An up close and personal look at the American medical system – and it’s not good news

“I should just go get on a plane and fly to Mexico,” my husband mumbled as he lay curled in a fetal position on a hospital gurney last week. “It would be so much cheaper there.”

He was right – it would have been. And the care would have been at least as good as he got here in Boise, Idaho. Unfortunately, when you’re in the throes of excruciating pain from appendicitis you don’t have the luxury of climbing aboard a plane to fly to another country for medical care.

I’ve written a lot about medical care abroad. We’ve been fortunate (?) enough to experience emergency rooms in a variety of countries throughout the years. In Egypt I broke my hand, in Malaysia my son broke his arm. My husband’s heart went into arrhythmia in Ethiopia and he thought he broke his thumb in Nicaragua. I had pneumonia in Argentina; my son had it in Malaysia. I fell down stairs in Vietnam and messed up my foot. We’ve sought medical care in Israel, Mali, Yemen, Mexico, Honduras, Panama, Colombia, Ecuador, Peru, and Bolivia.

And now we’ve sought medical help in the United States of America.

One of our major concerns when we made the decision to live in the United States six months ago was health care. Always before, both my husband and I had been teaching and had health insurance through our jobs. Now that we’re self-employed, we don’t. That’s scary.

We are still covered through our travel insurance – but that will end October 4 on our six-month anniversary of arriving in the USA. At that point, we will need to pick up another policy. We’re honestly not sure how long we’ll be able to maintain the high cost of the premiums (around $400/month just for the two adults with a very high deductible; the boys are covered through a state program). We may need to leave our country in the end.

Thursday morning John stumbled through the apartment door around 11 in the morning and collapsed into bed in pain. All day he clutched his stomach and groaned. By 9 in the evening, the pain had reached a point where he couldn’t tolerate it anymore and we headed to the ER knowing the cost of surgery in the US was outrageous. There is no question that, if he had had the luxury of time, he would have flown to another country.

Friday morning John underwent surgery to take out his appendix; Friday evening he came home. He opted for no pain pills due to the high cost and simply endured the pain instead.

On Monday, he called our insurance company – and was told he needed to get preapproval for surgery. Even emergency surgery. At this point, we aren’t sure if they will cover the cost of his treatment or not.

Tuesday the first bill arrived – $1357 for the surgeon. That doesn’t include any hospital bills at all – it’s only for the 45 minutes of the surgeon’s time in the operating room. In Argentina I stayed in the hospital for a week for $514.

There is no question in my mind that we received better medical care in other countries – yes, even third world countries like Nicaragua or Bolivia. The thirty minutes John spent waiting before even talking to a single person in the ER were excruciating – in other countries we’ve never waited thirty minutes before being seen by a doctor.

I’ve said for years that medical care in other countries is equally as good as in the US but a fraction of the cost. Now I’m rethinking that idea – I’m starting to wonder if medical care in other countries isn’t better than in the USA at a fraction of the cost.

And so I come back to the big debate I’ve been struggling with for ages – what is the price of quality of life? There are some great reasons to live in the USA:

  • The educational program our sons are in here in Boise is world-class and we would never find something like this anywhere else.
  • The boys are enjoying being part of a soccer team and a Boy Scout troop.
  • I love having my beads and being able to teach beading classes.
  • I know where the grocery store is and I know what I’ll find there.

But is it worth it? Truth be told, the reason we are here is for the school program the boys are in – if it wasn’t for that we would have hit the road a few months ago. Part of me is hoping the program doesn’t work out long term – if we were to leave the USA, we would have decent medical care again.

Which is more important? Great education for our sons? Or medical care?

And why the hell are we having to choose?

What experiences have you had with health care in the USA and abroad?

edited to add: We heard back from the insurance company that they approved his “preapproval” so they will cover their share. We still don’t know what our portion of the bill will be.


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About Nancy Sathre-Vogel

After 21 years as a classroom teacher, Nancy Sathre-Vogel finally woke up and realized that life was too short to spend it all with other people's kids. She and her husband quit their jobs and, together with their twin sons, climbed aboard bicycles to see the world. They enjoyed four years cycling as a family - three of them riding from Alaska to Argentina and one exploring the USA and Mexico. Now they are back in Idaho, putting down roots, enjoying life at home, and living a different type of adventure. It's a fairly sure bet that you'll find her either writing on her computer or creating fantastical pieces with the beads she's collected all over the world.

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78 Responses to An up close and personal look at the American medical system – and it’s not good news

  1. wandering educators September 18, 2011 at 7:23 pm #

    this is so very important. we can’t get insurance, bc of pre-existing conditions. it drives me crazy. and yes, we think hard about going to the dr. it’s really sad, that in our first-world country, people are locked out of health care.

    i hope that john heals quickly (and with minimal pain). i hear you on this issue – and i don’t see anything changing anytime soon, despite the president’s new law and the extreme importance of health care. SIGH.

    • Nancy September 18, 2011 at 7:29 pm #

      @wandering educators,
      Honestly, I can’t imagine living in the USA without insurance. We would leave the country for sure if it came to that. We are fortunate that we do have insurance, although the high deductible will be a challenge to meet.

      This is tragic – “in our first-world country, people are locked out of health care.”

