Check Ups


Mark waits in the doctor’s office as a ray of light shines down – a good omen?

A warning to any readers in the United States, this is probably going to upset you. If it doesn’t, it should.

In previous posts, I have mentioned more than once about getting Cream Puff ready for our next passage. We are getting ready to go to the boonies. The next two legs will be the longest passages we have sailed. From Panama to Galapagos is about 7 days. This is not that big of a deal but the next leg is a doozy. Galapagos to the French Polynesian Islands is about 15 days. This will put us south of the equator and about 4,000 miles away from the closest point in the Americas (Peru). We will actually be closer to New Zealand than South America. I recently read on a friend’s blog who sailed this route last year something provoking a “hmmm” from me. They made a rather profound statement. They noted during this passage the closest humans will be the astronauts on the International Space Station as they orbit over.

We maintain Cream Puff in a constant “ready to go” status so the list for boat projects isn’t too bad. We have made several trips to the stores and have tons and tons of food. Cindy has researched what is available in French Polynesia and the prices. Her plan is to stock up here and save money on non-perishable items we enjoy. So, we have a boat that is ready and food to eat. We have a water-maker that makes fresh water from seawater so we are unconcerned about water usage. The only thing at this point not ready is the two of us.

We are hoping to blow out of here as soon as we can

Because for the next couple of years we’ll be away from any major cities we decided to both have medical check-ups. Panama has excellent affordable healthcare. It makes sense to get physicals here and deal with any issues now rather than down the road where the resources might not be as abundant.  In Coronado, the little town close to our marina, is a clinic and a few independent physician offices. Cindy contacted a local ex-pat group and asked for a recommendation. We were referred to Dr. Levy. Victor Levy speaks perfect English and is a really happy person. We find most people in Panama tend to be happy. But, he is more so than most. It doesn’t take long after meeting this guy before a person realizes he loves his job. Cindy has been to this office in the past and was familiar with the setup. For me, it was a new experience. And I have to say, an exceptional experience.

Our local Coronado emergency clinic

Most large supermarkets have a pharmacy. They are well stocked. Often times prescriptions are not needed if you have the old box. They do not use the environmentally unfriendly plastic pill bottles here.

No appointments are needed. Just show up and get in line. We tend to be early birds so we were there when the doors opened at 8 am. On our day, we were first in line and both of us had extensive physicals. The first appointment was about 20 minutes each with the Doctor. I immediately liked Dr. Levy when he introduces himself to me as Victor. He poked and prodded all the places physicians do. He instructed us to abstain from food and return the next morning for blood work.

The following day, being very hungry, we arrived for our tests. This included a complete blood workup, electrocardiogram, urinalysis, and CBCs. The clinic has an in-house laboratory so the results are ready the following morning. But, we decided to wait over the weekend and return for our follow-up on Monday morning. This was a mistake.

Monday morning, we arrive at the clinic and find the lobby packed. I ask Cindy if we should come back later. She shrugs and says, we have nothing else planned for the day. So, we settle in for a long wait. It turns out the wait really wasn’t that bad. It was about 45 minutes. I have waited longer in my Atlanta Doctor’s office with an appointment. We noticed Dr. Levy wasn’t fazed by the number of people in the lobby. He gives each person the time they need. When it was our turn, he took his time and discussed all of our test results with us. In my entire time in the USA, I have never, not once, had a physician explain what each test was detecting and the result obtained. In the USA, you only get contacted if something is wrong. You must then make another appointment to see the doctor and pay again. Our extensive follow-up in Panama was no charge.  Keep in mind as you read the next two sentences, we have no health insurance here as tourists (not entitled to discounts) and our policy for healthcare outside of the USA is for catastrophic illness. Our visit is 100% out-of-pocket at full price. The total fee for all of this was $160 each.

How much do you think this examination would cost in the USA? When living in Atlanta my annual physical cost about $600. I was lucky if I had 10 minutes with the doctor. I had insurance and was only responsible for the co-pay.  My healthcare insurance company limited me to one physical per year. I learned this the hard way when I had a physical at 11 ½ months once and this resulted in a huge fight with the insurance company.

