Sunday, August 17, 2008

going to health

"Where is medical care on your list of factors?"

During the past two weeks, I have received several comments and email from people who were convinced that I had left out the most important factor for retirement: medical services.

I did not forget it. It is simply one of those factors that does not register very high on my list of concerns. If my employer did not provide "free" health insurance, I would not buy it for myself. In the United States that would be a somewhat risky proposition -- if only because of the high cost of medical bills if I guess wrong.

There are many reasons why medical care in the United States is so expensive. And because there are so many reasons, most of the fast fixes that politicians propose will simply not work. As a result, the medical community and the public are caught in a mutual suicide pact that is simply unsustainable.

Most people who ask me about medical care in Mexico are only slightly veiling the subtext of their question. The real question is: don't you fear for your life in a Mexican hospital?

The quick answer is no -- because the question is based on a false premise. Mexico does suffer a lack of rural health care -- just like in the United States. The more remote, the less care.

But almost every population center has a core of highly-trained physicians and modern hospitals to provide excellent medical care. And that is where most Americans get worried. If the care is excellent, it must also be expensive.

That is merely the automatic reflex that health insurance companies have taught us to believe. When I grew up in rural Oregon without health insurance, affordable health care was just miles away. Not any more. The moment that the patient ceased to be the consumer, the system was doomed to end up where it now is.

Even though some Americans label Mexico as a socialist country (even I have fallen into the trap), it is far more free market-oriented than my paternalistic home state of Oregon. Health care works in Mexico because patients are customers.

If you pick up any book on Mexico, you can read about any number of foreigners who have suffered some major medical crisis with attendant hospitalization, who have paid the full bill and cash and who have spent little more than a cruise in the Caribbean. Health insurance and "single payer" governmental health schemes have not yet caused medical expenses in Mexico to sky rocket.

Mexico also has a system designed to provide basic medical care for Mexican workers:
Mexican Institute of Social Security (Instituto Mexicano de Seguro Social -- or, as it is often abbreviated: IMSS). The system was not designed for foreigners, but anyone with a valid FM-3 or FM-2 visa can sign up for a very small annual premium.

The care is similar to that provided by public medicine throughout the world. The doctors often work for IMSS part-time, and part-time in their private practices. But, like every public health system, services are rationed through the age-old method of sitting and waiting. Many foreigners buy IMSS coverage as catastrophic insurance and then pay out of their pockets for day-to-day services.

That gives you an idea why medical care is not a big issue for me.

Now I need to come clean with a full disclosure. When I move to Mexico, I will not be running naked -- in an insurance sense. As a retired federal officer, I am entitled to medical insurance (TRICARE) that will reimburse me for some of my costs. And even though Medicare does not currently cover retirees in Mexico (and I will buy a large sombrero to enjoy for
la cena if Congress ever approves that drain on a hemorrhaging system), if I register for Medicare and purchase Medicare B, TRICARE for Life will continue to reimburse some of my expenses.

I have friends my age (pre-65) who have purchased health insurance in the States and in Mexico. They are healthier than I am, but they fear the unexpected. I simply do not have those fears.

And I guess that is the moral: if you feel you need to give more money to the insurance industry to buy yourself some piece of mind, Mexico is a place that gives you the freedom to do that. But it also gives you a fighting chance to be able to rely on your own resources and still meet your medical needs.

I will call to the stand, one of my blogger colleagues, Theresa of ¿What do I do all day? originally posted on Moving Kids to Mexico:

We decided to be self-insured. With the price of health care in Merida compared to California, we spend what would be our co-pays and see specialists without having to ask permission. Some of our friends have IMSS insurance, which is the national health care. It goes by age, but even the most expensive premium (for age 60 and above) is around $300 USD per year. But even without health insurance, a general practitioner costs around $150 MXP and a specialist at the state-of-the- art Star Medica costs $500 MXP. And this is not a 15-minute visit; it's as long as you need. Our neighbor was in the hospital for a week, he had emergency surgery for a bowel obstruction, he was in a private room in Clinica Merida which until Star Medica was built was the #1 hospital here. His total bill for everything was $70,000 MXP including a couple of days in ICU. The private room was $900 MXP. Really, I have known people to go into the hospital and their co-pay was more than the approximately $7,000 USD our neighbor paid, and they certainly didn't get the same level of care. If he had gone to the IMSS hospital he wouldn't have had a private room, but he would have had the same doctors and not paid a thing! Merida is where they send everyone from the peninsula and even from Belize and further south. So unless you are living in a pueblito, don't sweat the health care. It's a bargain.


