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Imagine this scenario. You go into a pizzeria for a pepperoni slice and a coke. But there are no prices. When you ask the young lady at the counter what the pepperoni slice and coke will cost, she doesn’t know. In fact, no one who works there knows. The only way to tell is to punch the proper pizzeria ordering codes into the computer. Okay, you say, punch in the codes. But the young lady can’t. She can only punch them in after you’ve consumed your pepperoni slice and coke. Weird, yes, but you’re hungry. So you get a pepperoni slice and coke and go to town. When you’re done, she punches in the codes and you get your bill: $27.43.
Does this sound familiar? It should, if you have ever obtained healthcare in this country. This is the healthcare business model brought to your friendly neighborhood pizzeria.
Our Anti-Consumer Healthcare System
One of the biggest problems with our healthcare system is the lack of price transparency. Doctors, hospital administrators, pharmaceutical executives, insurance bosses, and government officials all appear to be hellbent on sowing ignorance. Their collective response to the public is essentially this: “Don’t worry your pretty little heads about what things cost. That isn’t important. Your job is to get healthy. You worry about that. We’ll take care of the grubby money business. Trust us.”
Yeah, right. I’d trust the healthcare-industrial complex if a guy with reputable healthcare insurance left the hospital after bypass surgery and received a bill that totaled $500 and could be read and understood by a fifth-grader. But that’s not what happens. The guy with reputable healthcare insurance leaves the hospital after bypass surgery owing tens of thousands of dollars—he thinks. Only someone with technical training and years of experience can know for sure. The avalanche of bills and supporting documentation he has received in the mail is too byzantine for a layperson to understand.
The unvarnished truth is that our healthcare system is an anti-consumer mess. And healthcare insurance is hardly foolproof protection against it.
And here’s the real kicker. Our anti-consumer healthcare system isn’t changing anytime soon. Those who prefer the status quo have far more lobbying clout than those who don’t. So twenty years from now, just like today, your neighborhood pizzeria will be infinitely more upfront about prices than your neighborhood hospital, clinic, or pharmacy.
Is Medical Tourism the Answer?
So what to do? Take it? Allow the healthcare-industrial complex to bankrupt you for a procedure that could easily be covered by your emergency fund if the healthcare sector operated in an environment of price transparency, competition, and Yelp-like consumer reviews?
Aside from not getting sick or injured, the only real defense against the ravenous maw of the healthcare-industrial complex is to seek healthcare outside of the United States. That might strike you as exceedingly rash, but hear me out. America is no longer the only game in town when it comes to competent and technically advanced medical and dental care. You can now find excellent care that caters to healthcare tourists in Mexico, Costa Rica, Panama, Ecuador, India, and Thailand. More importantly, this excellent healthcare is very affordable—even when you account for travel costs. Check out the following YouTube clips.
Algodones, Mexico, for Dental Care, Glasses, and Medications
In this clip, vlogger Bob Wells documents how much it cost him to address his vision, dental, and prescription drug needs in Algodones, Mexico. Here’s the breakdown of those costs.
| Item or Service | Description | Cost |
|---|---|---|
| Glasses | Bifocals Including Frame and Exam | $95 |
| Dental | 1 Root Canal 2 Crowns 1 Cleaning | $795 |
| Prescription Meds - 300 Days Worth | Lisinopril - 600 Tablets Metoprolol - 600 Tablets Amlodipine - 600 Tablets | $159 |
| Total Cost | $1,049 |
What would the above have cost here, even with insurance? Four grand? Five grand? Not bad savings for a half hour drive from Yuma, Arizona.
Bangkok, Thailand, for an MRI and a Super-Duper Wellness Exam
In this clip (excuse the poor sound quality), Mr. Supersize himself, Morgan Spurlock, travels to Bangkok, Thailand, to determine the extent of his shoulder injury and get a thorough wellness exam. Here’s a breakdown of what his care cost.
| Item or Service | Description | Cost |
|---|---|---|
| Shoulder | MRI and 2 Exams | $400 |
| Wellness Exam | Blood Analysis Urine Analysis Stool Analysis Electrocardio Exam Exercise Stress Test Chest X-Ray Abdomen Ultrasound Eye Exam Colonoscopy | $2,600 |
| Travel | Round-Trip Airfare from New York and Hotel Accommodations for Three Days | $1,300 |
| Total Cost | $4,300 |
Do You Dare?