  2. Valerie Mellema September 18, 2011 at 7:30 pm #

    I so know what you’re struggling with here. My son and I are lucky to have Indian cards, we’re Cherokee. We live within an hour and a half of a clinic in Oklahoma (we’re in Texas) and the hospital is about 2 and a half hours away (also in Oklahoma). We’re self-employed as well and although we make decent money, we have a hard time forking out the amount of money we would have to for health insurance. So, my husband is uninsured and my son and I will drive to Oklahoma for healthcare. We actually moved to Oklahoma for a month while we waited on our son to arrive so that it would be free. For little things, like our son’s daycare physical, we went ahead and paid cash at a local doctor’s office, but for anything else we make the trip. That’s the beauty of having an Internet business, but it’s still not right. My sis-in-law on the other hand had her daughter in Spain and raved about the care she received there. Other countries are beyond us in healthcare, but we have to go broke for healthcare here – especially if you’re self-employed.

    • Nancy September 18, 2011 at 7:33 pm #

      @Valerie Mellema,
      I’m happy you can get the care, but having to drive 2.5 hours is crazy. I look at the health care situation in other countries and realize that people there simply don’t have to do that all that often. There are a few places where they do, but generally there are medical facilities in all the towns.

  3. Talon (@1Dad1Kid) September 18, 2011 at 7:42 pm #

    It is a sad state of affairs indeed. My blood pressure medicine at home cost me $20 a month in copays. Here on a tiny island in Honduras (so things are more expensive than the mainland) I can get 2 months’ supply for that amount, and I don’t have to see a doctor to get a refill. When I broke a filling, the dentist fixed my tooth for about $30 which included her exam as well as the filling. And her equipment on this small Caribbean island in Central America was more modern than any I had seen in the States. Sure things are priced according to people’s incomes here, but this particular dentist tells me that most of her patients are foreigners. One of the main local physicians is actually American and American-trained. A visit to him costs about $20, but you can see his counterpart for about $5.

    I do understand the costs are more in America, and I understand that thanks to sue-happy people rates are higher because of that as well, but there HAS to be a way of fixing it and making health care reasonable for everyone.

    • Nancy September 18, 2011 at 7:53 pm #

      @Talon (@1Dad1Kid),
      I agree – it’s such a shame that the USA has such a dismal system. There has to be a way to fix it – there simply has to be.

      I do understand why the system is the way it is – the people who are responsible are like I used to be. When I had coverage through my school I simply couldn’t understand all those people who talked about not being able to get insurance. As much as I read about it and all that, there was no way for me to understand until I was there.

  4. Chrystal September 18, 2011 at 10:13 pm #

    I think part of the issue is entitlement. Doctors go through a lot more schooling than most professions, so their student loans are astronomical … plus the start-up costs of running a business (overhead, advertising, equipment, assistants, etc.) and the cost of medical lawsuit insurance (because of all the people who abuse the system), they feel they’re entitled to charge big bucks.

    Think about other professionals who go to school just as long with a fraction of the income. Think of other professionals who go to school half as long but don’t even come close to half the income. It’s not a “can’t live without it” supply and demand system (since obviously we could find healthcare in other countries if it came right down to it). If “can’t live without it” were the case, we’d be paying a lot higher salaries to our teachers and garbage men.

    Why is a bottle of aspirin $2 at the pharmacy but $20 at the hospital? Middlemen, paperwork, and red tape.

    • Nancy September 18, 2011 at 11:36 pm #

      I feel like we should take our own aspirin to the hospital with us…

    • Ginger September 19, 2011 at 11:50 am #

      This cracks me up about “entitlement.” Medical practioner salaries (MDs, PAs, NPs) continue to go down. The price you pay is not set by the doctor, but typically by what Medicare pays for things and by the insurance companies. To become an MD in the US it takes a lot of money and a lot of education. It is 8 years of college minimal and then internship and residency. Yes, internship and residency are paid, but the number of hours you end up working makes it similar to minimum wage. The average family practice physician makes just over $100,000 which is not a bad living, but certainly not extravagant (given the cost of living in the US). I would say if things continue the way they are then the quality of our medical practioners will decrease because the pay has become very low. Insurance reform and capping lawsuit payouts are the keys to fixing this. People think that MDs, etc are living extravagantly, but for the most part that is not the case unless you are in a surgical specialty. I agree with the author that there needs to be change here, but I find it hard to believe that the quality of care is worse here than elsewhere. Was the appendectomy performed properly and has her husband recovered adequately? Then what about that says that the healthcare was suboptimal? I also have to argue about the cost of pain medication. Generic pain medication is not that costly. There is no need to save a few dollars to be in pain when you have already paid for a surgery. I have worked with many people who have also traveled the world with the Olympics, etc and they paint a completely different picture of healthcare abroad. There are also many stories of government run medical programs (socialist medicine) in which you can be told to suck it up because the government will not pay for newer costly medications. Many people travel to the US every year for healthcare too and it isn’t because the healthcare is poor.

      My two cents,
      Ginger (a physician assitant)

      • Nancy September 19, 2011 at 3:50 pm #

        I blame the malpractice suits for a lot of the problem – it’s crazy what people will sue doctors for. Yes, I realize that mistakes happen (and sometimes those mistakes cost people their lives) but doctors are human too. At some point, we have to trust them to do the best they can and leave it at that.

        • Joe September 24, 2011 at 6:20 am #

          @Nancy, If you look at the numbers, malpractice is not the driving force behind rising medical costs. (If it suddenly became illegal to sue for malpractice, costs would drop less than 1%)

          The real costs as many point out, are the insurance and pharmaceutical companies who are attempting to maximize their profit margins.

          • Nancy September 24, 2011 at 3:25 pm #

            That’s scary. The malpractice is scary too. Gosh – this whole American medical system is scary!

