The lack of price transparency in US medical care is a major issue! And all of the rigamarole of whether a doctor is in network or not etc. I had to have retina surgery two years ago. There was only one doctor less than a 45 drive through horrendous traffic in my “network”. The wait in his office was 4+ hours—ex. appointment at 1:30, see the doctor at 5 or 5:30, and he was only in the room for 5 or 10 minutes. every time I went. It was miserable! This was after going though everything, even setting up a surgery date, with another doctor only to find out the day before surgery he was tier 2 (vs. preferred), even though the other docs in his office were preferred (but not accepting new patients) on my network and the procedure out of pocket would be in excess of $20k, though no one could give me an exact cost (after multiple hours on the phone) because the doctor, anesthesiologist and surgery center all billed separately! Anyone who wants to understand why Americans are fed up look should at our healthcare system! It is definitely at the top of the list of our frustrations.
Thanks for sharing these detailed impressions and recommendations! Even though you call them “generalizations” it is still much more nuanced than most Americans who default to either “healthcare in other countries is AMAZING with NO downsides!” -or- “healthcare outside the US is a dystopia of death panels and horror.” Also appreciate you acknowledging that the experience and prices of tourists is necessarily different than locals.
I am curious if and how much your recs would change for people permanently moving as ex-pats compared to long term tourism?
Thank you. I know it depends on the country, of course, but honestly, I think things are generally much easier outside of America. Most countries require you to be insured for long-term stays (or you have to pay into the local system), but the cost will generally be very lower from a US POV. And if you want "better" care, that's always very affordable too. My big take-away is that there is much much more transparency outside the US: you are told in advance what things will cost. For a very strange reason, that simply doesn't happen in the US, and I don't understand why.
Thank you for the added context! It would be hard to imagine anywhere *less* transparent about price than the US, especially for any emergent procedures. I had to have an appendectomy in vet school on very skimpy grad student insurance (the year before the ACA passed) and I was sent a bill for FORTY THOUSAND dollars!!! After insurance paid their share I was still on the hook for $5k 😬
Thanks for writing about this. I always wondered about health care outside of the US and both of you have had positive experiences. The state of health care in the US is terrible and deteriorating rapidly.
Loved this. My cancer, surgeries, pt, ot, and now lifelong respiratory and pt has cost 3.5million in America. Insurance covered 10% the first year then we moved because a rural hospital told me I didn’t have cancer then almost killed me- so now all my care now which insurance claims as unnecessary costs us between 12-38,000$ a year (insurance has refused all claims the past two years). This is the #1 reason we are looking to move Portugal. And the fact my work is really there… but I appreciate this. I have been treated in France and England with no travelers health insurance and paid less than €100 so- I am praying we get visas and soon!
Michael and Brent—Skin cancer is actually caused more by an antioxidant (primarily vitamin D3) deficiency than by sun exposure. Therefore, you can wear sunblock religiously from infancy onward and still get skin cancer.
I grew up in SoCal before the advent of sunscreen and spent a lot of time getting burned and tanned on the beach and horseback riding—including during a college semester on a dig in the Mexican Caribbean. But from age 30 onward, I started taking really good vitamins—and for decades I’ve also taken supplemental D3 (5,000 i.u. a day). I’m very fair-skinned and parents and grandparents on both sides had all kinds of skin cancers—but I’ve never had one.
There are 2 very recent trends in US healthcare you may not have had the chance to experience yet: 1) the rise of "concierge" care to bypass the whole insurance-network thing (I'm not sure yet if this is a good or bad trend); and 2) the disappearance of MDs, especially from general primary care. The last few instances I've had to get a new provider, there were no MDs available, just DOs or nurse practitioners. I don't think this is necessarily a bad trend, but it is fascinating. And when I had to take a relative to the ER a couple of months ago, we waited hours while the only provider there, a physician's assistant, tended to 8 patients simultaneously, running from curtain to curtain.
