Medical tourism

This piece on health care for the insured v. care for the uninsured reminded me of this piece that I heard on the radio this morning.

It's about medical tourism generally and specifically about a hospital in Thailand that caters to foreigners. I thought medical tourism was something rich people did to save a few bucks on cosmetic surgery, but the reporter who did the segment claimed that more and more uninsured Americans are resorting to medical tourism. A woman who'd had both knees replaced in Thailand was duly trotted out. She said the cost of surgery in the US was around $100,000, while it cost her only $20,000 to get her knees replaced in Thailand.

Now my first thought was: "You can afford to pay $20,000 to replace your knees, but you can't afford health insurance?!?" And these people want cash upfront; they don't have to settle for an insurance company's negotiated rate. I thought the uninsured were supposed to be too poor to even be able to scratch up one-thousand-plus dollars for a plane ticket to Thailand let alone $20,000 for a new pair of knees.

What am I missing here?