  5. Jackie Rose (@letssitoutside) September 18, 2011 at 10:19 pm #

    It’s so tough. I can’t say where is better to live. I’ve traveled to about 30 countries across 6 continents and I’ve had a few great hospital stay (if I can say that) and a few terrifying hospital stays abroad. Of my time spent in hospitals in the US, I can’t say it’s been particularly scary but the bills, forget it.

    I fell off a roof in Argentina and while unconscious, a surgeon operated and put three pins in my shattered arm. In doing so, he severed tendons, nerves and other connective tissue. No, I didn’t pay much for the surgery, but I also almost lost my arm entirely as a result of it. After that first operation, World Nomads, my travel insurance company, helped me get to another hospital where another surgeon removed the pins and said I’d need to get to the US within a week to have my arm reconstructed.

    I did get to the US a few days later and by the amazing medical feat of titanium, cadaver bone dust, bone glue, seven more reconstructive surgeries and 2.5 years of PT, I have a 90% functioning arm.

    Sooo…what I mean to say is that when it comes down to the tough stuff, like open heart surgery or reconstructing a limb, for the most part, I want to be in the US and, as expensive as it was, I don’t mind paying.

    We don’t have a perfect system here, far from it, but I feel lucky to be able to have my arm reconstructed. At least I had that option here. In Argentina I would have had my arm amputated.

    I also broke my face in half, which wasn’t discovered until I returned to the US and had a proper CAT scan. If I had stayed in Argentina, I would have lost the use of my right eye and my face would have become paralyzed on the right side.

    As I said, it’s not a perfect system. It could be improved a lot, a lot A LOT, but overall I feel so lucky to be a US citizen, to be able to fly back here and wait forever in the ER and pay a bill but get great care.

    Check out this post on how I got around insurance BS:

    • Nancy September 18, 2011 at 11:36 pm #

      @Jackie Rose (@letssitoutside),
      I hear ya entirely. What you described is exactly the reason we will never go without insurance. Although 99% of medical situations can be taken care of whereever, there may come a day when we will want to be in the USA – maybe for extremely specialized surgery or long term care for something like cancer. We recognize the chances of that happening are slim, but they’re there.

      It’s a tough issue for sure. There are no easy answers.

  6. Theodora September 18, 2011 at 11:12 pm #

    I do not understand how basics such as painkillers can cost SOOOO much more in the US than they do in, say Europe, let alone Asia. Your system is screwed.

    • Nancy September 18, 2011 at 11:33 pm #

      You’re right. I don’t get it.

      • Elle September 20, 2011 at 9:32 am #

        @Nancy, It’s because of demand and willingness to pay. Countries to which US Pharmaceutical companies export medication only pay for the cost of producing the medicine. That leaves the (enormous!) R&D costs that need to be covered for the company to stay in business. The US market is large, drives most of the demand, and ends up paying for those costs through higher prices.

        Government subsidies (there, not here) also play a large role.

        • Nancy September 20, 2011 at 3:11 pm #

          I’ve heard that before – that the US is, in large part, paying for the research and development of new drugs which are then provided to other countries at little or no cost. I can certainly see that playing into the equation, but doubt that it’s a major player in the outrageous fees for medical care in America.

  7. Thomas Arbs September 19, 2011 at 12:04 am #

    Right, so your medical system may be screwed – but trust me, so are others. Just as you said you cannot imagine living without health care, neither can we, because over here it’s compulsory. That denies us the struggles you are facing – when my daughter fell off the monkey bars in the garden, I needed not reconsider for a second before calling the ambulance – but it also denies us choice. Since we’re both working, we have to be both insured, and have to cough up almost 900 Euro between us (OK, the kids are included, and if only one were working, the partner were included, too). We have no deductible (as a generally healthy person, I’d rather have one), but certain areas are still not covered, like simple painkillers or cough drops, or complex tooth jobs. (My Swiss in-laws went to Hungary to have their teeth done, a luxury summer holiday by Lake Balaton, pools, wine and wellness with the odd dental treatment strewn in between, and it all was cheaper than the teeth alone at home. An entire industry caters for the medical traveler.)

    You’ve seen your share of international medicine, I haven’t, but have you considered that maybe you were treated a lot faster and better than the locals because you were a guest, and a paying one? Are you sure the treatment a farm labourer (to whom oh-so-cheap 50 doláres may mean his family won’t eat the rest of the month) receives in country XYZ will be as good as yours?

    • Nancy September 19, 2011 at 12:53 am #

      @Thomas Arbs,
      I’ve certainly considered that maybe we get in faster than locals because we aren’t locals, but even so I think the health care in other countries is – many times – better than what we have in the USA for the standard stuff.

      Yes, we do have fabulous specialists here that can do amazing things. That’s why I want to make sure I have health insurance of some sort so that I can get that level of treatment if we need it. But for the basic, run-of-the-mill stuff it’s frequently better and cheaper in other countries than it is in the USA.

  8. Clark Vandeventer September 19, 2011 at 8:43 am #

    Great post and thanks for sharing…. and saying something that so flies in the face of conventional wisdom!

    When we were in Nicaragua a few years ago I had to see a doctor (who made a house-call). I also had to see a dentist in Ireland a few years back.

    I’m wondering what your experience is…. It seems to me that the States and other “developed” countries are much in the same bag. In Europe people talk about taking “medical holidays.”

    It seems that the “under-developed” countries are really the places where you can get quality care at an affordable price.