Is medical tourism risky? Yes. Doctors and dentists who cater to medical tourists are not superhuman. They are just as fallible as the doctors here. What happens when your Mexican dentist or Thai doctor screws up? Who will fix the shoddy work? Will you have to seek corrective measures from the overpriced healthcare system that forced you overseas in the first place? And what happens when your Mexican dentist or Thai doctor really screws up and you die in either one’s care? Will the Mexican or Thai legal systems allow your loved ones to seek damages? [Mrs. Groovy here. Never mind damages. Will the Mexican or Thai legal systems allow your loved ones to collect your body?]
I’m a reluctant proponent of medical tourism. In one sense, the notion of traveling halfway around the world for a crown or a colonoscopy is absurd. In another sense, however, the notion of a healthcare system that keeps patients in the dark about prices is equally absurd—especially when you consider that that healthcare system’s bills are the leading cause of personal bankruptcy.
Medical tourism is absurd. But sometimes the only way to combat one absurdity is to turn to another absurdity. I’m putting medical tourism on my radar. And so should you.
Final Thoughts
Okay, groovy freedomist, I’m almost done. What say you? Is medical tourism a reasonable way for you to defend yourself from the ravenous maw of the healthcare-industrial complex? Or is medical tourism too risky? Let me know what you think when you get a chance.
Finally, I have some great news. Groovy Home is under contract. Yesterday we signed the papers and we’re closing in a few weeks. Mrs. G and I have to quickly hightail it out of here. And because of that, there won’t be any activity over here for the next few weeks. We were hoping to continue with our weekly Groovy Ranch updates, but that won’t be feasible. Sadly, Freedom Is Groovy is going dark. Have a great weekend. See you next month. Cheerio. [Mrs. Groovy here. Mr. Groovy forgot to mention we may publish a guest post or two. “Cheerio.” Yeah, right. I married such a wit.]
An interesting subject, although not an easy one. I think I’d put it on my radar, but I’m not sure what I’d do if faced with an actual rather than hypothetical decision.
It just doesn’t seem right that people’s health is so blatantly mined for profit, but with the money/profits at stake, I can’t see that genie being put back in the bottle.
We have some family friends that go to Costa Rica for dental work. This is mostly because they are self-employed and need serious dental work done. It’s cheaper and they get a family vacation out of the deal.
I’d only go if I heard a first hand testimony from somebody that’s been there. And we’re open to it in the future ourselves because it’s so expensive to get certain procedures done here in the U.S., even if you pay cash.
Congrats on the home sale by the way. I bet that’s a financial relief, now you just got to moe into the new place.
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I guess in the case of an accident it might be worth the risk to get your teeth done in Mexico. Our son’s skateboarder friend had an accident that completely destroyed his teeth and needed huge amount of work.
He went to Mexico and of course he saved a lot of money! The dentist was really good so he was lucky.
I don’t actually think it’s too risky in China or Korea or Japan.
My mom needed her ovaries removed because they caused her massive pain every month. There was no way we could have done it in the states with no insurance so my parents saved for a flight ticket back to China (mom alone) because Chinese doctors are generally better trained and much cheaper.
I always assumed that’s what Chinese people believe because we’re Chinese and prefer the same doctors but actually – I have more and more American friends who decided to go to China for surgery even though they have decent coverage here in the states. Really weird how the landscape is changing…
On this you and I agree Mr. G! Our healthcare system is a complete travesty. My son had an emergency appendectomy in January (on his 10th birthday, poor kid!) and every few weeks we get random bills from different places. Just yesterday I got a $300 bill from the anesthesiologist. I faintly remember already sending a check to someone for anesthesia! The whole thing is shrouded in secrecy and for consumers to not have any power to assess prices before something is done to us and to not understand what our insurance covers beforehand is the ENTIRE reason we are all in this mess. The issue of healthcare gets me extremely worked up. If I lived within driving distance of Mexico I would be checking out my options for sure!
