Guest Post: Health Care Costs Got You Down? Try Internationalizing

Tyler Durden's picture

Submitted by Simon Black of Sovereign Man

Health Care Costs Got You Down? Try Internationalizing

If you’ve followed this letter for any length of time, you know that I hardly spend any time in the United States. Sure I visit friends and family from time to time, but professionally I’m much more interested in what’s happening outside of North America.

You might be surprised to know that, despite how little time I spend there, I actually have a small health insurance policy to cover emergencies and unforeseen medical problems while I’m traveling. After all, you never know when you’re going to end up with a police baton to the cranium these days.

2378893 Health care costs got you down? Try internationalizing.

Now, I know that America’s politicians and crackerjack team of central bankers don’t see any signs of ‘non-transitory’ inflation, but anyone who has been to the doctor or written a check for an insurance policy knows otherwise. Hey, they’re on government health plans anyways, how could they know?

My little plan essentially only covers accidents, emergencies, and catastrophes, yet I still receive an annual (or sometimes semi-annual) Dear John letter from Aetna that usually starts something like this:

“Dear Policyholder,

Due to the continually rising cost of healthcare, we regret to inform that we your monthly premium will now be raised to ______.”

The increase is usually in the ballpark of 10% to 20%. It’s crazy to think about the thousands of dollars each year that go out the door on a plan that I never use, all so that I don’t get stuck with a $200,000 emergency room bill in case of some highly improbable event. It makes no rational economic sense.

In every other country that I travel to, I don’t have any insurance. If I go to the doctor, I pay cash. If I go to the emergency room (and it’s happened quite a few times), I pay cash. This is one of the great things about travel and living overseas– healthcare is usually quite reasonable, often downright cheap.

And as for quality, westerners are typically brainwashed into thinking that doctors outside of North America and old Europe are all quacks. Nothing could be further from the truth.

Here in Thailand, for example, many of the doctors themselves are actually westerners who have chosen to relocate to Thailand. Others are Thai but have studied overseas in places like Switzerland and Canada. Many speak three or four languages.

Thailand has become a model of medical tourism; patients come from all over the world to receive high quality, inexpensive treatment. I was just at Bangkok Hospital in Pattaya yesterday. It’s a clean, modern, highly efficient facility where the price of treatment is often shocking.

The hospital is always full of westerners who are there for procedures ranging from childbirth to cosmetic surgery to cancer treatment. One person scheduled an elective appendectomy– his prepaid ‘package’ price was about $3,600 including several days in a luxury recovery suite.

Another man that I met said that, aside from the ridiculously inexpensive doctor visit, his high blood pressure medication costs 70% less in Thailand than he used to pay back home.

And then there’s Bangkok’s Bumrungrad Hospital, which has become renowned for its top quality care and efficiency. The hospital is so well organized that Microsoft bought the patient management software a few years ago.

Patients hardly spend any time in a waiting room; you’re in and out of there very quickly. When you’re finished with the doctor, you settle up with the cashier, and most people walk away staring at the receipt in disbelief.

Now, Thailand isn’t the only place in the world that delivers high quality, inexpensive healthcare, and specialized niche hubs are developing. India, for example, is quickly becoming one of the top destinations for fertility treatment.

Curiously, other countries are great for health insurance; we recently published a story in Sovereign Man: Confidential about high quality care in Chile, as well as contact information to buy low-cost health insurance that covers you worldwide, even when you’re not in Chile! It’s an extraordinarily valuable policy.

The other thing that I’ll mention about international healthcare is that it opens up a world of possibilities that might not otherwise be available back home. I have some friends who are en route to China right now to receive stem cell treatment. Another routinely gets HGH (human growth hormone) injections in Panama.

Whatever it is you’re looking to do, there are places in the world where it’s perfectly legal, low cost, and high quality: three great reasons to consider internationalizing yet another part of your life.

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Fukushima Sam's picture

With any luck Simon will contract a rare parasite from the snake blood he is drinking in Thailand, saving the rest of us from more of his globe-trotting posts.

