Sunday, March 24, 2019

Using Medicare in Mexico

Would you support an amendment to the Medicare law permitting American citizens to use Medicare benefits to pay for health care in approved medical facilities located outside the United States?

Image Credit: Mexperience

Here’s my problem: for the past five years, I’ve been having abdominal pains. I’ve seen doctors in San Miguel de Allende, Mexico, Tucson, AZ, San Antonio, TX, and Los Angeles, CA. A few of them investigated whether hernias (which were quite apparent in my CT scans) might be the problem, but they rapidly rejected that possibility, eventually leaving me only with the choice of using duloxetine and gabapentin as nerve medication for treating the symptoms (which doesn’t work very well). Now, five years later, the pain is getting more significant. I wake in the morning without any pain. I take the medication and slowly the pain grows. By three o’clock it is significant (on some days) or has subsided (on others). But now in Mexico two doctors, one American and the other Mexican, have both decided that the cause are the three hernias. And the Mexican doctor has offered to tie off the hernias for an operation costing $6,500.

The cost isn’t terrible, but I’m hesitant. I have more trust in American doctors (don’t know why, because some of them are really terrible). Moreover, if I go to the States, I can supposedly get the same operation under Medicare, which means that all that I am paying for is the trip back to Los Angeles. The Mexican doctors tell me that the operation can be done in an office, takes two hours, and might require an overnight stay in a hospital but might not.

The trick to getting the procedure done by Medicare in the States is that the American doctor will want to “see me” before doing the operation. This is pretty odd, since the Mexican doctor in Mexico did hardly anything but give me information and shake my hand, He did do a thorough CT scan, but that information would be available to the American doctor, and he can interview me by telephone (on FaceTime or Skype). Why don’t American doctors use these modern mechanisms, rather than forcing us to trek across the continent to their offices?

I’ve been informed by the American doctor who saw me with the Mexican doctor that hernia removal is considered “elective surgery” by Medicare. In other words, it might not be covered. When I wrote to my gastro doctor in Los Angeles, he said that the $6500 price for the Mexican procedure might well beat Medicare, because of the “incidentals” which Medicare does not cover. I’m wondering if this is really true. If it is, then this is another failure by our crazy Medicare system. Why shouldn’t all the costs be covered for a procedure to rid me of pain?

In the meantime, I am suffering while waiting. During the five years that I have tried to get a real answer to my pain, the only answer that any of the doctors gave me was to use duloxetine and gabapentin.  But this “answer” has been only partially successful. I can take these drugs, and many times the pain gets through, anyway. The only sure cure is to lie down.  But that lasts only so long as you’re lying down. If you’re sitting up, the pain usually comes though.

The real answer for those of us on Medicare who live overseas is to permit us to get treatment where we live. For me, in Mexico. Yes, there are risks in trusting Mexican doctors – but I discovered along the way that American doctors are no better. There are specialists in the U.S. in removing hernias – but if Medicare won’t pay for the treatment, for what have we been working so hard and long all of our lives?

What we need in the U.S. is the same sort of single-payer system that Canada, France, and other countries have. Single payer will work.  I enjoyed that system while living in Canada and France. Once I was traveling through England and my wife became ill; she went to an English hospital and got free care. If the U.K. can give this treatment to tourists, why can’t America give it to all of its citizens, even if they reside outside the U.S.?

The reason why single-payer works is simple.  With one payer, the doctors don’t have to pay for an insufferable amount of administrative costs. I read that “[t]he number of billing clerks at Massachusetts General Hospital is about 300. Toronto General, a hospital of equal size, has three billing clerks.”. And the other reason is that private insurers spend incredible amounts of money on advertising (to draw clients) and profit distribution to stockholders and corporate leaders (“UnitedHealth Group CEO Stephen Hemsley made $17.8 million in total compensation in 2016 for running the nation’s largest health insurance company. Hemsley’s compensation grew by 22.4% over 2015, according to a document filed with the U.S. Securities and Exchange Commission.”)

It’s insane to pay a CEO so much money in compensation; the same amount of funds in a single-payer organization could provide coverage for thousands of sick people.

Yes, it’s true that if the U.S. went to a single payer system, the private health insurers would go out of business. But many of the underlings working in those companies would be employed by the single-payer organization. And, as for the rest, it would be up to our society to find employment for them so that they and their families could enjoy life.

If one could imagine a perfect, world-wide health system, it would be one in which every country contributed to a single-payer system, and in which every citizen of the world could have full health care payable from that system. Some day in the future, that may be possible. But in the meantime we in the U.S. need to concentrate on making our national system fully functional. The way to do that, frankly, is to have a single payer system, on the one hand, and to abolish private systems. If all of our citizens, rich and poor, had to use the same system, you can be sure that the wealthy citizens would make sure that the system worked.

If you want to find a system like this, examine the educational system in Finland, where schooling is compulsory, and the few private schools are provided money by the state and are prohibited from charging fees for their services. The result is one of the best educational systems in the world, where homeschooling and private schools are rare. Naturally: because the wealthy want their children to be well educated, so they support the public system.

In the meantime, the United States should create a single-payer system that will provide the best healthcare to all of its citizens, wherever they may be. If an American citizen is living in Mexico, the American healthcare system should either provide the funds for treatment in Mexico or, if the Mexican system is inadequate, provide funds to carry the citizen to the nearest adequate place, wherever that may be. If the cost of treating citizens abroad is too high, then the U.S. can tax its citizens accordingly. (After all, the U.S. taxes its citizens anywhere in the world). But I think that the Mexican system is “adequate,” and it is certainly a lot cheaper than the American system.

My greatest hope is that “Medicare for All” will be established as soon as possible, and that this will include citizens such as I who have retired to a foreign land. I have paid much of my working life into Medicare, and I receive Social Security payments monthly. Then why am I deprived of healthcare benefits? Others – such as the hundreds of thousands of Filipino-Americans who have worked all their lives in the U.S. and want to retire to the Philippines – have the same predicament.

Here’s what Bernie Sanders says about this issue:

Question: Would you support an amendment to the Medicare law permitting American citizens to use Medicare benefits to pay for health care in approved medical facilities located outside the United States?

I support a Medicare-for-all single-payer health care plan to make health care a right, not a privilege, for all Americans, including Americans living and working abroad. Instead of spending federal health care dollars on the multi-million dollar salaries of insurance company CEOs, it is time to use this money to guarantee health care to every American citizen.

As you know, retired U.S. military personnel and their dependents living overseas are reimbursed by the U.S. government for most of their medical bills through the TriCare For Life system. In my view, there is no reason why we cannot use the Tricare program as a model for a Medicare delivery program for all Americans living overseas.

Bravo, Bernie!  Your plan is what we need.

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