By the way, I had a friend get sick on a Caribbean cruise and had to be hospitalized in Mexico, then medivac flown to the USA. The expense was stunning–tens of thousands! Likewise when my daughter, who lives in Singapore, got sick when visiting here, the emergency room charges were exorbitant. If you are vacationing outside your home country, medical emergency insurance is cheap and definitely worth it.
I know it’s a lot cheaper in these countries, but with healthcare I’m moreso concerned about quality instead of price. Are the doctors in these countries as good as ones in developed countries?
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It’s hard to get a price on medical procedures, sure. But ask yourself: Why?
If -everyone- demanded prices like a pizzeria, they’d have to post them in order to compete. But they don’t tell, because -we- don’t ask. Because collectively we don’t care, because “someone else” is paying for it. And I believe that’s the core problem. Which is the core of all of our country’s financial problems:
We don’t really care how much something costs if (it feels like) we’re not paying for it.
All we need now is free college and a $15 minimum wage (“free” things we’re not directly paying for) to round out the package.
I love the idea of medical tourism, though. Why not! It’s an option. And part of freedom is having options like that. I’m just surprised the government “allows” us to do it!
ps – dirty little “secret”: We ARE paying for it. All of it.
Congrats on the house sale! We’ll miss you over the coming weeks but totally understand. Hoping all goes well.
Not sure I’m ready to travel to another country for health care, but ya never know about the future.
Congrats on the house!
As for our medical system, I’ve often said how ridiculous it is that they can’t/won’t tell you how much you’ll owe until after you’ve had the work done. Come to think of it, my otherwise favorite pizza place actually does play fast and loose with the prices as well, but it seems to be within a limited price range, and their pizza is fabulous, so I put up with it. But the healthcare racket is a real problem, like when my reputable insurance co. said they weren’t going to cover my heart attack hospital bill and the hospital was coming after me for $80k+ (eventually my insurance appeal won out). And while the dental system can at least quote me a price, it’s generally not an affordable one for any serious work.
That all being said, I’d be very nervous to try medical tourism. I like to think that all the bureaucracy and expense is at least guaranteeing me a certain standard of care.
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The kicker with medical tourism is when you need to be seen quickly. My hearing loss last year is only half as severe as it would be otherwise (ie I’m not totally deaf in one ear) because I got seen and on steroids right away. Apparently if I had waited even a few more weeks, the worst of the damage would be permanent. Worth having the remainder of my hearing, but meant I had no choice to worry about cost.
Congrats on selling your home! Hopefully everything goes smoothly for you.
My wife’s grandfather did some medical procedures in Mexico. He found the treatment and care to be quite good. I think it was pertaining to stem cells if I recall. Great post.
Y’all. I am SO FED UP with the healthcare BS in the States. I don’t think we realize what a cluster-eff it really is.
I had surgery last month and it was such a painful, agonizing journey dealing with people to even get that far. And dealing with surgery billing? I’d prefer to eat a crawly bug, to be honest.
To me, medical tourism sounds awesome. I don’t think I would want to do it for surgical procedures, though. I have friends who make the 6+ hour drive to Mexico just to get cheaper medicines/glasses.
Seems like a great idea. I think people still need catastrophe insurance though! If you have an emergency illness, you can’t fly to another country.
Things that could happen:
You get into a serious car accident
You get appendicitis
You get very serious food poisoning
But I agree, for normal checkups, it might be cheaper to do it in another country!
Will miss you guys in your hiatus! Good luck!
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Great post, Mr. G. As a long time employee and administrator in our anti-consuner healthcare system (until May 4!!!!) you are exactly right. The idea that I, or my employees couldn’t tell a patient how much our services would cost them is preposterous.
A primary reason for this is that consumers have been insulated from the actual cost of care by the convoluted employer-based system we use. And because costumers have had very little exposure to the costs of care (versus costs for insurance), health systems and providers have no incentive to become cost efficient.
Medical tourism is an option for us if the subsidies for the ACA go away next year. Go Curry Cracker has written a couple of interesting posts about their experiences.