A few years ago, while traveling in the UK, we thought my husband had lost his medication. (Turned out the TSA had, for some Godforsaken unknown reason, shoved the medication in his suitcase UNDER THE LINING when they inspected it, which we didn't discover until we got home.) Anyhoo, this led to our spending half a day in a Welsh clinic to get him meds to get through the week. He saw 2 doctors within the 4 hours and got the prescriptions from the onsite pharmacy, and the price was a fraction of what it would've been in the US. I remember being grateful we were not in the reverse situation, being international travelers trying to get the same prescriptions in the US. I can only assume that would be epically horrible.
Can you imagine? It's a wonder anyone ever visits the US!
I have heard about the concierge thing (seems depressing), and we have sensed the nurse practitioner thing as well. I don't understand why so many folks are getting healthcare (so that there are no doctors available) when it's so insanely expensive. I suppose America is a uniquely unhealthy country. It seems to be on our return visits. 🤔
It does seem like social and health policy in the US is governed by the principle of, "How can we keep making this more complicated and more expensive?" Yet most Americans seem to believe we have the best healthcare in the world. It's bizarre.
This was so interesting and something I think about all the time. When I was in Bangkok I learned a lot of people went there for medical tourism. I went to a specialized eye hospital and the wait time was much less, and the medications much cheaper than in the US. There were two other random patients in the room during my appointment though, which was both weird and fascinating.
This is super fascinating to me. I’ve always wondered how exactly the healthcare system works in the U.S., as the way I was picturing it was similar to what you described and it just seemed too bad to be true 😂 I’m relieved to hear you mentioning you got great dental care in Romania, too. We’ve had some trouble with dentists over the last two years, but ultimately we found a good one who was able to fix most of my wife’s problems that other dentists weren’t able to. What sucks in Romania is that dental care is not really covered by insurance, so it ends up being stupidly more expensive than other forms of medical care and you often find poor people with rotten teeth, or even without teeth at all. And while our healthcare system wouldn’t leave you to die, and most of the “state” treatments are pretty cheap, it can take forever to get an insured appointment. Several months, sometimes. But overall, it’s pretty easy to find decent and affordable medical care here. It’s one of the reasons I haven’t left yet😂
This all very reassuring. I just dropped my health insurance because we will be traveling for 6 or more months in South America. My husband and I have had ACA coverage for some time, but our income has been going up with retirement money and last year our investments did well. This meant that our insurance was no longer fully covered by the subsidy. The thing I really hate about this insurance is that you have to be in your home state to use it and even if we are in the US we are hardly ever in our home state. Anyways my husband is now on Medicare and I just dropped my inurance because it is too much to pay for something I can't even use. I'm going to look into your international insurance.
For many years in a row my husband went to a dentist in Los Algodones, Mexico. His dentist was great. And waiting in the waiting room was always fun. We always seemed to show up on some holiday. Several times I got cake while waiting, and once they were celebrating American Thanksgiving and they let us fill a plate from their pot luck before we left. Everything is more fun in Mexico.
My favourite topic! I love comparing systems as I, too, have experienced many.
While other countries can’t match the medical expertise of the US, they do so much better with preventive care through actual access. When I lived in China, I called up a hospital department and was screened by the receptionist. I got an appointment within a day or two, saw a specialist within a week, and paid for it all out of pocket (I’m embarrassed to say how little it cost!). I got an ultrasound that a physician family member told me would cost upwards of $10,000 where I now live in N America and wasn’t sure if the equipment were even available. All of my paperwork in China was electronic and moved seamlessly from department to department. I instantly accessed 10 weeks of physiotherapy (the real cost to access this care, of course, is a functional level of language ability!).
Returning to my wealthy home country, I feel like I’ve gone back in time. Yes, the quality of care is better in some ways but I simply can’t access it very well and everything is paper! I always laugh when walking papers around.
I lived in the US for many years but never really experienced the private system. When I was briefly in the private system, I was thoroughly overwhelmed. No, thank you. That is not medical care. That is a market I am not interested in participating in! There’s too many burdens on you just to get through life in the United States (the burden of navigating insurance is insane!).