British people are laughing at the above because they pay nothing for a visit to the doctor and this type of extensive examination. I recently watch a funny video. The purpose was to promote the NHS (National Healthcare Service –UK) and they did so by poking fun at the system in the USA. As you watch the video, keep in mind all the services they ask Brits about are provided by their NHS for free. If you don’t see the video below you can click here.

One of the things people in our lifestyle have to get quickly used to is seeking healthcare in foreign countries. For many, including us, this was eye-opening. It was eye-opening in a good way. Affordable good quality healthcare is readily available even outside of wealthy countries.  Panama now has a booming business providing healthcare to people from the USA who visit for dentistry and medical treatments. The medical-tourism industry in Panama is booming. Seriously America, not just one or two people are doing this. It is millions of Americans each year seeking treatments overseas. And, the numbers continue to grow. Even some American healthcare insurance companies are starting to cover expenses for procedures performed in countries other than the USA because of the massive savings. I recently read in the Wall Street Journal about a guy who traveled to Singapore for surgery and his USA policy waived all the out of pocket expenses and paid 100% of the procedure. It was less expensive for them than the US hospital where they had negotiated contracts.

Panama’s Punta Pacifica Hospital – A Johns Hopkins affiliate – click this picture for an interesting read about healthcare tourism

Healthcare costs in the USA are stupid expensive. I have written the previous sentence more than once on this site. It still amazes me how the people of the USA are so accepting of having the most expensive healthcare in the entire world. They might complain a little bit about it but yet do nothing to change the system or get involved. I think people in any other nation on earth would be outraged if the USA healthcare system was implemented in their country. People in the USA are being forced to pay more than twice what other wealthy countries pay.

Contrary to the general consensus of the American population, the quality of US healthcare ranks well below all other wealthy countries. It costs more money to have a baby in the USA than anywhere else in the world, yet infant mortality rates in the USA are about 30% higher than in other wealthy countries. Since 1970, the cost of healthcare in the USA has outpaced all other wealthy countries, yet the number of all Americans reporting poor health has grown 3% in the past 6 years. If people are paying more for healthcare, why aren’t they feeling better? With the increasing costs, people are not getting better treatments. One of the best overall healthcare systems in the entire world belongs to the French. Per capita (total cost of healthcare divided by the population), the average French person spends less than half (45%) on healthcare compared to the average American. In some areas of France, doctors still make house calls.

According to April International (a global healthcare insurer) rankings of healthcare systems around the world, the USA doesn’t even make the top ten. Wealthy countries with an excellent level of care are typically subsidized by the government and taxation. Most Americans are adamantly against taxation for healthcare. They think they are not paying taxes for healthcare because it is provided by employers. But, they are dead wrong about this.

Let’s take a large company like Proctor and Gamble. P&G provides excellent healthcare for their employees. It’s great if you work there. The cost of corporate provided healthcare in the US has skyrocketed in the past 30 years. The employees pay some of the cost but the bulk is paid for by the corporation as a benefit provided to employees. P&G’s corporate cost of proving healthcare for employees is passed to consumers in the cost of goods manufactured and sold. So, if you purchase a product made by P&G, or any other US Corporation for this matter, you are paying for the P&G’s employee healthcare. Yes America, for those of you without good healthcare, if you are using Head and Shoulders or Tide, you are paying for healthcare for P&G employees. Isn’t this a tax?

Panama’s Hospital Nacional offers state of the art robotic surgeries, nuclear medicine, and radiology. Click this picture for a very interesting read on USA healthcare cost vs other countries

When I first arrived in the USA, I was stunned. In fact, stunned is not a strong enough word. Perhaps heartbreakingly astonished is more in line with my feelings when I learned of a middle-income couple who were trying to raise money for their child’s operation. This was quite a few years ago. Today, it is hard to imagine a child living in one of the wealthiest countries in the world has to suffer due to an inadequate healthcare system.  However, sadly this still goes on in the USA.