Though actually, I am getting rather fond of him as a ZH whipping-boy...

trav7777's picture

good luck collecting on malpractice in those countries as well.

Additionally, catastrophic insurance coverage is available and quite cheap here in the USA.

However, it is not typically offered by employers and it sure as shit doesn't mean Obama's idiotic coverage law that is intended to further cost-shift from his voting base onto the backs of the healthy.

Take a look at obesity, disease, homicide rates for his primary voting bloc.  They will all get even better coverage from you than you are already subsidizing.

There can be health care in these 3rd world places Simon Black seems to fancy because it isn't offered to people with behaviors typical of the people we give freebie trauma surgery and diabetes meds to

malek's picture

Catastrophic insurance coverage is available and quite^H^H^H relatively cheap here in the USA.

My catastrophic insurance went up 14% per year in the last 3 years... if it continues like that, in 5 years it will leave the range which I can still somehow call relatively cheap.

glenn17's picture

Hi! This is my first time viewing of your site! I appreciate your sharing, I always enjoy reading quality articles by an author who is obviously knowledgeable on their chosen subject. I’ll be following this thread with great interest. I love your blog, and am a regular follower.

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Tapeworm's picture

I suggest a speedy oxcart ambulance service for gansta medical trauma needs.

glenn17's picture

This is great! It really shows me where to expand my blog. I think that sometime in the future I might try to write a book to go along with my blog, but we will see.Good post with useful tips and ideas.

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gaoptimize's picture

I like to believe my nauseatingly huge fist full of antioxidants and other supplements, as well as healthy eating and lifestyle keeps my expenses way lower than the people driving up these costs.  It doesn't seem fair that their triple bypass surgery is covered and my supplements and gym membership isn't.  It isn't the health care industry, it is the morbidity industry.

barkster's picture

your supplements will soon be covered, once codex and big pharma make sure that you purchase them only with a prescription and only from big pharma. The downside is that they will be a lot more expensive and your premiums will go up...

ricksventures's picture

a friend of mine works as a drug pusher for big pharma, besides nice salary, he and his family get to fly anythere around the world, paid for by the company

this summer he went to new zealand, tahiti, australia and africa


life is good !



Bob Sacamano's picture

Guess we could stop buying big pharma's products if we don't like the price or what they do with their revenues.   Or maybe just force them to sell at a price us buyers deem appropriate. 

FeralSerf's picture

No you can't.  Thanks to the Bush Part D Medicare Plan, big pharma will get its pound of flesh from the taxpayers and the SS trust fund.  Plus there's the heavily armed DEA and FDA to make sure you don't try to bypass them.

toady's picture

Thats what I did.

About ten years ago I was going to script-crazy DR who had me on $500 worth of pills a month. The bill kept creeping up to almost $1000 a month. I finally told them all to fuck themselves.

Azannoth's picture

When you walk into a pharmacy today anywhere in Europe it's all Beauty Products and Vitamins you don't even see the drugs anymore, you have to know exactly what you need(from a doctor + prescription) to get anything more powerful than Aspirin, hell you can't even buy a strong Anti-Fungi creme or anything else that actually works unless you got a 'Permit' and now they are going to ban anything that has any health benefit unless you buy it from the Big Pharma so they can put Fluoride and other Psychotropic substances in everything you ingest

shansnv's picture

There are certainly a lot of details like that to take into consideration. That is a great point to bring up. I offer the thoughts above as general inspiration but clearly there are questions like the one you bring up where the most important thing will be working in honest good faith.

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ricksventures's picture

you got yourself commies in the white house and obese peasants on the street screaming for more chips.....

time to either rise up and hang the commies and starve the peasants for a while or else u be next on their menu



Mariposa de Oro's picture

Strictly socialized medicine is definitely unfair.  We should have a true free market health care system AND socialized system.  The 'healthy' skinny people can have their government run 'free health care' while the 'fatties' are 'punished' with a free market' health care system.  As a 'fatty' due to an untreated (20 effing YEARS) hypothyroid condition, I would welcome a free market solution.  With a truely free market solution, I would have been free to find a doctor that would take my symptoms seriously rather than be locked into a system with 'plan' doctors.  I'm one of those people who don't fit the charts.  My blood test always came back 'normal' even though I had damn near every symptom of an underactive thyroid.  I'm now getting treated for my condition and feeling much better.  I've even slimmed down a bit.  How 'bout that?

