Tuesday, August 12, 2008

Democrats Abroad Pushes For Expat Medical Coverage

Sherman Oaks, California

An American citizen who is forced to pay into Medicare her entire working life can retire abroad and be forbidden from receiving Medicare benefits.

Medicare only authorizes payments to medical providers in the United States. Even though quality health care can be obtained in other countries for a fraction of the U.S. cost, Medicare refuses to pay for extraterritorial procedures. If you want to incur $40,000 in costs for heart surgery in Bangor, Medicare will gladly pay; if you offer to fly to Bangkok and have the doctors at Bumrungrad Hospital (room pictured) perform the identical procedure for $4,000, Medicare will refuse.

While this seems like a perverse incentive, it's exactly what the Medicare system was designed to do. Contrary to political myth, Medicare does not provide health insurance to people; it provides payment insurance to the health care industry. In the post-war years, health care executives realized that the best way to protect their revenue was to identify the people who most used their services -- people over 65 -- and have the government guarantee their hospital bills. Thus was born Medicare Part A.

Viewed in that light, Medicare's rule against foreign reimbursements makes sense. The low price of high-quality, overseas health care is good for patients and good for the Treasury, but it's terrible for U.S. health care providers. They want that money! And they damn sure won't allow their pet goose to stop laying golden eggs.

So the Medicare laws contain a "Benedict Arnold" provision which prohibits otherwise eligible U.S. citizens from collecting benefits if they are treated abroad. While this theoretically affects everyone, the brunt is felt by expat retirees.

So I'm glad to see that the political group Democrats Abroad has raised the issue and, given the ulterior motive of the Medicare system, offered a practical proposal: allow Medicare-eligible expats to receive care from the U.S. military's global TRICARE system (which is controlled by U.S. health care interests).

Sadly, even this common sense proposal has little chance of passage. Americans are not a well-traveled people, and the thought of retiring to a foreign country is alien to most Americans (although retiring to Mexico is a growing trend in the Southwest border states). And, since Americans do not value freedoms with which they disagree, most voters won't care that some weird one-worlders are getting shafted on their Medicare contributions.

But maybe, with an aging population and ballooning Medicare costs, the economic argument will win the day, and Congress will recognize that it can't continue subsidizing the U.S. health care industry -- not at ten times the Thai rate.

LINK: My three-day stay in a Thai hospital, which cost $550, is described here.



Anonymous Anonymous said...

I heard that the SSDI COLA was going to be substantial year... I also heard that the Medicare premium would eat most of it up.

since I could use the case I decided to cancel my Medicare Part B.

I am disabled, living abroad in Belize, and there's free healthcare here, so I don't need Part B. (I'm keeping Part A in case there's some future emergency, that seems wise)

but just TRY to cancel Part B from abroad !!

you can't do it .

your choices are, to phone a toll-free number, (USA 800 numbers don't WORK from Belize), or, an in-person visit to a Social Security office.

I'm not going to spend $1000 bucks for a round-trip plane ticket, just to have a ten minute appointment!

apparently, Social Security MUST discuss it with you, either on the phone, or in person, to explain the "ramifications" of such a choice (disenrollment is unsafe!)

geez, Louise, I am frustrated by this.

oh, and the special form for disenrollment (CMS-1763) is "privately owned" and NOT available online:


1:19 PM  

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