Compare the Guatemalan and American doctors. Both studied at prestigious universities and earned advanced medical degrees. They perform the same procedure with the same care and skill, and work in modern world-class facilities. Patients should know that the reason they can pay $7,000 instead of $35,000 for their surgery is because the Guatemalan surgeon does not have the burden of huge malpractice premiums, or the payroll expenses for a team of insurance processing clerks in his office. American doctors also pay staggering licensing and permitting fees, hospital privileges, inflated rent and union-approved wages. If their business expenses are five to ten times those of the Guatemalan doctors, then they will have to increase fees to the patient at the same rate.