I think care is THEORETICALLY better (or can be) but I have also gotten a lot of really bad care in the US. Most of it is because of overworked doctors, however. How did the system get so screwed up???
Totally agree. I think US medical care is better really only in terms of, say, an excellent cancer clinic or transplant centre. If you have insurance, you can eventually access world-class surgeons and services. But you have to endure so much misery and poor quality services/massive headaches/financial ruin to get to that point!
There's just no area of life that capitalism hasn't invaded and degraded in the US.
As a (mainly!) Spanish resident, we find their public system healthcare in general is good. Much better than Ireland, which is more like a system in a developing country.
I like the way you refer costs for locals etc. You consider the local impact of the costs and services.
But what could be another factor is in some countries where you could be considered wise foreign men (bear with me here!).
As a woman who has accessed healthcare in many countries, including Asia, I have to add that in some cases you are not listened to, or respected. Due to cultural norms. So I would also advice people be aware of this type of disadvantage and discrimination - that it may arise. Often I have asked a male pal to advocate for me, when I think I am not been listened to or taken seriously. Sad to say, but this can be the case and worth anyone travelling knowing and being aware of.
Thank you. And good point about gender bias! I think men are also more likely to stand up for themselves (and in Michael's and my case, for each other). Good reminder!
Yep. I’ve started saying to people that it’s literally cheaper to fly to another country to get medical treatment of nearly any kind, than it is to stay in the US and get treatment there. I had a scary incident yesterday — some kind of food poisoning, or I think the tap water — which the Taiwan government says is safe, but locals tell me is not. Anyway, I ended up throwing up on the subway platform, and the attendant immediately called a medic, who called an ambulance, which got me to an emergency room, and let me rest and got me medications. I feel so much better now. It was such good care. The total cost for everything? $37.
Haha oh lord! I think that's what.i hate most about the US: The insane lack of transparency and the insane cost of emergency care. No one wants to get in an ambulance -- for very very good reason!
I hate to be reductive, but it's neoliberalism. Delivering healthcare is the kind of problem "the market" can't solve on its own, because the incentives of the principal actors are decidedly not aligned. It'll get better over time, though. Even money can't stop the march of progress, despite holding it up time and time again.
So glad you are getting better care while traveling!
EltaMD 40 is the only sunscreen I can tolerate. It has been amazing.
But I now also wear hats, lightweight long sleeves and light pants. Because I'm now just realizing how much sun we get exposed to while walking or biking everywhere.
I totally think the US healthcare system must be run by the states or the fed. Healthcare practitioners become state employees. They'll receive a great pension. Or let them open their own private care, apart from affordable care. I just don't see another way out of this US healthcare expense, as it's completely unsustainable.
Yeah, there are too many vested interests AGAINST affordability. Also, I think the media do a terrible job of pointing out who is the ally and who is the opponent.
If you'd asked me two weeks ago, I would have had three different brands in three different languages! But right now I like the Turkish Watson's brand Love My Skin Guness Losyonu Sprey. Light but STAYS ON all day.
The lack of price transparency in US medical care is a major issue! And all of the rigamarole of whether a doctor is in network or not etc. I had to have retina surgery two years ago. There was only one doctor less than a 45 drive through horrendous traffic in my “network”. The wait in his office was 4+ hours—ex. appointment at 1:30, see the doctor at 5 or 5:30, and he was only in the room for 5 or 10 minutes. every time I went. It was miserable! This was after going though everything, even setting up a surgery date, with another doctor only to find out the day before surgery he was tier 2 (vs. preferred), even though the other docs in his office were preferred (but not accepting new patients) on my network and the procedure out of pocket would be in excess of $20k, though no one could give me an exact cost (after multiple hours on the phone) because the doctor, anesthesiologist and surgery center all billed separately! Anyone who wants to understand why Americans are fed up look should at our healthcare system! It is definitely at the top of the list of our frustrations.