Thanks for another great and insightful post, and congrats on the house! Hope to see you and Mrs. G next winter or spring!
It’s interesting isn’t it? I’ve thought of making a product that would look at every lab, procedure, and billing practice we have… Then referencing the insurance that patient has… To come up with an estimated price to the patient.
The problem is that this has so many moving parts. Every patient. Every insurance company. Every one of the plans at the same insurance company. They’re all different.
I will say, I take offense at the idea that we, as physicians are complicit in this system. Because of the complexities above it is impossible for me to know how much something will cost a patient. The doctors generations before me sold the ship I now sail on. I just wanted to heal the sick and endagered.
I hate the system as much as the next, but I don’t know what the solution is. I know very clearly what the problem is, though… And definitely agree something has to be done.
I personally wouldn’t do medical tourism being a doc.
Just my two cents.
How DARE you sneak the “We Sold The House” into the second paragraph of Final Thoughts. CONGRATS!!
On the medical tourism, I’ve heard some podcasts about it, and have put it on my radar, too. I’m far from making a trip, but it’s always good to know your options. Good luck with the home sale, happy for the two of you!!
Conragts on the contact and closing! Exciting news. On to the next adventure.
I think if I was head outside of the U.S. for medical attention, I’d head North to our Candian friends.
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Is anybody doing “customer reviews” of foreign medical facilities and practitioners?
Hola Freedomists,
This year my wife, son, and I have learned a lot about the healthcare system here in Merida, Mexico. My son had to have x-rays on two occasions for a twisted ankle and a sprained foot. Both times we went to the Clinica de Merida where it cost us about $70 U.S. for a doctor’s consultation and x-rays. The place is top notch and our doctors spoke English.
Our son also had an MRI for a stomach issue; the price was also $70. There was a price list for MRI and x-rays; prices varied by body part.
At the dentist, it cost us $500 pesos for a cleaning. Our son was $400 pesos. Our dentist spoke English, had a DDS from Mexico City, and had further training in L.A. and Buffalo. My wife got a crown for $7,000 pesos. The dentist told us the price of any service he offered right off the top of his head. I told him how refreshing it was to be able to get a price; he seemed confused by the comment.
For contacts, I went to Costco where I got a free eye exam in a modern office. The cost for a years worth of contacts was $2,100 pesos for the same brand I buy in the States (Air Optix)
I asked a buddy of mine if we should join the Mexican national healthcare plan (IMSS). It would cost us $9,000 pesos a year for the family (roughly $500 U.S.). He said that we’d be better off paying out of pocket like we do now.
Finally, there are many pharmacies that have doctors on site. The price is $0 to $50 pesos per consultation. I went to one doctor at Farmacias del Ahorro who was great. The cost? $0…he wouldn’t even accept a tip.
I just thought I’d share with all you groovy cats, Ed
Its the 3rd Party payer. Ask any repair shop if they charge more when it is “an insurance job.”
Imagine you order your pizza (with prices as you describe) but instead of handing you a bill for $27, the Mr. Pizza hands a bill for $270 to the fella over there wearing the striped pants, Mr. Monopoly. He smiles benignly and you enjoy your slice. You even get a statement of benefits telling you how generous Mr. Monopoly is. Sweet! Nobody notices that Mr. Monopoly charges a $1200 premium and is happy to pocket the difference $1200-$270.
Who is the idiot who started paying Mr. Monopoly premiums?
During WW2 there was a worker shortage. Price controls didn’t allow companies to offer higher wages, so they competed for workers with perquisites. “I can’t pay you more at GM than you’re getting at Ford, but free health care.”
And since health insurance was both cheap, tax deductible and made the workers think their soulless corporate masters at GM had a heart, that’s how they got the best workers. Like my dad.
Fast forward a few decades and tort lawyers discover medical malpractice windfalls. Congress passes a law forcing hospitals to treat anyone showing up at an Emergency room. Costs skyrocket because nobody cares since Mr. Monopoly over there is footing the bill.
Now employers find Health Insurance isn’t as cheap as it used to be and workers are not as scarce (unless they know SQL). They now require you to pay some or all of Mr. Monopoly’s huge premiums.