    • Nancy September 19, 2011 at 3:51 pm #

      @Clark Vandeventer,
      For many things, you really can get better care in underdeveloped countries. Yes, there is a lot to be said about American specialists for “big” things, but you’ve got to have really good insurance or be independently wealthy to afford those.

  9. Justin September 19, 2011 at 11:58 am #

    I have been trying to think of a defense for the US on this and I just can’t. I want to believe that somehow the system is good and beneficial, but it clearly is a wreck.

    With all the talk of freedom in the US, it is our healthcare system that is the least free of all. Americans have very little choice but to get a job, stay put, and feed the system in order to be able to afford healthcare. And this is often why so many Americans are opposed to long-term travel and such. They just can’t imagine how they would get around the healthcare dilemma. It is a mystery.

    If you have to stay, you will find a way, but I am not sure it will be the way you want to live your life. If your kids stay in school, work might be the only option for a few years until they graduate. Such is the life of an American at home.

    • Nancy September 19, 2011 at 3:49 pm #

      There are a lot of good things about the USA, but the health care system is not one of them. It’s so hard for us right now – we want to stay here, but may not be able to. It’s crazy.

  10. lisa September 19, 2011 at 12:29 pm #

    The question is, why as a country are we not rioting in the streets over this issue. When we returned to the US after our travels, we obtained health insurance through my husband’s employer. The employer covers next to nothing of the cost, so we have to pay for almost all of it – to the tune of over $800 per month. That’s for a policy with a $2500 per person deductible. That means, we would be out of pocket $20,000 before insurance would ever have to pay a dime. We tried to get an individual policy with an even higher deductible thinking it would be cheaper, but the declined us; citing any little problem as an issue not to insure us. So the fact that we take no medications, have no heart conditions, no diabetes, don’t smoke, exercise… doesn’t mean a thing to them. The insurance companies only want to insure the young and 100% guaranteed healthy. Yes, you should be outraged! We all should be outraged. So why aren’t we out in the streets like other countries?

    • Nancy September 19, 2011 at 3:48 pm #

      And that is a good question. I just don’t understand how Americans have stood for this for so long. It’s outrageous.

  11. John Higham September 19, 2011 at 10:15 pm #

    Lot’s to say here, but sadly, it would be too much for the comments section. Our family is fortunate enough to have great insurance, but that doesn’t mean we haven’t experienced the nightmare of our (US) medical system. Our son was in a bad bike accident a few years ago and suffered a fractured skull (he’s OK now) but his bill went over $100k. Over the next several months, it was a constant fight with the insurance company over what they would pay. For example, he was initially taken to hospital A in a private car. Hospital A wanted him at hospital B because they had specialist pediatric neurosurgeons there. OK, fine. This required a 15 minute $3500 ambulance ride, even though he arrived at hospital A in a private car.

    Well excuse me for not screening the ambulance with the insurance company first! They weren’t on my insurance’s preferred vendor list, so, only a fraction of the $3500 was covered. WTF? Sorry, but I was at a hospital who demanded an ambulance and my son had a fractured skull. I wasn’t going to wait on hold for the insurance company to check its preferred vendor list.

    I could go on and on.

    When our daughter Katrina broke her leg in Switzerland, she got great care in Switzerland and all over Europe. In fact, in Switzerland, the follow-up doctors visits were less than a Big Mac. Go figure. All in all, we’ve experienced great health care in many places in the world, from Europe, to Japan, Turkey, Costa Rica and others.

    I was saddened by the reader who had a bad experience in Argentina, but quacks exist in the states, too.

    There are lots of reasons the medical system is screwed up in the US, but I’ll save that rant for another post.

    • Nancy September 20, 2011 at 6:54 am #

      @John Higham,
      Oy! That’s just crazy. We’ve been fortunate before now, but aren’t sure what’s going to happen with this one. It’s just not right when you’re expected to contact insurance companies in the middle of a medical emergency.

  12. Nancy September 20, 2011 at 6:56 am #

    @John Pedroza,
    The $400 is cheap on US standards, but still a big chunk of change. That price is through Blue Cross of Idaho, is for two healthy adults, and comes with a $10K deductible. It’s only for a major catastrophe – and what are the chances that we’ll encounter that catastrophe?

    When we were on the road, we had a policy through IMG (that’s what we still have for another few weeks). It’s a policy designed for expats and long-term travelers and stipulates that we be out of the USA for at least 6 months per year. That was fine when we were traveling, but now we want to live in the USA. That policy is very reasonably priced for the four of us.

  13. Alex Dupuy September 20, 2011 at 8:23 am #

    The current US health care system is pretty indefensible, but your cost comparisons to other countries are a bit misleading. Labor costs in other lesser developed countries are typically *much* lower than they are in the US – which makes it much more affordable, but only if you are earning a US salary – when you compare that to local incomes the differences are not as striking. In the specific instance of Argentina that you gave, indicates that adjusting for incomes the week of hospital vs. surgeon cost would be about the same. Argentina still comes out quite well as you have much more service for the income-adjusted dollar, but the fact remains that for many citizens of third-world countries, their health-care systems do just as poor a job (or worse) as the US in making health care affordable and available for them, even if for traveling or expatriate Americans, they are a great bargain.

    • Nancy September 20, 2011 at 3:13 pm #

      @Alex Dupuy,
      Agreed. However, in Argentina health care is provided free of cost to everyone. Argentinians were stunned that I had to pay – according to them all medical costs should have been free of charge. I didn’t mind paying my $514, but locals felt that I shouldn’t have had to pay at all.