AldousHuxley's picture

As long as medical cartel controls supply of doctors, your medical service labor costs won't go down. Government may subsidize it but these guys will increase their price by exact amount of government subsidy.



  • Cost control: As long as medical cartel controls supply of doctors, your medical service labor costs won't go down. Government may subsidize it but these guys will increase their price by exact amount of government subsidy. The solution to bring down price is more competition. Why does a doctor need 4.0 and go through all the hoops of bs education? Most medical services isn't rocket science nor is it phD. It is just a fancy by the books human mechanic work except certain specialities. not everyone needs best of the best all the time nor can government be expected to provide everyone such quality. You want the best doctor in the world, you pay. You want average doctor for routine procedures that any dumbass can do with enough practice, government can provide without having the profit motive.
  • Basic coverage: socialize the basic medical services such as emergency care, and basic check ups, labs which any nurse can do. You don't need to study 10 years for basic check up where lab tests provide all the data. Also vaccines and cheap but most efficient routine medicine and procedures should be provided by the government. Profit margins are low anyway.
  • better allocation of dollars: Set the age limit for socialized medical coverage to average life expectancy, so that we are not paying $10M to keep a 110 year old person alive for another 6 months while depriving education scholarship to a 10 youngsters in medical research science.
  • Personal responsibility: No government medical service for people with multiple criminal records, no lung cancer treatments for smokers, no liver transplants for alcoholics, no heart bypass for fattys who have been told by doctors to exercise and eat less fat for last 20 years, etc. Conditional medical services to reward good behavior
  • Right incentives: Doctors should be paid hourly not per transaction. C-section rates are twisted way of what the system has become. Doctors want to cut mothers up before they go on vacation because that's how they get paid.
  • Pharma Innovation: Charge other countries for importing US created drugs and innovations while providing the same cheaper to US citizens
  • Eliminate coverage for illegal aliens and prisoners: allowing hospitals to write off their losses from providing services to illegal aliens  while charging the double for US citizens to make up for the loss and increasing taxes is just sick. This is subsidizing the industries where illegal aliens work. Either face the true cost or provide subsidies for all. US middle class is paying for the lower class





BigJim's picture

Big Brother knows what you need, healthcare included.

AldousHuxley's picture

In America, it is the Big FAT brother who wants you to pay for this triple heart bypass after eating all of those chips while watching some "reality" show.

shano's picture

You can get your own blood tests for thyroid levels at any lab.  then you can buy Bezweken products on Amazon to fix your levels.  bio identical hormones are a miracle compared to anything big pharma has on the market.

midtowng's picture

The reason health care costs are so outrageous is becuase of the insurance industry.

Buckaroo Banzai's picture

Don't forget-- Medicare and Medicaid are also insurance.

Insurance is insurance, whether it is provided by the Gov't, or by private industry.

Health care is not an insurable risk. Trying to insure health care is like trying to boil the ocean-- keep doing it, and it will eventually consume 100% of your resources. That's why health care costs are rising to infinity.

Anybody who doubts me, ask yourself why medical procedures NOT covered by insurance (i.e., LASIK or cosmetic surgery) get cheaper and more effective, while medical procedures covered by insurance or the gov't get more expensive and less effective.

AldousHuxley's picture

This is how government subsidies work in real life.

Advil costs $1 wholesale, but Doctor cartel (monopoly in several small towns) will charge $10. Costs a lot but not unaffordable that demand is zero.

People complain to the government. Politicians say we will subsidize it  by $5 to make it affordable. In the beginning people pay $5 + government subsidy of $5 and Doctors+Hospitals sell for $10. Eventually, Doctors+Hospitals push the prices up by $5 making it $15. So people still pay $10 + government subsidy of $5. Keep repeating this cycle and you end up with people paying $15 + government subsidy of $15 and doctors+hospitals charging $30 for a drug that is generic. Then government increase taxes to pay for these subsidies, so in effect a person pays $15 + more taxes for the same pill that used to cost $5.

