Tuesday, June 26, 2012

"You Can Get the Same Healthcare in Costa Rica"

     "Work for change, but have an escape route."  This is Ron Paul's advice.  Many fifty-somethings are doing just this.  Or they've given up on change and are planning their expatriate futures.
     One of my friends has a plan to move to Spain.  The cost of living in the Spanish countryside is half that of the United States, and he can get health insurance through an American company, United Healthcare,  for $68/month in Spain.  He can use this insurance in Spain, the United States and throughout much of the European Community.  The same insurance company won't issue him a policy in the United States.
     Another friend is building a house in Costa Rica.  "One can get the same quality medical treatment in Costa Rica for a lower total out-of-pocket cost than insurance co-pays in the U.S.," he informed me.  One dentist in Gainesville routinely refers self-pay patients to Costa Rica for extensive dental work, including implants.  I have seen the results of Costa Rican dental work:  it is excellent--and one-twentieth the cost.
     I just returned from an educational conference in Switzerland.  What a shock to meet so many Americans who have decided to settle permanently in Switzerland, despite the high cost of a work visa!  Each one gave me a variation on the same theme:  it's frightening to live in the United States these days.  Our country is out of control, they say, having turned over the reins of decision-making to big business, lobbyists, and politicians whose tenure depends on campaign contributions.  The story of the FBI raid on my clinic  and the theft of my clinic's hard-earned money corroborated for them the auspiciousness of their decision to relocate.  Many are thinking of giving up citizenship in the United States in order to stop being required to submit tax returns, but the paperwork is voluminous.
     While I respect their decisions, I love the United States.  I want to stay on the rural farm I have improved with wildflowers, palm trees, butterfly gardens, and fruit groves.  I have formed deep connections to my patients and employees.  It's true that the powers of political hegemony seem insuperable and that I could be facing prison time for--please remind me--for what?  I don't even know, and my lawyers can't surmise.  Are we in a fascist state?  This is what some of my emigrant friends believe.  I am under assault... and it's unbearable, a staggering fact of my life and a sad commentary on my many years of education and devotion to the medical profession.  But my roots are here.  I feel sorry for political refugees and all those who have been displaced from their birth homes.
     The temptation to relocate to Bali or France--or to join my friends in Equador, Spain, Costa Rica-- is, nevertheless, powerful these days.  When my lawyer instructed me last year to turn over my passport to him so that, "If the FBI comes to your house to arrest you, I can tell them you aren't a flight risk, I have your passport, they should release you on bail," I suddenly felt as though all my freedom had been usurped.  I took back my passport this month to go to Switzerland.  The lawyer returned it to me it without hesitation, saying, "I don't know what the Feds are doing.  Go wherever you want."  I am confused.
     Meanwhile I go to work, I pay taxes, I cast my vote in every election, and I provide health insurance for all my staff.  The premiums are close to $600 a month per person... an astounding sum by the standards of any other nation, but for all this I get to live in America.  I'll do what is required for the privilege of abiding in this country, which is trying so hard to be great.

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