      What we found in Argentina were clinic in every tiny town staffed with great, knowledgeable doctors. Medications were free and we never paid for visits to the clinics at all. The only time we had to pay was when I was hospitalized – and many people feel I was only charged because it happened in a very touristy town. If it had happened elsewhere, I probably wouldn’t have paid at all.

  14. Bruce September 20, 2011 at 11:13 am #

    The quality of healthcare in the developing world is many instances is largely the same as the quality in the USA. The main issue being its great if you can afford it. So, for instance, while Americans may think Mexican healthcare is cheap and is a great deal, well it is not if you are a Mexican. So I wouldn’t go as far as to say other countries are better/cheaper for locals. Americans just have the luck of playing geographical arbitrage.

    As far as healthcare in Europe. Technically it is expensive as well but instead of paying high premiums as an individual it is subsidized through higher taxes with the higher income earners subsidizing the lower ones. And the less frequent users subsidizing the more frequent users. For reference, the total of income taxes plus healthcare costs in the USA are actually lower than my income tax in Europe.

    The biggest issue with the USA isn’t really the quality of healthcare and it isn’t the costs. It’s the bureaucracy and paperwork and the time it takes to handle it all. That you don’t have in other countries.

    • Nancy September 20, 2011 at 3:09 pm #

      I certainly agree – to a point. When we lived in Ethiopia we were able to go to a private clinic, whereas the vast majority of Ethiopians had to go to public hospitals – which weren’t the greatest. That being said, there are plenty of countries with great medical care for the local people.

      I agree that bureaucracy and paperwork are a huge downfall of the American system.

  15. Nancy September 20, 2011 at 3:41 pm #

    @Susan, I’ve never heard of NASE – will check into it now! Thanks!

  16. Pamela September 20, 2011 at 7:10 pm #

    We are US citizens currently on assignment in Canada. All our friends talked about the “free” health care here, but it is not available to us. It is in no way free, as Canadians are highly taxed (13% sales and service tax on everything) + income taxes.

    Our neighbor had a cancer scare, which turned out to be legitimate, and was told he could get a scan in “about 18 months”.”Free” health care is rationed and doctors are limited, by the Ministry, to how many procedures they can perform annually. It’s all about limiting costs. Our neighbor went to the States, paid for his treatment, and saved his own life. He often says, “Here, it’s not health care if you’re actually sick.”

    The local ER has a 3+ hour wait. Moms with a baby with the sniffles must go to the ER and wait for approved services, because no one can afford a general practitioner on their after-tax income. It’s interesting that most GPs moved across the border to the US when Canada adopted this new system. The health care system here is expected to be broke within 3 years. The majority of outlay is paid for services and doctors in the US. (Our Toronto friend was sent to Buffalo, NY for all her breast cancer treatment.) There are no CT scan machines in Ontario, a statistic I find unbelievable.

    I had my first doctor appt. today. I was running a fever and had laryngitis, and the doctor never got out of his chair. He typed a lot and looked in my ears once. After the “exam”, he wrote me 3 prescriptions and handed me his bill! I’ve decided not to take the meds and to make the drive to Detroit, and the Henry Ford clinics, on Thursday.

    People from other countries flock to the US for education and our health care system. The US system is far from perfect, but the law requires every hospital to treat persons regardless of their ability to pay. I’ll take that over rationed and hierarchal care any day.

    • Nancy September 20, 2011 at 8:21 pm #

      There certainly is no perfect system, that’s for sure. I have a lot of friends in Canada and they all report that they’ve received good care – but that could very well be a regional thing.

      It is true that the ER can’t turn people away. I hate to get to the point where I need to rely on that though.

    • Nancy September 24, 2011 at 6:26 pm #

      @Ian and Wendy Sewell,
      Wow – awesome post. Thanks! I love your last paragraph about self-employment. It’s so very true.

  17. Lori September 20, 2011 at 9:41 pm #

    Seems to me that you gave them the very BEST “world class education” already! And I’m sure there is no formal educational structured education that can begin to compare with that gift. As to the insanity of our health care system here…and the insane cost of health insurance, don’t get me started. I have a family of 3 and we are self-employed and my husband is 64. We pay a FORTUNE.

    • Nancy September 20, 2011 at 9:55 pm #

      We agree with you! Our sons did get a world-class education while on the road and nothing can compare with that. That being said, we feel that our job as parents to provide our children with as many varied experiences as we can. We’ve given then the expat life, the fulltime travel on bikes life, and now we would like to give the the typical American teenager life – although it would be at a special school with advanced math and science classes. It’s different from being on the road – not better or worse, just different.

      I can’t even imagine how much you are paying for insurance. I don’t know how families do it.

  18. momofthree September 20, 2011 at 10:00 pm #

    We have on of those supposed “cadillac” health plans as my husband is a public employee. Most people assume this means we pay nothing for it and go to the doctor whenever we feel like it. I wish!

    Instead, they don’t cover well-child visits for children over the age of 4. There is a copay, coinsurance, and deductible on everything – even on preventative care for those of our family they cover.

    We just now, not quite a year later, paid off the hospital bill from when my son was having difficulties breathing and had to go by ambulance. Except that we had to take him in to see the doctor and it was more than $500 for a half hour visit. We haven’t met any of our deductibles yet this year (because there just isn’t room for it in the budget – though being a public employee my husband is apparently single handedly bankrupting our state…funny how that works).

    There are no easy answers in this, but I don’t think less than perfect solutions mean we should sit around and do nothing.

