Health Insurance

What is it they say about the best made plans?  Well, in the middle of my search  for a boat, life has thrown me a little curve ball.  A few days ago I had to go in for a minor outpatient surgery.  I'm at home recovering now and everything should be OK, but it has put my search on hold for just a little bit.

This got me thinking about healthcare again.  Of course right now I, like many working stiffs in the U.S., have health insurance provided by my employer.  Over the past years the portion of this insurance that the employee pays for has gone up considerably while the coverage seems to have gone down.  While I haven't received the final bill, between all the deductibles and copayments and multiple billings. I expect I will owe several thousand dollars...for this outpatient procedure.

I'm pretty sure that for the cost I'll end up paying myself, I probably could have flown to one of a number of places where healthcare is both decent and affordable.  If I had been able to think straight at the time, I should have looked into this.  Maybe I could have been recuperating in some tropical locale where I could look at some boats instead of sitting at home.  Oh well.

General Hospital in St George's, Grenada

In the U.S. we always hear that we have the best healthcare in the world. (We should tout that we have the best propaganda and advertising in the world).  While I'm sure we have some very cutting edge research and procedures that can better save lives here, I think the truth is that for most of the average working stiffs in the U.S. our medical care is determined mostly by an insurance company that works as a for-profit business. Their primary concern is to make a profit for their shareholders and their secondary concern is selling their insurance to the companies we work for as a reasonably cost-effective "benefit".  The end result is that I doubt most of us actually have direct access to the "best" due to the prohibitive cost and lack of coverage by our insurance providers.  When pitting my well-being against the profit of a corporation, I don't think I'll be betting on my well-being as the insurance company's primary motivating factor.  So, this leaves most of us with more "average" healthcare.

I have a friend whose father retired to Mexico a number of years ago.  As with most traditional retirement-aged folks, they have had somewhat regular experience with the medical care there.  The father is happy with the healthcare he has received and finds that the quality of care is very similar to that found in the U.S., with many of the doctors and specialists actually U.S. trained. The difference is that the cost is significantly less, on the order of 25% to 33% of what comparable care costs in the U.S.  By the time I calculate what I've paid in insurance premiums and what I'll pay in deductibles, co-payments, and co-insurance (a fancy term for a percentage that you will have to pay out-of-pocket anyway), I'm pretty sure I'll have paid for more than 33% of my U.S. priced medical care this year.

The only thing that the insurance companies seem to really do for us is to negotiate somewhat more reasonable rates with medical providers (you know, when the doctor charges you $100 for something, the insurance says they apply a "discount" and the charge is reduced to $10).  Ironically, this isn't that different from the cost controls used in many of the public healthcare systems in the rest of the world.

When I was doing research on this subject a while ago, I ran across an insurance company that would provide international health insurance.  I don't recall the exact figures but from what I could remember at the time, I could get insurance for my wife and me that would cover us everywhere except the U.S. and it seemed fairly reasonable.  If we wanted to add coverage in the U.S., the cost of coverage was multiplied by a factor of about 8.  So, apparently the U.S. does have the most expensive healthcare in the world.

It seems in most cases we plan to be in places that will have decent healthcare at reasonable prices.  So, do we simply "self insure" (a.k.a. pay our own way)? Buy a policy with a high deductible that would cover more catastrophic issues? Should we consider some sort of evacuation plan (can fly you to somewhere with better medical care if you are not near facilities that can help)?  Lots of questions to be answered.  Depending on the cost, I think we will likely do some catastrophic/self insure combination.  If we do include an evacuation plan, would we evacuate from the U.S. to find reasonable healthcare.  Hmmm...

Here are a couple links for health insurance for cruisers/travelers:
Health Care International
International Medical Group
Diver Alert Network (DAN) - Scuba-oriented, but covers other issues as well.