There's a pricing/information problem. Say you hear that the hip replacement is $10k in the US and $2k in India. But there's also a place that's $1.5k in India

There's a pricing/information problem. Say you hear that the hip replacement is $10k in the US and $2k in India. But there's also a place that's $1.5k in India and a place that's $2.5k in India. Which place is good? You haven't a clue. Do you take the risk? Are you going to end up with a hip that lasts shorter than you want it to? That'll be bad for you. And then comes the fact that insurance pays for most people so the price is hidden. You don't actually pay $10k. Instead everyone pays slightly more than they should for insurance.