Why US Expats are Obsessed with Health Care

Or, A Tale of Two Cysts

US expats — in fact all who live in the US — are obsessed with health care. At least, that’s the impression the rest of the world has of us.

And they’re right. Totally right, but we have good reason to be so OCD about it.

Let me explain…

My husband and I have just passed our one-year anniversary of living back in the United States. In a lot of ways, I wish we hadn’t returned, but having an expat mindset is all about expanding options. Last year we had an opportunity we decided to grab, so here we are.

Shortly after arriving back in the States, I arranged for health insurance. It’s the first time I’ve had coverage since 2009. Shopping for coverage, and comparing plans, was not for the faint of heart! However, I was able to buy a plan for what I consider to be a reasonable price.

I intentionally chose a plan that, although it carries a higher deductible, covers lab, hospital and specialist fees completely (or almost completely) once the deductible is met.

I did that because I knew I had some deferred maintenance on this older body, and I figured this sort of coverage would give me the biggest bang for the buck.

And indeed it has. Let me explain…

Bumps on my Head

No, not the kind of bumps you get from bashing into something. Quite some time ago, I started feeling these two little bumps on my scalp. Over time, they grew. Very slowly, but they got bigger.

Now, Bump #1 had always been sort of soft and gooshy. (Yes, that’s a medical term.)

Bump #2 had always been hard.

This spring, with my newly acquired health coverage, I decided to have them looked at.

The Office Visit

I went to the doctor, a general surgeon I’d been referred to. He took one look at Bump #1 and said, “Wow! That one’s about to blow!”

“What does that mean?” I asked.

He explained that the skin was very thin, and the cyst was likely to break the skin at any time and erupt. This would be oily, messy, and “extremely malodorous.”

I was scheduled to fly to Denver the following week for the Authority Rainmaker Conference, and I had visions of this thing blowing up like Mt. Vesuvias at 30,000 feet. Not a pleasant prospect for me or my fellow passengers.

I explained this to him, and he kindly cleared some room in his schedule that afternoon, took me across the hall to where he had the proper lights and equipment, and removed it then and there. It took about an hour altogether. My scalp was sore afterwards, and I had a big scab, but other than that I was fine.

The bill, when it arrived, showed that without insurance, I’d have paid about $360 for this procedure. With the insurance, it was only $160.

The Outpatient Hospital Adventure

After it had healed, I went back to have Bump #2 removed.

However, after looking it over carefully, the doc decided he wasn’t comfortable removing it in the office. He wanted better lighting, better tools, and better sterility. In other words, the hospital.

So we scheduled an out-patient appointment.

I had to go in a few days in advance for pre-screening, then return on the day of surgery.

They took me into a pre-operative area first, where they took my vital statistics and set up an IV. From the time they wheeled me into the operating room until the time the doc came out — dressed in street clothes, not scrubs — to talk to my husband was about 40 minutes. We figure the surgery itself took about 20.

The bill, when it came, showed charges in excess of $18,000. Yes, you read that right. Eighteen Thousand Dollars.

Thankfully, I didn’t have to actually pay that much. However, I did have to pony up my entire annual deductible out of pocket.

As a consumer, what was the difference in value to me between the $160 to have the cyst removed in the doctor’s office, compared to $18,000 to have it removed in the hospital? None. None at all. In fact, I would have preferred to have it done in the doctor’s office. It took less time, it was far less stressful, and the outcome was exactly the same.

Oh — in case you’re wondering — although Bump #1 was soft and Bump #2 was hard, they were both benign pilar cysts, caused by an infected hair follicle. So no medical difference there.

How is this Useful to Expats?

Well, if you’re an expat living in the US from somewhere else, you’d better get health insurance. No ifs, ands, or buts. Otherwise, one illness can send you to the poorhouse.

If you’re from the US and you move overseas to almost anywhere, medical costs are much more manageable. In many countries, unless you have a serious, chronic condition, there’s not a lot of point to buying insurance and you’re better off paying out of pocket.

That’s not hard to do when costs are reasonable.

For example…

A friend in Las Tablas, Panama, had a scooter accident one night. He’s retired, in his 70’s. He’s also diabetic. He spent three days in Intensive Care in the local hospital, then another week on the diabetic ward. He had no broken bones, but he was badly bruised, scraped, and banged up.

When he checked out, he received two bills. The first, for $85, covered the cost of his x-rays. The second, for $35, covered the cost of his 10-day stay.

That’s right, $120 total for 10 days in the hospital.

Now, this is a “no frills” facility, and they expect your family and friends to provide your meals and bring you clean sheets. But compared to my $18,000 for a couple of hours?

Just do an online search for “medical tourism.” You’ll find Panama listed as a destination, along with Thailand and a bunch of other countries. You can literally fly to Asia, get a knee or hip replacement or some other non-emergency procedure, spend a month (or two, or three), and fly back to the US with a companion for less than you would spend for the same procedure in the US.

Cost vs. Outcome

In fact, the US spends more — far more — per capita on medical care than any other nation. So you’d think we would also have the best outcomes, right? But you’d be wrong. In 2012, average cost of health care was $8,915 per person.

A 2011 study by the Center for American Progress found that health care costs had grown 818% since 1960, while wages had only grown 16%.

A report by The Commonwealth Fund showed that, despite costing the most, outcomes flagged behind 11 other countries in terms of access, efficiency, equity and quality. The one exception is in preventive care, where Americans fare better.

By most standard measurements, including mortality, infant mortality and healthy life expectancy at age 60, the US lagged behind:

• Australia
• Canada
• France
• Germany
• the Netherlands
• New Zealand
• Norway
• Sweden
• Switzerland
• United Kingdom

World Health Organization data from 2011 puts US life expectancy behind the above countries, as well as Finland, Japan, Denmark, Portugal, Spain, Italy and Japan.

Living in the US, I have a hard time imagining a life where medical care isn’t a huge stress point. When we were in Panama, I never gave it a thought.

And that, my friends, is why US expats seem obsessed with health care. We are one illness or medical emergecy away from bankruptcy even with insurance.