Exactly. It is absolutely crazy.
I'm sorry, your experience sounds just terrible.
Thanks for sharing these detailed impressions and recommendations! Even though you call them “generalizations” it is still much more nuanced than most Americans who default to either “healthcare in other countries is AMAZING with NO downsides!” -or- “healthcare outside the US is a dystopia of death panels and horror.” Also appreciate you acknowledging that the experience and prices of tourists is necessarily different than locals.
I am curious if and how much your recs would change for people permanently moving as ex-pats compared to long term tourism?
Thank you. I know it depends on the country, of course, but honestly, I think things are generally much easier outside of America. Most countries require you to be insured for long-term stays (or you have to pay into the local system), but the cost will generally be very lower from a US POV. And if you want "better" care, that's always very affordable too. My big take-away is that there is much much more transparency outside the US: you are told in advance what things will cost. For a very strange reason, that simply doesn't happen in the US, and I don't understand why.
Thank you for the added context! It would be hard to imagine anywhere *less* transparent about price than the US, especially for any emergent procedures. I had to have an appendectomy in vet school on very skimpy grad student insurance (the year before the ACA passed) and I was sent a bill for FORTY THOUSAND dollars!!! After insurance paid their share I was still on the hook for $5k 😬
JFC
Thanks for writing about this. I always wondered about health care outside of the US and both of you have had positive experiences. The state of health care in the US is terrible and deteriorating rapidly.
Thank you. Yes, it is extremely frustrating.
Thanks for sharing your story. Have you looked into healthcare costs in Portugal?
No, mostly because right now Portugal isn't on our list of countries to move to.
What is your take?
Loved this. My cancer, surgeries, pt, ot, and now lifelong respiratory and pt has cost 3.5million in America. Insurance covered 10% the first year then we moved because a rural hospital told me I didn’t have cancer then almost killed me- so now all my care now which insurance claims as unnecessary costs us between 12-38,000$ a year (insurance has refused all claims the past two years). This is the #1 reason we are looking to move Portugal. And the fact my work is really there… but I appreciate this. I have been treated in France and England with no travelers health insurance and paid less than €100 so- I am praying we get visas and soon!
OMG how terrible! I'm so sorry 🫤
thank you. sadly, I know my story is one of countless stories here.
I'm so sorry. That sounds like a typical, horrible experience. I hope you can make the move.
It's sad that we just accept this instead of demand change in our system. We will make the move!
Michael and Brent—Skin cancer is actually caused more by an antioxidant (primarily vitamin D3) deficiency than by sun exposure. Therefore, you can wear sunblock religiously from infancy onward and still get skin cancer.
I grew up in SoCal before the advent of sunscreen and spent a lot of time getting burned and tanned on the beach and horseback riding—including during a college semester on a dig in the Mexican Caribbean. But from age 30 onward, I started taking really good vitamins—and for decades I’ve also taken supplemental D3 (5,000 i.u. a day). I’m very fair-skinned and parents and grandparents on both sides had all kinds of skin cancers—but I’ve never had one.
Good to know! We just started taking supplements, will look into this...
There are 2 very recent trends in US healthcare you may not have had the chance to experience yet: 1) the rise of "concierge" care to bypass the whole insurance-network thing (I'm not sure yet if this is a good or bad trend); and 2) the disappearance of MDs, especially from general primary care. The last few instances I've had to get a new provider, there were no MDs available, just DOs or nurse practitioners. I don't think this is necessarily a bad trend, but it is fascinating. And when I had to take a relative to the ER a couple of months ago, we waited hours while the only provider there, a physician's assistant, tended to 8 patients simultaneously, running from curtain to curtain.