Government subsidies inflate prices. If you want to lower costs, introduce competition. But any subsidized industry hates real competition but loves government subsidies. Thus, Obama's healthcare does not introduce public option (competition), but only subsidies.


Look around and you will see that things/services that rise with inflation are government subsidized (education, healthcare, housing) while quality is stagnant. While Steve Jobs gives us apple computer to faster better iPad in less than 20 years at a lower cost. Innovation industries are subsidizing industries that drag society down.

myne's picture

Government subsidies inflate prices.

Not if your government isn't totally incompetant, corrupt or malicious.

policy initiatives include:

  • Removing industry representation on the PBAC;
  • Making the PBAC processes more open and accountable;
  • Extending the PBAC remit to include making recommendations about the price at which a product will be cost effective;
  • Establishing a rapid response mechanism for reviewing the prescribing patterns and cost of new medicines in their first year on the PBS;
  • Controlling excessive pharmaceutical industry promotion to medical and pharmacy professionals through setting a $10 cap on the value of gifts and entertainment, and more tightly defining educational and entertainment activities;
  • Extending the ban on ‘direct to consumer’ advertising of prescription medicines to close loopholes that have allowed inappropriate promotion through public relations and media activities;
  • Providing medical practitioners with independent and evidence-based information to reduce their reliance on pharmaceutical industry marketing messages. This information will be provided electronically and by specialist advisers visiting doctors to discuss new developments; and
  • Providing consumers with factual information so that with their doctor they can make informed choices about the medicines they take and how to take them effectively

The cost of the PBS is not out of control

When benchmarked against expenditure on pharmaceuticals by OECD nations, the PBS is affordable. PBS cost as a percentage of GDP peaked in 2004/05 at 0.67 per cent and has since declined to 0.62 per cent in 2007/08.  Cost-effective expenditure on pharmaceuticals should rise with the increasing and ageing population.  Anything less reflects insufficient investment in health care by government.


Sure, it's socialised medicine, but shit, it works.

theman's picture

Hi Buck,


In view of your many informative posts, I respectfully disagree.  Anything can be insured (Lloyds of London) it is only a matter of statistics - allocation of risk.  Medical costs here in the US are out of kilter because of a very fundamental reason - the consumer has been seperated from the payor.  Restated, the consumer has no incentive to shop price.

Azannoth's picture

For such a well written and informative service Simon has astonishingly many Haters on ZH(of all places) what are you people afraid of ? .... the Truth ?

TGR's picture

No, the truth is fine - I tend to draw the line at those who fly in to countries and announce themselves experts after a day or two: typically the case with our Simon. Having lived in this region for too long than I care to remember, I can assure you it's not all beer and skittles. Not that there is anything wrong if you want to fly in to Bangkok on your private jet to nurse a sore toe to save a few dollars...but if you are comatosed or with a life-threatening condition requiring repatriation out of Asia, or even within, the costs of an SOS flight are as exorbitant, if not way more, than any other place on earth. The problem with the pay as you go system too, while fine for a cold or broken finger, gets somewhat tricky when you are unconscious and by yourself, as many are when in a serious accident. Plenty of cases or people not being treated properly, not at all, or conversely, being extorted or waking up with massively inflated bills.


ricksventures's picture

rather than asia (where there are no courts, no check on doctors etc.) i would suggest EU, in fact the cheaper health care countries like Hungary, Budapest


and in fact even the austrian and german health care costs  are cheaper than usa


FeralSerf's picture

Just about everywhere on Planet Earth health care costs are a lot cheaper than in the U.S.  I can't think or anywhere they're more expensive, even in the countries like Switzerland where the average wage is twice that of Americans.