When I retired at age 53, I had a huge shock. Like most people living and working in the USA, my healthcare insurance was tied to being employed. Waving goodbye to my boss also meant waving goodbye to healthcare. A person only receives healthcare as good as the amount their employer is willing to pay. Generally, a large company can afford to pay more and the employees receive a good quality of healthcare. Small businesses struggle with healthcare costs. When I resigned, I was forced to shop for healthcare in the open market. I thought this wasn’t a big deal since even Costco sold healthcare insurance. I can just buy a policy at Costco, right? Boy was I wrong.

Keep in mind, I retired early and by most standards would be considered wealthy. I needed healthcare insurance because the USA is one of the very few countries in the world where a catastrophic illness will take every penny you have and leave you living on the streets. I could afford healthcare. I am also healthy with no pre-existing conditions. But because of my age, I couldn’t get an insurance company to sell me a policy. I filled out at least ten applications including Aetna at Costco and was declined without reason on all of them. We avoided the catch-22 by buying a corporate policy via Cindy’s company to cover both of us. This was prior to the Affordable Care Act mandating insurers to sell insurance via the Marketplace.

I remember a fun conversation with some friends over a poker game. The Affordable Care Act was a hot topic in the news as the legislation was being written at the time. All of the guys sitting at the table worked for large companies and had healthcare provided as a perk. They were all adamantly against the passing of the bill mostly because of all the misleading information being put out by the bill’s opponents. I turned to the group to ask why they didn’t want me to have healthcare. Dead silence. I explained how for the past few months I had been trying to buy a policy on the open market and concluded it was just about impossible for a man my age.

Since the implementation of the Affordable Care Act, health insurance in the USA has become available to people like me who can afford to buy it. Because of the act policy applicants cannot be turned away. However, because of the political environment in the USA, the future of the Affordable Care Act (Obamacare) is anything but certain. I can’t help but wonder if it’ll be available when we return to the USA.

If Cindy and I returned to the USA now to live, we would need to get jobs just so we could have healthcare insurance. If Obamacare is still available to us, it will cost us about $22,000 a year to be covered on an average plan that will include adequate coverage for both of us. And, we still have to pay the first $10,000 of expenses ourselves. Until we reach the ages of 65 we could be tied to these crazy costs of living in the USA. At 65 we qualify for Medicare, the USA equivalent of socialized medicine. Only then does the cost of coverage for us become drastically reduced.

I am a British Citizen and enjoy the right to free healthcare in the UK. Although I haven’t lived in England or paid taxes there for a long time, as a British Citizen I am entitled to free healthcare as soon as I establish a residence there. This must seem like a very alien concept to Americans; good quality free healthcare. Cindy can also get free healthcare in the UK as she is entitled by being married to a UK National. I would like to point out; we can rent an apartment in London, yes London the most expensive city in England, for less money than it would cost us to have healthcare insurance in the USA. With our apartment rental in London comes free healthcare. This is a very real option under consideration for us once we stop the cruising life.

On a final note about healthcare outside of the USA, in almost every country where we have sought the advice of a physician, they have provided us with an email and/or personal cell phone number to contact them. They make themselves easily accessible to patients should questions arise. It might take a couple of days to get an email response but they do write back. And, the follow up is from the doctor themselves, not a staff member. In the USA this level of service would only be available with a concierge physician service which, you guessed it, cost a lot of money.

So, I know this is not the normal post you expect to read. But, this is a very big part of our lifestyle and concerns we have. It is not all cocktails at sunsets and walks on the beach. I’m sorry if you were hoping for something a little bit more uplifting than this. I tend to write about the things on my mind and this past couple of weeks, this was the primary topic occupying my brain. And as we all know, my brain is a very scary place.

“Donut worry, be happy!” The moto on the box from Joko Loko Donuts. Celebrating our good health with a sweet treat, Yum!

Categories: About Us, Panama, Pre-sailing Preparation, Questions Women Ask, Shorts and Musings

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