The battle over who pays for the delivery of health care in the United States is heating up.

Congress is preparing for budget negotiations that will include, among other topics, the future of Medicare. Will it survive as a legal entitlement for every American who reaches a certain age, or will it become a voluntary program, with coverage purchased through individual accounts?

Meanwhile, the U.S. Supreme Court will begin hearing testimony on the future — or possible demise — of the Affordable Health Act, the sweeping health care reform law passed by the Congress in 2010. Designed to take effect in stages over several years, the law has already changed behavior of thousands of American seniors on Medicare who have received free “wellness” examinations, free screenings and have begun to see financial savings as the “doughnut hole” in drug coverage is gradually reduced.

Will these, and other changes already in place for seniors, families and individuals, be eliminated?

Most of us don’t follow these issues. We just know that adequate health care in the United States is expensive. Paying for a procedure can be more stressful than the procedure itself.

For the approximately 46 million Americans who are uninsured, costs can make treatment impossible. For the rest of us, even those on Medicare, which usually covers 80 percent of a procedure’s cost, it’s still daunting. And, if you are a senior, don’t even think about dentalcare: Medicare doesn’t cover it, unless it’s required as treatment for an existing condition.

But do we recognize how expensive medical procedures actually are in the United States? Some estimates show heart bypass surgery in the United States at upward of $145,000, compared with $25,000 in Costa Rica and $5,200 in India.

In 2004, a Raleigh, N.C., man who needed a heart valve transplant, received an estimate of $200,000 from his hospital. After futile attempts at negotiations over a reduced price, Howard Staab sought alternatives and found Escorts Heart Institute in India, a facility with international accreditation and good references. The procedure, including two weeks in the hospital, cost $6,700. The experience, including a month in India and airfare came to less than $10,000, Maggi Grace, his partner, testified at a 2006 Senate Hearing on “The Globalization of Health Care.” After a month, she told the Special Committee on Aging, he was back at his job.

As reported in the Washington Post this month, the International Federation of Health Plans compared costs in the U.S. for some procedures with those of Western European Countries and Argentina, Canada, Chile and India.

Again, the U.S. led the way: coronary artery bypass: $68,000 in U.S., compared with $4,500 in India, $9,300 in Argentina, $40,000 in Canada. Hip replacement: $38,000 U.S., $16,000 Canada, $16,000 Germany, and so on.

Politicians say they want to control the costs of medical care, but so far, they have been unsuccessful.

In the meantime, Americans, like Staab, are seeking treatment overseas. In 2008, the Deloitte Center for Health Solutions estimated that approximately 540,000 Americans traveled abroad for medical care. Medscape, a publication geared to health professionals, recently reported that in 2005, Bumrungrad International Hospital in Bangkok, Thailand, saw 400,000 foreign patients, of whom 55,000 were Americans. According to Medscape, centers in India, Malaysia, Singapore, Mexico and elsewhere “also attract significant foreign patient populations.” Such travel is labeled “medical tourism,” and appears to be growing among Americans, although still remaining between only 1 to 2 percent of the patient population.

While excellent care is available overseas, one needs to be aware of risks. Just as in the United States, lack of planning and information can lead to problems. In a future column, I will explain the hows and the risks of traveling abroad for medical care, including tips from the Center for Disease Control and Prevention and other sources.

Joan Aragone writes about senior issues. For column ideas and comments, write to joanaragone@gmail.com.