    • Nancy September 21, 2011 at 7:03 am #

      “I don’t think less than perfect solutions mean we should sit around and do nothing.” – that’s very true. I know I just feel so overwhelmed and have no idea where to even start fixing this system. I’m sure many are like me – where do we even start???

  19. LJO September 21, 2011 at 4:37 am #

    I am an American living in Australia. My husband wanted to go back to the US and my one condition was “you have to get a job FIRST, because I will not go back to no insurance” – so, for now, we are staying here. (He got a job here – thank god!) We have permanent resident visas here so we get the benefit of having Aussie Medicare.

    We are in an income bracket and at an age that requires us to purchase private cover for hospital or pay a levy. (So, they require those that can afford to to take some pressure off the public system for hospital … but everyone has the same access to / benefits for office visits / GP services.) We pay around $150 (US) / month for a family of 3 for an good hospital plan (ours doesn’t cover OB since we’re not having more kids) plus “extras” that are not covered on Medicare (chiro, dental, eyeglasses, etc.). All our medical experiences here – with Medicare / public services and the private system have been excellent – from routine check-ups to diagnostic tests, mammograms, etc.

    But the anecdote I really wanted to share, b/c it addresses many points in comments above: my mom came to visit me 2 years ago … and had a heart attack. She ended up needing bypass surgery. She was in a private hospital for 12 days – private because that hospital is closest to me and it is where I took her to the ER. The surgeon that did her operation works at BOTH public and private hospitals. (If I had initially taken her to a public hospital ER we probably would have transferred her to private only for the “amenities” (i.e. nicer room / fewer room-mates). She would have gotten the same care as a private-paying patient in a public hospital anyway. Same nursing ratios, same equipment, same surgeon, etc. She had an excellent outcome and really good care – world class. (And, by the way, wine with dinner on the cardio ward!) Grand total was $28,500 AUD. (At that point in time I think the Aussie $ was at about 85 cents … now it is at $1.03. Regardless – a bargain.) She lives in Boston. She would have paid at least $60K for the same procedure / hospital stay there.

    FWIW, labour costs here? Higher. (Minimum wage here = $15 / hour. Nurse make more here than in the US – according to nurses I know who emigrated from the US to Aus.) Mom had travel insurance – but she put all the charges on her Visa to get the points and the insurance co reimbursed <-;).

    This has been a "soap-box" issue of mine … I think that Americans really honestly do not know how bad they have it. They are told over and over that the US medical system is the best in the world and no one – even during the "Obamacare" policy discussions – ever really compares current or proposed US systems to anywhere else in the world except maybe Canada and the UK. So insular! Wake up Yanks!

    • Nancy September 21, 2011 at 7:01 am #

      @LJO, I think you are totally correct in saying that Americans don’t know how bad they have it. We’ve traveled extensively and have seen the medical systems around the world – and we’ve learned not to fear them. Yes, we do have some spectacular specialists in the USA, but you can also get world-class care in other parts of the world.

  20. Angela September 22, 2011 at 5:20 am #

    This is pretty bad, I’ve always heard the US medical system is unfair, and I honestly don’t understand why. Is health not the first and most basic human right?
    In Italy the health system has always been good, now these last years is getting worse and worse. If you need a specialist soon, you better go for a private doctor as hospitals will give you an appointment after months. I remember when I was younger and lived here in Italy I never paid for any kind of visit or treatment, unless I decided I wanted another doctor, but that was entirely my choice, now I have to if I want some guarantee.
    Although, I have to say, my parents have had a car accident last July and they haven’t paid for anything, be it ER, follow-up visits, plaster, x-ray, only the public ticket which is a couple of euro.
    I think the population in the US should unite and make itself heard, it might be true that the salary is higher than in other places, but life is also more expensive, so the power of purchase reduces a lot. Besides, unemployment has also been a big problem recently, how do unemployed people face health issues?

    • Nancy September 23, 2011 at 8:04 am #

      There is no perfect system, that’s for sure. That being said, the American system is very, very, VERY far from being perfect!

  21. Marina K. Villatoro September 23, 2011 at 11:17 am #

    we live in Guatemala and I love the majority of the health care here, it’s much cheaper, better service and quality

    THAT IS if you’re not seriously ill.

    my friend’s 4 year old has been operated on 3 times, in his tiny little life, all were life and death situations. the operations were fine, but no one in the entire country can diagnose him.

    they are desperate now, and want to take him to the states for a real diagnosis, but it’s practically impossible. there is 18 steps to even getting 1 perliminary appointment. and step #2 you need to prove you can pay for it. and then what happens? do they move there, it’s really tough for them.

    I would say US sucks in many ways with medical care, but for the ultra serious stuff they have a better grasp on medicine!

    • Nancy September 23, 2011 at 3:22 pm #

      @Marina K. Villatoro,
      That is very true. I’ve often thought about that issue. For the little stuff, I’d rather be in another country. For the big stuff I’d rather be in the USA – with enough money to pay for the treatment. If I didn’t have the money, I think it might be very frustrating being in the USA knowing they could take care of whatever I had if I had access to it.

      I don’t know – there is no perfect solution for sure.

  22. lisa September 24, 2011 at 10:02 am #

    This is SO true, US insurance is shockingly high and care is sometimes not what it should be. My experiences in Germany were excellent and affordable.

    • Nancy September 24, 2011 at 3:25 pm #

      I will admit that the USA has excellent medical care – great specialists and advanced equipment. But dang – it comes at a cost!

