Medicare Isn't Fair To Expat's

Life, it’s a wonderful thing.  The “good life,” isn’t that what the American Dream is all about?  What about the “American life?”  What’s up with that these days?

In this rapidly aging Twenty-First Century, the “F” has been sucked out of American life, and all we’re left with is the “LIE.”  The “F” has been repurposed into a big fuck you for many of America’s poor, working class and middle class.  Oh, and retired Americans too. 

Ha! Remember the middle class?  It’s a sign of your chronological maturity if you do.

The American Dream became stressed in the early Seventies; since 1980 it has been under sustained attack by selfish interests in and out of government.  Outside forces like productivity gains from robots, computers and the ‘Net have only served to channel increased wealth to the upper end of the demographic.  Forgive me for being a Johnny One Note about this, but I’m not the only one complaining.  From what I read, even 90% of the One Percent are being left behind by now.  To paraphrase, “first they came for the poor, and I didn’t do anything because I wasn’t poor.”  Now they’re coming for 99.9% of us.   

By now the American Dream is moribund, lost to most people.  It is much harder to attain in the first place, and it’s slipping away from many people who once enjoyed it. 

Our Ungrateful Country

I love my country, I do, but they don’t make it easy anymore.  I’d like to live there if I could, but I don’t think that I could afford it at this point.  Approaching retirement I actually had a plan that would have worked.  That plan will still work out fine for my ex-wife, but I wasn’t so lucky.  So I live in Thailand where my skills are still marketable, age is less of an issue, and the cost of living is much more reasonable. 

I’ve worked all of my life and along the line I have served voluntarily in the United States Navy and the Peace Corps.  America is a funny place though, very free with the come-on-and-lend-a-hand stuff but not very free at all with its gratitude.  But, you say, at least I have my Social Security retirement benefits and my Medicare.  You’d be half right.  If I had one wish, it would be that Medicare would cover medical services provided overseas for expatriates. 

The Medicare Dilemma

Many retired Americans are living overseas these days, something like 500,000 of us.  I say, “us,” although my retirement plan includes working until I die.  Some just prefer to live overseas; some, like me, would be hard pressed to find the money it takes to live in America.  Let’s face it, even out in Honey-Boo-Boo territory everything is expensive, and there are taxes to pay.  At the present time, Medicare does not pay for medical services provided outside the United States. 

Well, it does pay for “some” American retirees overseas.  My research is in an early phase, but I’ve read that retired military and Federal employees are probably covered anywhere, and “some” veterans, and “some” Medicare beneficiaries.  This kind of unequal treatment is galling in itself. 

Why should overseas care NOT be covered?  Isn’t Medicare supposed to provide us with medical security as a big thank you for working and paying taxes all of our lives?  We need probably look no further than lobbyists for American medical providers paying politicians to keep it so.  It doesn’t make a great deal of sense from either a financial or a fairness angle. 

It’s frustrating to me, because Medicare would actually save money by paying Thai hospitals to take care of me if need be.  Thai hospitals are very good too, it’s not like I’d be getting shoddy treatment.  I can prove it:  American medical insurance companies are sending subscribers to Thailand for treatments ranging from knee replacements to heart surgery.  Would they do that if they thought that there was a liability issue?  I’m very happy with my own neighborhood private hospital here in Bangkok.  One of the reasons that I go there is that I found out from a friend in the Thai insurance business that Americans are being sent there so that they, and their American insurers, can save money.  The insured is given a choice:  get the care in America and pay a substantial co-pay, or take a free trip to Bangkok and get the work done there with the company picking up 100%, including transportation and living expenses.  I’m very happy with the quality of the services that I have received at this hospital.  The doctors speak English, they don’t fool around, and quite a few of them graduated from top American medical schools.

Fred Is Complaining, As Usual

But it’s not just me complaining.  You can bet that most of the half a million retired American expat’s are complaining. 

There’s even something called the Center for Medicare Portability, up in Washington, D.C.  I don’t know enough about them to know whether to trust them or not.  Signs are mixed. 

For instance, they seem to have proposed four ways that Medicare could be changed to allow overseas payments, and none of them is “just get the care where you are and Medicare will pay.”  All four proposals call for new levels of bureaucracy and “oversight” and accreditation that would eat up most of the savings.  Why a fully accredited Thai hospital would need to be further vetted is beyond me.  Many of them are American Board Certified already, and more would take that step if it would get them Medicare business. 

And the savings are real!  The money people are always complaining about the high costs of Medicare.  Wouldn’t they like to save between 50% and 70% on my care?  (That's 50% at an American Board Certified hospitals in Bangkok, and 70% at my neighborhood hospital, which is not.)  Maybe they should start sending Medicare beneficiaries residing in America overseas for some treatments, like the insurance companies do. 

And it’s not like we expat’s are saving the money that we would otherwise have to take out of our precious few Social Security dollars to pay for Medicare.  No, we have to pay for it even though we may never use it, or else pay considerable penalties for coming on board later.  There’s always the chance that I or someone just like me will come down with something terrible and have to return to America for the Medicare benefit.  There are terrible, long-term, debilitating diseases out there waiting for the unlucky.  So when we turn sixty-five we all sign up and start to pay the $114 every month.  That’s ten percent of my Social Security, by the way.  Thank you very much. 

Complaining won’t do much to change things though.  Maybe this is a political cause that I could get involved with in some more active way.  Time will tell, I suppose.  It’s always easier to just let go with some righteous indignation on a blog, but maybe it’s time to put on my tough-guy pants and try to do something.  Maybe.