A few years ago, while traveling in the UK, we thought my husband had lost his medication. (Turned out the TSA had, for some Godforsaken unknown reason, shoved the medication in his suitcase UNDER THE LINING when they inspected it, which we didn't discover until we got home.) Anyhoo, this led to our spending half a day in a Welsh clinic to get him meds to get through the week. He saw 2 doctors within the 4 hours and got the prescriptions from the onsite pharmacy, and the price was a fraction of what it would've been in the US. I remember being grateful we were not in the reverse situation, being international travelers trying to get the same prescriptions in the US. I can only assume that would be epically horrible.
Can you imagine? It's a wonder anyone ever visits the US!
I have heard about the concierge thing (seems depressing), and we have sensed the nurse practitioner thing as well. I don't understand why so many folks are getting healthcare (so that there are no doctors available) when it's so insanely expensive. I suppose America is a uniquely unhealthy country. It seems to be on our return visits. 🤔
It does seem like social and health policy in the US is governed by the principle of, "How can we keep making this more complicated and more expensive?" Yet most Americans seem to believe we have the best healthcare in the world. It's bizarre.
Yup.
This was so interesting and something I think about all the time. When I was in Bangkok I learned a lot of people went there for medical tourism. I went to a specialized eye hospital and the wait time was much less, and the medications much cheaper than in the US. There were two other random patients in the room during my appointment though, which was both weird and fascinating.
In your examining room?? Ha, never saw that.
Yes! They just sat in the corner and waited while the doctor examined my eyes.
LOL
This is super fascinating to me. I’ve always wondered how exactly the healthcare system works in the U.S., as the way I was picturing it was similar to what you described and it just seemed too bad to be true 😂 I’m relieved to hear you mentioning you got great dental care in Romania, too. We’ve had some trouble with dentists over the last two years, but ultimately we found a good one who was able to fix most of my wife’s problems that other dentists weren’t able to. What sucks in Romania is that dental care is not really covered by insurance, so it ends up being stupidly more expensive than other forms of medical care and you often find poor people with rotten teeth, or even without teeth at all. And while our healthcare system wouldn’t leave you to die, and most of the “state” treatments are pretty cheap, it can take forever to get an insured appointment. Several months, sometimes. But overall, it’s pretty easy to find decent and affordable medical care here. It’s one of the reasons I haven’t left yet😂
Oh, thank you. We loved Romania and will definitely return.
That is disappointing to hear about dental care, however.
Honestly, our dentist in Sibiu was perhaps the best of our seven years of travel.
This all very reassuring. I just dropped my health insurance because we will be traveling for 6 or more months in South America. My husband and I have had ACA coverage for some time, but our income has been going up with retirement money and last year our investments did well. This meant that our insurance was no longer fully covered by the subsidy. The thing I really hate about this insurance is that you have to be in your home state to use it and even if we are in the US we are hardly ever in our home state. Anyways my husband is now on Medicare and I just dropped my inurance because it is too much to pay for something I can't even use. I'm going to look into your international insurance.
For many years in a row my husband went to a dentist in Los Algodones, Mexico. His dentist was great. And waiting in the waiting room was always fun. We always seemed to show up on some holiday. Several times I got cake while waiting, and once they were celebrating American Thanksgiving and they let us fill a plate from their pot luck before we left. Everything is more fun in Mexico.
Everything IS more fun in Mexico! They know how to live. 😂😍
We are in the same boat, losing our subsidy soon. Not sure what we will do then. 🤔🤔🤔
My favourite topic! I love comparing systems as I, too, have experienced many.
While other countries can’t match the medical expertise of the US, they do so much better with preventive care through actual access. When I lived in China, I called up a hospital department and was screened by the receptionist. I got an appointment within a day or two, saw a specialist within a week, and paid for it all out of pocket (I’m embarrassed to say how little it cost!). I got an ultrasound that a physician family member told me would cost upwards of $10,000 where I now live in N America and wasn’t sure if the equipment were even available. All of my paperwork in China was electronic and moved seamlessly from department to department. I instantly accessed 10 weeks of physiotherapy (the real cost to access this care, of course, is a functional level of language ability!).