  23. Abby September 24, 2011 at 10:42 am #

    Oh no! That breaks my heart. I’ve had good experiences with healthcare through freelance writing groups in the northeast and Kaiser Permanente in California. Have you thought about moving to another state? I never thought about it boiling down to that choice. When I was unemployed, I lived in Central America to save money. Healthcare was excellent and cheap. But my friends always moved back home when their kids good to a certain age because education there was so bad.

    • Nancy September 24, 2011 at 3:26 pm #

      We’ve seriously toyed with moving elsewhere, but right now we want to be in Boise. We are hoping to make it work here, but I guess only time will tell.

  24. Deb September 25, 2011 at 6:39 am #

    So sorry to hear about your problems. There is a lot of discussion going on here that I can’t comment on being Canadian. I can’t imagine going through what you have to go through now. Good luck with all of your decisions ahead and thanks for the breakdown. I have always wondered what it really cost Americans for health care. Reading your post, it is as I suspected. Too bad, it shouldn’t be that way.

    • Nancy September 25, 2011 at 8:59 am #

      I know way too many people who have piles upon piles of medical bills sitting on their kitchen tables – and absolutely no way to even begin paying it off.

  25. Wendy-Escape NY September 25, 2011 at 7:34 am #

    I feel your pain and anxiety.

    The bottom line is for profit institutions should not have control over the health care of individuals. There is no reason why a Tylenol should cost $5 when staying in a hospital.

    People should also not have to be employed by the government or a big corporation in order to have access to affordable care/health insurance.

    I live in the US, am self employed and searching for affordable insurance in New York, which is non existent. Have looked into the Freelancers Union where the cheapest plan for an individual is $220 per month with a $10,000 deductible. This is the best deal I’ve found to date.

    Thanks @Susan for mentioning NASE. Will def check that out.

    I know Americans who lived overseas (in this case South Africa) and when they moved back got pregnant. They were uninsured and flew back to SA to give birth as the cost of the flights, health care and accommodation there was much less expensive than giving birth here.

    I have a friend who lives in Southern Cali who has MS and lost his health insurance years ago. Each month he drives to Mexico to get the medication he needs as it’s a fraction of the cost. He has no choice.

    • Nancy September 25, 2011 at 8:58 am #

      @Wendy-Escape NY,
      We already know that, if we have to have some kind of planned surgery, that we’ll go to another country. I have two bad knees and will need surgery at some point – I’m looking into where to go for that as I know I won’t be staying in the USA. It’s crazy.

  26. Warren Talbot September 25, 2011 at 8:31 am #

    Nancy, thank you for sharing what is a personal story on a politically charged subject. As Americans who have been traveling for the last year this is a topic we have discussed at length with everyone we meet.

    In every country people are shocked when we explain our healthcare back in the US. Others cannot understand that there are people who have to make a decision between eating and going to the doctor. Yet I would contend that most people know someone who has had to make this decision in the past.

    I would love to see your story go to your Congressional representatives to highlight the issue that faces anyone looking to set off on a path outside of corporate America. It is a reality that people want to live in the US for all the reasons you state and hundreds more, but should we let healthcare be the one thing that stops it from happening? Your story is wonderful and it would be great to be able to highlight this experience to our policy makers.

    There is a long rant I could go on about all the incorrect data and figures trotted out to support the “status quo”. But, the fact remains that the “Land of the Free” should not be limited to those that can afford to get sick and the rest need to move.

    • Nancy September 25, 2011 at 8:57 am #

      @Warren Talbot,
      I hadn’t thought about sending it off to my local politicians, but I think I will – you’re right that it highlights the struggle we go through in the USA to get medical care.

  27. Ron Bridges September 25, 2011 at 5:56 pm #

    Doesn’t everything cost more in the United States than in these other countries you mention ? Why should the cost of medical care be any different ?

    • Nancy September 25, 2011 at 6:10 pm #

      @Ron Bridges,
      That’s true that things are more expensive in the USA than in many other countries, but health care is generally cheaper even in countries that are more expensive than the USA.

  28. Emily @travelated September 28, 2011 at 9:33 am #

    It really is a sad state of affairs… my boyfriend and I are self-employed, and we don’t have insurance. I am terrified that something catastrophic will happen, but what can we do? Insurance is so unaffordable!

    • Nancy September 28, 2011 at 4:33 pm #

      @Emily @travelated,
      We can move to another country… That’s what we may end up doing. We’re going to give it a shot here in the USA, but paying those massive health insurance premiums will be tough. Good luck – and I hope nothing happens to you!

  29. Ade Flavell September 30, 2011 at 2:56 pm #

    Dear Nancy
    I’m from England and I am surprised no-one else has commented from here. Our taxes (income and National Insurance) are deducted straight off any salary/income, this amounts to approx 20%. Whilst the NHS has its critics and issues, having worked in it and experienced it as a patient I can say that I feel its a good system. Never having to worry about seeing the doc, a fixed prescription charge and simply able to turn up at A&E (ER) without worrying about insurance, seems to me to be a great weight lifted.
    It seems to me that whilst your worries and concerns are entirely understandable does this one issue really mean you want to leave the place you are settled? If it does then come here (!) but a family as resourceful and resilient as yours will find a way I am sure. All the best, Ade,

    • Nancy September 30, 2011 at 4:29 pm #

      @Ade Flavell,
      We are seriously hoping to make it here in the USA. We realize we may not be able to afford living here and are prepared to leave if we have to. That being said, I don’t think I should even need to think about this choice!

