While it might not seem directly related to my blog theme of the exploration of Mexican ex-pat life, health care is a poweful motivator and worrisome issue - especially for those who are early-retired and without some sort of sponsored or subsidised coverage. I suspect a significant portion of the Mexican ex-pat population from the U.S. was influenced in their relocation choice by this issue.
For now, just a few links here that provide context so I can easily refer back to a single location for discussion of this topic. Perhaps over time I'll come back and refine this reference.
My essential position: We need single-payer health care like every other advanced western country on the planet. They all get much better outcomes (like longer life span with better health) at a fraction of the cost of our current dismal U.S. system, where horrific high premiums go largely to wasteful things like tens of millions in executive salaries (within a single company) feeding into 30% or so overhead for billing, marketing, and administrative costs. There is a national movement to make this happen. The OECD has a good summary of our inferior current arrangement. The Affordable Care Act (Obamacare) is a poor substitute for a national single-payer system.
A number of those leaving the U.S. for life in Mexico and elsewhere are in part seeking a better opportunity to maintain their health without ruinous expense. In addition to affordability, the way care is accessed and the resultant process and outcomes can be vastly superior and more sensible. Much fewer unwarranted tests and interventions, and a more humane interface to the system are likely. Aversion to exposure to the crushing expense (for those with unsponsored, high deductible, or non-existent coverage) and byzantine processes of the U.S. system can keep U.S. residents from receiving early or preventive care that may be life-saving or prolonging.
If I have a health care concern here in the U.S., and would like to get in to see a doctor, it is likely a difficult thing to schedule, and there will be reams of paperwork on arrival. It will likely cost hundreds of dollars no matter how small the complaint, and it will not be covered by my high-deduction overpriced policy. I will expect to be under-served and treated badly by the staff, and assume the treatment I receive and outcome will probably be largely determined by profit and legal liability concerns of the practioner's office. If I see a doctor at all, it will probably be for five or ten minutes - just as likely I will be seen by a physician's assistant (but still billed a high dollar amount). Weeks or months later, I will receive complex explanation of benefit paperwork (required to track my high deductible) from the insurance company that shows my ultimate charges by the doctor office.
In Mexico, if I had a concern, I would make an appointment (with a specialist M.D. if I thought it appropriate) probably for the same or next day, and the cost would be around $25, cash. With a minimum of paperwork, I would see the doctor for maybe a half hour to an hour, while a proper assessment of my situation was accomplished. At the conclusion of our appointment, the doctor would hand me a card with his or her cell phone number and an invitation to use it. They would probably be available to visit my home for a followup if I did not feel well enough to return to their office later. I would pay for this inexpensive visit out of pocket. If a more serious condition was revealed, I might have to use either affordable private major medical insurance, or one of two very inexpexpensive national health care programs that are open to ex-pats.
Mexican hospitals and physician offices may appear to be modest, with plastic resin chairs in the waiting area and peeling or scuffed paint on the walls, while U.S. facilities often resemble lavish exotic resort hotels or spas. I would rather pay for my care, rather than prestige facilties that establish and enhance an elite rarefied atmosphere for the U.S. un-wellness industry and its denizens.
If I had only a minor concern in a Mexican village or city, I might just go a nearby pharmacy clinic for three or four dollars and see a doctor for a few minutes, and walk away with a prescription medication (if indicated), although no actual prescription is required at the pharmacy counter for most medicines.
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| Mexican pharmacy clinic - $30mxn equals about $2.50 USD |
For those willing to self-diagnose and medicate this no-prescription policy can be very helpful. Years ago I experienced a minor problem with my eyelid a few times. Treating it required a prescription anti-bacterial ointment used for several days. In the U.S., I would have to make a $175 appointment with a doctor to have him (or his PA) look at the eye, then write the prescription. Maybe another $20 to fill the prescription. In Mexico, I would simply go to a pharmacy and buy over the counter for maybe $5-10. I should note that one doctor wanted to do a fairly invasive surgical remedy, which I declined, and proved to be entirely unnecessary.
Finally, on another note, there is the issue of end-of-life care. Perhaps a subject for another discussion, for now I will post a link to an excellent article. I think it is reasonable to assume that Mexico would be instinctively, practically, and culturally more inclined to provide the more sensible and humane exit from an incurable or hopeless situation that many of us may one day have to deal with.
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