Then Mr. Monopoly gets the government to pass a law forcing you to have his product.
Medical tourism makes great sense if you can get there at a reasonable price. We are totally F’ ed up in the US. Things have to change!
I can speak to dentistry in Thailand. While traveling there for a couple of months I cracked a tooth and needed emergency dental help.
Don’t hurt your teeth in a small town! Totally not recommended! But do head to Bangkok for world-class dental services.
After seeing a couple of dentists and an oral surgeon, having the tooth extracted, receiving follow up services, pain meds and antibiotics…the total bill came to $161.
Congratulations on closing. On to the next adventure!
Dental is crazy here in the US. A thousand bucks isn’t going to cover a crown. My friend is going to Hungary for 5 weeks this summer and getting all the dental work done.
If you don’t have insurance or are under insured, dental tourism is a no brainer. As for medical tourism, I guess it depends. If it’s not urgent, I’d be willing to visit Thailand and hang out at the beaches for a few weeks.
First, congratulations on the home sale. I’m going to miss you for a few “dark” weeks. But hey, that’s about how often I manage to post 🙂
When I first retired in 2010, I was most fearful of the medical situation. But right before I left work, my project took me to Scotland and I met a coworker who contracts around the world. He has had kidney stones removed in Thailand, dental work in Cabo, and many procedures where he lives part of the year in Philippines. He just laughs at the crazy system here, which he refers to as the LOTF (land of the free!).
I traveled with him and his wife on a road trip to Baja. The first thing we encountered was a gauntlet of drug stores and dental offices in Tijuana. I’ve spoken to lots of people that get their meds over the border from Yuma. I’m glad you’ve shared some good YouTube videos. Even with Obamacare, these things are probably part of our future. Sadly. At least we have choices and competition that way.
The medical tourism thing is something I’ve been on the fence about. I see the training my wife goes through here for her specialty and I’m like, how can a less developed country do the same when they’ve got other issues to deal with. My wife is pretty much anti-medical tourism.
My solution to avoid this problem was just to marry a dentist. Free dental care for life now. Takes some dedication to do that though…
Your concerns about foreign medicine’s technological advancement are well placed, particularly as it relates to big-ticket technological diagnostic tools.
But “less developed” includes omitting paperwork, regulations, malpractice torts, defensive medicine, and non-paying free riders. I’ve seen an explosion in the bureaucratization of medical service delivery in just the last decade. Everyone is nice, but everyone has to go through a lot of monkey motion to do their jobs.
Contrast with India where they’ve done amazing things in terms of making something as crazy-hard as eye surgery efficient/affordable. Same or inferior expertise, superior organization.
Congrats on the contract!!!
When I had a traditional low co-pay Heath plan I was okay with the lack of transparency in medial pricing. Now, with a high deductible plan, pretty much all medical costs come out of pocket. The lack of transparency is beyond frustrating. I spend $300 the other day to get a Doc. to prescribe an antibiotic that I knew I needed before going in. It does not make sense to fly to Mexico for this either. I bet this system gets fixed by the time my kids have to deal with it. For now, it’s just eternal frustration.
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Congrats on the house contract!
I like the idea of medical tourism, but I’m not sure if I’d do it myself. I guess it depends on the procedure. I certainly wouldn’t go to Mexico just to save on my annual eye glasses prescription and order.
Speaking of which, it seems that if glasses can be bought in Mexico for 1/5th the price, shouldn’t we be able to order online and have them shipped from Mexico? Or does the US have laws preventing that type of free-market interaction?
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I definitely don’t think I would be comfortable with this just yet (although maybe I shouldn’t be?). Healthcare is something that I would prefer to not have any potential screw-ups with, and the U.S. usually has the best doctors to perform numerous types of operations.
At the rate our healthcare system is going though, I may not have a choice in the future! I have been fortunate to be relatively healthy my entire life, and have never needed to visit the doctor often.
I will definitely keep this on my radar though!
I’m with you, Sean. Medical tourism is still too drastic a move for my blood. But if things continue as is, I’ll be open to it. I’m not going to let the healthcare-industrial complex obliterate my portfolio.