  30. Peter Ratcliffe October 3, 2011 at 12:59 pm #

    As a Canadian who grew up in the USA and came back 30+ years ago, I’m not fully satisfied with our universal access healthcare system, but it is actually there when you need it without a “wallet biopsy” and I’m very glad NOT to be part of the US medical system.

    The USA is the only top industrialized country in the world without universal access healthcare, and you’ve probably got one of the most punitive and over used civil legal systems.

    You and your family are very much more at risk because you have equity and assets to chase and seize in the event that you need healthcare and are uninsured or under insured. You’d be less at risk if you were penniless and uninsured, and you’d still get treatment in an emergency.

    The choice of an “alternative” lifestyle or an artist, writer, small start-up business, and even those downsized and working several part-time jobs all leave people exposed to potential financial disaster if they are uninsured, yet most of those groups can’t afford insurance and gamble.

    It’s sad that one must even worry about these issues, or conform to a “standard model” of employment to insure coverage for themselves and their families.

    I’ve watched the US use fear tactics and misrepresent the Canadian delivery model for many years. You’ve actually got far more to fear in the USA, and you’re a long way from a good solid fix.

    I wish you luck with these decisions. Somehow it’s crazy that this part of your life was simpler when you lived a nomadic cycling life.

    • Nancy October 3, 2011 at 3:50 pm #

      @Peter Ratcliffe,
      That is so very true. Those that are truly penniless will be fine in the US medical system. Those with insurance are fine. It’s us, in the middle, who are not.

      We own some properties and could quite easily lose all of them if we opted to go without insurance and something major happened. The trouble is that those properties are our source of income so if they take those, they take everything. It’s a sad situation for sure.

  31. Living Outside of the Box October 5, 2011 at 9:16 pm #

    I agree…medical care I’ve experienced outside of the US is awesome. No waits, detailed explanations (like you’re worthy of actually knowing WHY they want to treat you a certain way), knowledgeable and trained staff, and superb care. I get annoyed at the comments from family members when we talk about medical care in Mexico. They roll their eyes and talk under their breath about how you have to be careful who you see…and the good ones must be the exception. It is too bad that the US has to be so overpriced and give sub-par service. And it’s a bummer that you have to choose between kids’ education and affordable healthcare!

  32. Trans-Americas Journey November 5, 2011 at 6:49 pm #

    We’re glad the insurance company did you the “favor” of approving coverage despite the fact that you didn’t call, text and email them from the ambulance. Sheesh. We let our US insurance lapse after seeing how great care and costs are here in Latin America. Currently seeking orthopedic surgeons for a hip joint issue and the idea of getting this medical attention in the US never even crossed our minds. Odds are we’ll choose a doctor in Antigua, Guatemala where we’ll get a top trained professional using equipment and medicines and procedures that equal or surpass was the FDA has approved for use in the US.

    We recently had routine dental x-rays taken and the machine the Guatemalan dentist used was amazing–he was horrified when we told him what type of x-ray equipment was still being used in the US…Oh, and it cost less than $20.

    • Nancy November 11, 2011 at 9:33 pm #

      @Trans-Americas Journey,
      I long for the great health care and reasonable rates in Latin America… We are loving living here in the USA, but the whole health care thing is definitely a problem. We may end up leaving our country eventually for exactly that reason.

  33. Cornelius Aesop December 1, 2011 at 10:01 am #

    I am no expert on this matter but I know that my American TESOL teacher stated that she gave birth in Algeria, UK and California and that the former two were far better experiences than the latter. I have only had one experience overseas but it was quick and painless (to my wallet) to see a dermatologist. Also I know my wife is waiting until she returns to Peru to have her wisdom teeth removed due to the cost even though she has great dental insurance. There is two sides to everything but I feel we get swooped into this “we have the best this and that” mentality and fail to truly take a critical look at what we have and evaluate it for what it’s worth. Which gathering from your stories and those shared in the comments is not that far above those “third world countries” as we may like to believe.

  34. Deann Rogers December 10, 2011 at 7:01 pm #

    Wow – awesome post. The choice of an “alternative” lifestyle or an artist, writer, small start-up business, and even those downsized and working several part-time jobs all leave people exposed to potential financial disaster if they are uninsured, yet most of those groups can’t afford insurance and gamble.

    • Nancy December 10, 2011 at 7:34 pm #

      @Deann Rogers,
      This whole health insurance thing in the USA drives me crazy. I’d like to live in my own country, but may not be able to. The system is busted, that’s for sure.

  35. Dayna December 30, 2011 at 3:48 am #

    I had to comment in agreement… the more we travel the more we learn just how awful things are at home. As a university student a few years ago, I needed stitches in my finger, and the total bill was over $1,200!! Luckily, I was covered by my parents medical insurance at that point, but that coverage goes away in a year. Medical care is one of the main reasons we are considering not returning to live permanently at home in the US. An inhaler that would have cost us almost $100 at home, we received for $8 in the Netherlands. The difference is astronomical, and I sincerely hope people at home start to really question our system instead of letting themselves go in our their heads in debt.

    Many thanks for the post!!

    • Nancy December 30, 2011 at 10:05 am #

      It’s scary, eh? The saddest part of the equation is that many people truly feel that the USA has the best medical system in the world. If they got out and explored the world, I think they would learn the fallacy of that belief.

  36. Rachael Emerson February 26, 2012 at 2:44 pm #

    I’m sure many are like me – where do we even start??? For many things, you really can get better care in underdeveloped countries.

    • Nancy February 26, 2012 at 6:35 pm #

      @Rachael Emerson, Where to start for sure. There are so many options, it’s hard to narrow them down.


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