Thursday, January 17, 2019

Medicare for all Americans – everywhere

Basically, Medicare is geographically limited. But what’s the point of this exclusionary rule?

Image Credit: Michael T. Hertz

Most Americans who receive Medicare do not realize that they cannot get those benefits if they live outside the United States. Basically, Medicare is geographically limited. The program is only good (for the most part) within the borders of the United States. If you live outside the United States more or less permanently, you aren’t covered unless you have some way of getting back inside relatively easily.

What’s the point of this exclusionary rule? While it is not expressed specifically, the reason for the rule is plain: the government wants retired persons with their disposable income to remain within the American economy. And, of course, the American medical establishment wants older patients to remain within their economic grasp.

The negative part of this plan is that the cost of medical care within the United States is generally much than medical care outside the United States. If retired people were able to receive coverage outside the United States, their care would cost the Medicare system less than if the same care were achieved within the United States. Moreover, those living outside the United States would avoid the substantial cost of traveling back to the United States in order to get their healthcare paid by Medicare.

I learned the painful financial facts of Medicare coverage while living in Mexico as am ex pat senior. Through no fault of my own, I developed bladder cancer. The treatment to prevent worsening of the condition is injections of BCG, requiring weekly doses of this drug for three weeks, following by a urinologist’s inspection a month later. Due to some peculiarity of Mexican law, BCG is extremely difficult and expensive to obtain in Mexico. It costs over $600 per treatment, even though you can purchase BCG with a prescription in the U.S. for $200. So if you live in Mexico, you either have to find a way to live in the U.S. for two weeks and get BCG, then go away for a month and come back for the resection.  Or you can pay the elevated BCG cost in Mexico plus the cost of the resection. (I could never find out why BCG is so expensive in Mexico. The manufacturers would never answer. You can’t import it because the drug has to be frozen in order to move it, and that requirement is a bit much for a traveller).

If Medicare were covering treatment in Mexico, you can be almost certain that Medicare would find a way to get BCG available cheaper in Mexico to avoid the higher cost of the drug there. And it would make sure that it was possible to get the resection done inexpensively.

Politicians in the U.S. who support Medicare for all would be wise to learn about this peculiar problem with Medicare and promise to remedy it. There are many voters overseas, and most are conscious of the problems with Medicare. Particularly the retired ones whom Medicare rules impact. There are as many voters overseas involved in American elections as are in the state of Colorado – meaning around 5.7 million. Plus these voters are very conscious of the importance of their ballot in issues which impact them and other ex pat voters.

Listen up, Bernie – here’s a issue for you.

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