Returning to my wealthy home country, I feel like I’ve gone back in time. Yes, the quality of care is better in some ways but I simply can’t access it very well and everything is paper! I always laugh when walking papers around.
I lived in the US for many years but never really experienced the private system. When I was briefly in the private system, I was thoroughly overwhelmed. No, thank you. That is not medical care. That is a market I am not interested in participating in! There’s too many burdens on you just to get through life in the United States (the burden of navigating insurance is insane!).
I think care is THEORETICALLY better (or can be) but I have also gotten a lot of really bad care in the US. Most of it is because of overworked doctors, however. How did the system get so screwed up???
Totally agree. I think US medical care is better really only in terms of, say, an excellent cancer clinic or transplant centre. If you have insurance, you can eventually access world-class surgeons and services. But you have to endure so much misery and poor quality services/massive headaches/financial ruin to get to that point!
There's just no area of life that capitalism hasn't invaded and degraded in the US.
Just infuriating
Such an interesting read Brent.
As a (mainly!) Spanish resident, we find their public system healthcare in general is good. Much better than Ireland, which is more like a system in a developing country.
I like the way you refer costs for locals etc. You consider the local impact of the costs and services.
But what could be another factor is in some countries where you could be considered wise foreign men (bear with me here!).
As a woman who has accessed healthcare in many countries, including Asia, I have to add that in some cases you are not listened to, or respected. Due to cultural norms. So I would also advice people be aware of this type of disadvantage and discrimination - that it may arise. Often I have asked a male pal to advocate for me, when I think I am not been listened to or taken seriously. Sad to say, but this can be the case and worth anyone travelling knowing and being aware of.
Thank you. And good point about gender bias! I think men are also more likely to stand up for themselves (and in Michael's and my case, for each other). Good reminder!
Yep. I’ve started saying to people that it’s literally cheaper to fly to another country to get medical treatment of nearly any kind, than it is to stay in the US and get treatment there. I had a scary incident yesterday — some kind of food poisoning, or I think the tap water — which the Taiwan government says is safe, but locals tell me is not. Anyway, I ended up throwing up on the subway platform, and the attendant immediately called a medic, who called an ambulance, which got me to an emergency room, and let me rest and got me medications. I feel so much better now. It was such good care. The total cost for everything? $37.
It's true though!
Haha oh lord! I think that's what.i hate most about the US: The insane lack of transparency and the insane cost of emergency care. No one wants to get in an ambulance -- for very very good reason!
Great analysis. I've worked in and around U.S. healthcare my entire adult life. It sucks.
Thank you. It's madness, and I honestly don't understand how we ended up here.
I hate to be reductive, but it's neoliberalism. Delivering healthcare is the kind of problem "the market" can't solve on its own, because the incentives of the principal actors are decidedly not aligned. It'll get better over time, though. Even money can't stop the march of progress, despite holding it up time and time again.
I very much agree. Health care is unique.
I can guess how we ended up here: the profit motive, and paranoia about "socialism"
Thanks for sharing!
You are very welcome.
Oh my goodness, this sounds so familiar.
So glad you are getting better care while traveling!
EltaMD 40 is the only sunscreen I can tolerate. It has been amazing.
But I now also wear hats, lightweight long sleeves and light pants. Because I'm now just realizing how much sun we get exposed to while walking or biking everywhere.
I totally think the US healthcare system must be run by the states or the fed. Healthcare practitioners become state employees. They'll receive a great pension. Or let them open their own private care, apart from affordable care. I just don't see another way out of this US healthcare expense, as it's completely unsustainable.
Love these posts!
Thank you!
Yeah, there are too many vested interests AGAINST affordability. Also, I think the media do a terrible job of pointing out who is the ally and who is the opponent.
I love European sunscreen, I really do.
Do share your favorite European sunscreens! 🙏🏼
If you'd asked me two weeks ago, I would have had three different brands in three different languages! But right now I like the Turkish Watson's brand Love My Skin Guness Losyonu Sprey. Light but STAYS ON all day.