Theresa in Mèrida said...

I am a bit wordy aren't I? I remember writing that, but I don't remember where. LOL....
Oh, one thing the $900 pesos for the private room was per day, not total but I sincerely doubt that you could get a private room in the USA for $85 dollars a day!

American Mommy in Mexico said...

It was on my Blog Theresa! We are still working out all our insurance details. Since we are just here on temporary basis we have to keep major med in USA to get credible coverage cert when we go back.

I am have some numbness in my left foot and need to go see doctor. I have a feeling I am about to get 1st hand experience with Mexico medicine.

Babs said...

I SO agree with Theresa - I've had three bouts in the hospital here and the three day stay was less then $600 and that includd the cardiologist's bill.
I asked my cardiologist if I should buy health insurance and he said, well if someone needs a heart transplant in mexico it won't be over $10,000 US - I decided to forget it. I DO have Medicare in the US for catastrophic stuff. Some Blue Cross-Blue Sheild policyholders DO get reimbursed for their costs in Mexico once they have paid their own bills.
My son had a hernia operation and it was $3500US for the surgery and the hospital stay in Queretaro. I have no idea what that would be in the US.
It's not a big issue for me either.

Steve Cotton said...

Theresa -- You said it so well, I thought others should be able to enjoy your experiences. Thank you for the material.

American Mommy -- Good luck on the foot. I am willing to bet you will have an experience that is as pleasant as contacts with doctors can be.

Babs -- You are correct that medical decisions are so much easier -- especially on the pocketbook -- in Mexico.

Hollito said...

I visited a dentist in the DF - or better, two, as they were sisters - and paid what I would have paid in Germany as an addition to what my health insurance would pay.
Needed an X-Ray. No problem, went to that place, got my "photo" and paid something like 20US$. Took me 30 minutes.
Had a really bad problem with my back just before I was going to my marriage in DF (and no, it was not because of what you think, so stop giggling ;-)) and it was no problem, went to the university hospital in DF. They looked for it, wrote down a medicine, and everything was fine...

I assume that in most of the "developed" countries, the bureaucracy just eats up a lot of the money.
Here in Krautland you pay a horrible money for health insurance (you are not free to pay it, you have to by law) and you get less every year, even you have to pay more each year. Strange.
Where does all that money go?

Steve Cotton said...

Hollito -- Great question. Every developed country asks where all of the money goes for medical services. The chief problem almost always is someone getting between the consumer and the provider of services. Doctors and patients can easily work out prices -- or, as in your example, the Mexican system has figured out how to do it. Ironic, that a nation known for its love of forms and signatures can perform this very important function better than Europe, Canada, or the United States. I am willing to bet a lot of it is expectations.

Anonymous said...


One thing you should think about is this. Most of the glowing reviews of Mexican healthcare that we see from the blogosphere center around procedures, which appear to be cheap and high quality. But where you could run into some first-world prices would be where drugs are concerned. Take oncology drugs, which are very expensive here in the U.S. I have a hard time believing that they'd be a whole lot cheaper in Mexico. Sure, we all know that the U.S. pays the highest drug costs in the world to support all that research, but still, a lot of these drugs are quite expensive. This could also be the case with novel antibiotics which might be needed for drug-resistant bacteria.

On one of my trips to DF, I was asked by a friend to try to buy her Levaquin, which is a newer antibiotic (not covered by her plan, but used for urinary tract infection), and quite expensive in the US. Bottom line? Nowhere I went even had it or had heard of it. And that was DF, not some colonial town.

So just keep clear in your mind that whatever is locally produced (doctor's efforts, room rates, nursing care, etc.) will enjoy a very low price relative to the USA, but other things like expensive drugs could be a nasty surprise if you have no insurance.

Also, things like cancer have become very survivable here in the USA, due to expensive and aggressive therapies. I wouldn't be surprised at all if the low costs of Mexican healthcare were also accompanied by plenty of people who simply die before they rack up huge bills.

