care in both cases. And the cost difference is staggering.

This year’s medical tourism gathering hopes to draw as many as 2,000 participants.  Last year’s congress (the first of its kind) drew around 850 attendees from 45 countries. Insurance companies and insurance providers came, along with representatives from hospitals, clinics, and governments around the world. Everyone wants in on this new industry, which, according to Deloitte, will have up to 23 million Americans traveling internationally for medical care by 2017, spending up to $79.5 billion dollars each year.

For more on health care in Costa Rica

Photo credit: zipline from Skytrek, Monteverde

Medical tourism, the practice of going abroad for medical care, is growing at an astonishing rate. The Centers for Disease Control (CDC) estimates that in 2006, half a million Americans traveled abroad for health care. According to the Deloitte Survey of Health Care Consumers, the number rose to 750,000 in 2007; the report projects that the figure will increase to 6 million by 2010.

The motivation is simple. Traveling halfway around the world for medical care has one enormous advantage, at least for U.S. citizens: you save money–often tens of thousands of dollars. And if you choose wisely, the quality can be as high as the best care you’d get in the U.S.

People travel abroad for root canals, routine dental work, face lifts, hysterectomies, joint replacement, and bypass surgery, to name just a few of the more common procedures. Some of those heading overseas are among the nearly 50 million Americans without health insurance. Some have insurance that doesn’t cover what they need or that has a deductible or co-payment so high it’s cheaper to pay out of pocket in another country. A small minority of the people going abroad for care are sent by their own insurance companies.

Recently, the nation’s largest health insurer, WellPoint, began a pilot program with Serigraph, a graphics company with operations in Wisconsin, Mexico and Asia. U.S. employees of Serigraph can opt to travel to India to have non-emergency surgery. WellPoint says the cost of care is about 80% lower in India, largely because of dramatically lower charges for labor, drugs and medical devices. WellPoint is partnering in India with Apollo Hospitals, a consortium of 47 medical facilities.

Just how much can you save?  Recent figures from the CDC: spinal fusion surgery in India costs $5,500, compared to over $60,000 in the U.S.; a heart bypass in Thailand costs $11,000, compared to as much as $130,000 in the U.S. A report last year in Business Week echoed the CDC’s figures for heart bypass operations in Thailand and the U.S., adding that in Singapore that operation would cost $18,500 and in India $10,000.

See more on Wellpoint in the Los Angeles Times.

1. Johannesburg, South Africa
2. Monterrey, Mexico
3. Asuncion, Paraguay
4. Karachi, Pakistan
5. Wellington, New Zealand (pictured)

Above are the 5 least expensive cities for expat living, according to consultant firm Mercer UK.

The survey covers 143 cities across six continents but concentrates mostly on Europe,  Asia, and the Middle East.  The only countries in the Americas covered, for example, were the U.S., Canada, Mexico, and Brazil. Mercer looks at more than 200 factors, including the cost of housing, transport and food.

Note that just because a city is cheap for expats doesn’t mean it’s cheap for native residents. In Johannesburg, for instance, costs are rising for local residents, with even basics such as bread becoming more expensive.

Here are the 5 most expensive cities for expat living, according to consultant firm Mercer UK:

1. Tokyo
2. Osaka
3. Moscow
4. Geneva
5. Hong Kong

The Mercer survey, considered the world’s most comprehensive cost of living survey, is aimed at firms thinking of sending workers abroad. The survey covers 143 cities across six continents and looks at more than 200 factors, including the cost of housing, transport and food.

Different “winner” last month
Last month, a different survey, by ECA International,  looked at a wider range of cities and deemed Angola’s capital, Luanda, the most expensive in the world for foreign workers. It reported that a meal there could cost more than $100 and a “decent” apartment could be as much as $15,000 a month, despite the fact that most Angolans live in poverty.

Pictured: Tokyo subway map.