Congrats. Hopefully you make it through inspection and closing with no hitches. Good luck with the move.
Not sure about medical tourism, but I share your frustration with the system.
I consider myself pretty financially savvy, but can never really understand what I’m getting charged and what my insurance will/won’t reimburse. How ridiculous is that?
Tom
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Check this out, Tom. A few years ago, my PA told me during my wellness exam that my ears needed a cleaning. I knew I would be paying for the cleaning out of pocket because my high-deductible plan only covered a basic wellness exam. But I said okay. Let’s clean those ears. After all, how much could an ear cleaning that took all of five minutes cost? When I got the bill my knees buckled. One hundred and twenty-five dollars. Never again.
It’s such a huge, complex issue isn’t it? Even as a teeny tiny cog in it I only understand 2% more than the average patient. I think it’s definitely a cost benefit analysis type situation. Would I fly to India to avoid an office visit fee for an annual exam? No way (unless I was already planning to visit and that was just a small part of one day). But if I had crap insurance or none at all, or needed a very expensive or multiple procedures? I’d certainly say it’s reasonable to run some numbers and ask around online.
Also CONGRATULATIONS!!! We on the interwebs will miss your wit and banter, but await with baited breath your final homecoming news. Sending happy thoughts and warm wishes these next few weeks.
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Agreed, BE. Cost-benefit analysis, for sure. I can’t believe it has come to this. When I was born in 1961, my father was a baggage handler for American Airlines and didn’t have health insurance. But it wasn’t a big deal. My mom was in the hospital for three days. The bill for the delivery and hospital stay was under $200. My dad paid $10 a month until the bill was paid off. Now if healthcare costs kept pace with general inflation, that bill today would under $1,600. But nooooooo! Today, the average cost for delivering a baby vaginally in New York is $8,936. What happened?
P.S. Thank you for your kind words about Groovy Home and our impending move. Can’t wait to be neighbors, BE.
First, congrats on selling your house!
I’m one of those optimistic people to think that someday we’ll actually have Universal Health Care here in the good ole US of A. Until then, I think medical tourism is an excellent option.
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Hey, Mr. FF. I hear ya, my friend. But I fear universal health care. If it basically amounts to Medicare for all, it will only perpetuate the price secrecy that’s killing us now. If universal health care can be instituted in such a manner that mandates price transparency and incentivizes people to seek the cheapest care possible, it might work. But can our political class accomplish such a feat?
If I lived close to Mexico I’d consider simple things like dental and eye care perhaps. But as you say, what happens when things go wrong?
As crappy as our “healthcare system” is – and you adeptly point out the lack of price transparency as one huge problem – we still have the most talented doctors in the world. There’s a reason people come to the US for world-class and cutting edge treatment when things go wrong. We have the best.
Last year the wife of one of my employee’s developed a very rare and dangerous cancer. It took them trips to numerous places in the US (Cleveland Clinic, Hopkins, etc), but in the end they cured her. She got the best, cutting edge treatment in the world. And yes, they thankfully had most of it covered by insurance, but I’m sure the paperwork will continue for years.
The problem is figuring out how to deliver that world-class treatment in an affordable way using insurance that doesn’t simply screw the consumer. I have little faith that we’re close to a solution.
I hear ya, AF. Medical tourism is only a thing because people are desperate. I really think price transparency if the “broken window” of healthcare. In NYC in the 90s, the mayor and the police changed policy and started arresting people for petty crimes and violations (turnstile jumping, public urination, etc.). And what they found was that many of the people who committed petty crimes had warrants out for their arrest for major crimes. Going after petty crimes (i.e., broken windows) took a lot violent criminals off the street. Could price transparency be the “broken window” of our healthcare sector? I’d love to see it tried. If every patient knew what things cost, and had an incentive to seek out the cheapest care, I doubt healthcare would account for 17% of our economy. Oh, well, I suppose we’ll just complain about the current situation and do nothing. Sigh. Thanks for stopping by, AF. Cheers.
“The Broken Window of Our Healthcare Sector” – what a great blog post title that would be.
Intriguing indeed, great comments