Mexico would be a terrific place to break a leg, have diverticulitis, replace a bad knee, etc. But I'm sure there are plenty of areas where your outcomes would be dicey, especially if you had something unusual.

I have given this subject some thought, and were I to move to Mexico, I think I'd buy a high deductible policy just to cover the above situations. With a $20K USD deductible, you would probably pay a fairly low rate, but protect yourself against disaster, which I sincerely hope you'll never face.


Kim G
Boston, MA

Steve Cotton said...

Kim -- A lot of my outlook gets back to my basic philosophy on life.

Rule #1. I am going to die.
Rule #2. I cannot change rule #1.

At most, medical care delays death. It cannot stop it. Mexican health care will provide me with the basics at an affordable price. If I need something else, I basically have two choices. I can either purchase what I can afford and choose to pay or not pay for services. Or I can ask somebody else to pay for those services -- either through payments government has involuntarily seized or from an insurance company. I have no objection to insurance, I am just not certain that trying to extend my life is worth the expense of insurance premiums.

Now, I have already told you that all of this libertarian talk is cheap because I am covered by TRICARE -- where I pay approximately 25% of my medical costs. But it does reflect my philosophy.

John W said...

I love the medical care I get in Mexico. Doctors here practice medicine, not law. Less defensive testing, friendlier, personalized interactions. Sore back? Bacterial infection? Food poisoning? These guys handle this kind of stuff as well as anyone in the world.

But the system sometimes breaks down, and that can be downright dangerous. In January 2002 I had a serious heart attack here, leaving me with a lot of scar tissue in the heart muscle. After hours of confusion and delays at our small local hospital (while heart tissue slowly continued to die) I was transported to a major hospital in a nearby city for angioplasty. The machine broke halfway through the procedure. Ultimately the work was completed, but the cardiologist was unable to clear one of the two defective arteries. I was patted on the back and released as fit to go live my life. Cost: $9,000.

I went to the states where I checked in with my California GP. He took an EKG and immediately threw me in an ambulance. At the hospital, they repeated the procedure, clearing the second artery and installing a defibrillator. Cost: $110,000.

Today I visit a heart clinic in Houston every six months. I sit patiently in a waiting room, surrounded by rich patients from Mexico City.

What do they know that we don't know?

Steve Cotton said...

John -- For all of my libertarian ranting, there are things I truly enjoy about the American health system. The fact that people come to the States for care is a good testimonial. I went to grade school and high school with my doctor. It will be hard to replace that relationship no matter where I go.

Theresa in Mèrida said...

Healthcare is one of the reasons we picked Mérida. It isn't a pueblo,it is a major city, the state capitol. For most things we go to Clínica Yucatán, 3 blocks away. For something really minor I might even see the doctor who is attached to the pharmacy (he charges $30 mxp for a visit). But we also see a specialist in respiratory aliments(I can't remember what that is called, pulmonologist?) who is one of the Latin American consultants to an international pharmaceutical firm. Our palliative care specialist routinely travels to conferences in the USA. Our internist also works in Houston. To see these specialists costs between $350 and $500 mxp.
Steve quoted me answering American Mommy, regarding health care for her healthy family. I still stand behind what I said to her and her situation.
If you are elderly or have health issues you might not want to live in a rural environment even in the USA.For example,my son's paternal grandmother died en route via helicopter to Sacramento, California when her hospital wasn't equipped to help her.
As for rich Mexicans going to Texas,my friend told me this story, I hope that I can retell it correctly.A friend needed surgery, his doctor advised him to have it in Mérida. But the patient was adamant that the surgeons were better in Houston. As he was being wheeled back to his room, the surgeon came over to him and lifting up his mask said "I told you it would be cheaper to have the surgery in Mérida" it was the same surgeon (who also practiced in Houston).
I have been told that the rich Mexicans here like to go to Cuba for health care because it is less expensive.

Steve Cotton said...

Theresa -- Thanks for the supplement. You are correct that there is no perfect medical system. Life is not perfect. The goal is to find "good enough." But, like all humans, having found "good enough," we still look for "something better." From what I can tell, a perfect medical system simply does not exist.