AldousHuxley's picture

50% of healthcare costs go to doctors (unionized with artificial supply) and hospitals (writeoff costs). Doctors and hospitals don't want you to die, but want to you get sick often so they can maximize their profit. The same way mechanics doesn't want a manufacturers put a car out there that never breaks down.

Insurance does profit, but they are not the top cost driver.


also, it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures.


also most of the industry is non-taxed = government subsidized.


it is all about incentives. Right now the money makers don't want to give up. That includes bleeding heart hospitals who wants government to pay for every loss and bad doctors who don't have your best interests at heart.


Kick out smokers, alcoholics, fatties, tanners, and illegal aliens out of general insurance pool and see costs go down.



Buzz Fuzzel's picture

I and many others have been saying it for years.  The problem with health care cost in America is third party payer, insurance.  Think about it what forms of health care can most Americans still pay for out of pocket?  Dental care and eye care are generally still not insured and generally still affordable for the common man. Get to a point where the consumer pays direct for his healt care and it will become affordable.

docj's picture

Strangely (perhaps) though, I'm sure there are people - maybe even smarter folks who read this board - who will read your comment and say "And that's why we need to Fed.Gov to pay for everyone's medical care" completely oblivious to the irony of that very line of thought.

Buckaroo Banzai's picture

That's because those people are fucking socialist douchebags, who don't understand that when Fed.Gov pays, that's just another form of insurance.

shano's picture

Sorry, but thats bullshit to say that people can afford Dentistry.  it is really expensive.  People die every year from untreated dental infections.  And we all pay for last ditch and very expensive treatments in the emergency room to try to save their lives (from brain infections etc)

Jena's picture

Not to mention the costs of disability for those who survive the infections but are disabled by the lasting effects of those dental to brain infections missed or misdiagnosed.

malek's picture

Each year people die from untreated infections in every country of the world.

If you have a high fever over 102 F for 24 hours and do not visit a doctor absolutely ASAP, you should apply for your Darwin Award.

docj's picture

The cost to have my appendix removed in 2009 at a not-first-tier hospital south of Boston, plus 2-days in a non-private recovery room that was, at best, servicable was north of $30K. The nurses and staff were wonderful, but aside from that nothing about the stay was notable.

Thing is, once I started getting the pains it was already too late, even were I inclined, to hop a plane for SE Asia. So "internationalizing" one's health care doesn't seem to help one much domestically in the event of an emergency.

shaxmatist's picture

For emergencies you cant really outsource and have to get treated on the spot.

But for some problems that can afford to wait a week, like say a knee reconstruction or dental implants, a trip out of the country can be very much worth it

AldousHuxley's picture

sure you can't outsource ER but you sure can import more foreign doctors, and allow non-license unionized staff like nurses to perform more work. competition decreases costs while increasing quality and productivity. Healthcare industry is not competitive when compared to global standards. Sure top 1% of doctors are among the world's best, but 99% of doctors do same routine procedures other doctors around the world do for 3 times the cost.

shaxmatist's picture

LOL Aldous, with all the outrage about American Jobs getting outsourced overseas, and how americans are all unemployed because stuff gets done in china and india now, and stuff at home gets done by mexicans, so your solution is to double down on that and import cheap indian doctors to replace expensive american doctors? :)


I am not disagreeing, just not sure if you realise how politically unacceptable this is.

shaxmatist's picture

"I was just at Bangkok Hospital in Pattaya yesterday"

Pattaya is worlds capital for prostitution and transexuals.. you kind of exposed yourself there Simon!

Just make sure you use condoms, or the thai hospital will have a new venereal disease case to treat

defencev's picture

Pattaya is actually a wonderful resort and the posts like that demonstrates what kind of idiots populate thiswebsite. But returning to the essense of the article: SB is simply dishonest. As someone who frequently travel to Thailand and familiar first hand with facilities mentioned in the article, I can say the following. First of, yes, in places like Bumrungrad one can get a decent care but it by no means cheap. And the trend is definitely up. Unfortunate thing is that they learn some tricks from the West and in case of serious problem will try to impose various kind of unnecessary procedures to push your bill up. Regarding Bangkok Pattaya hospital, the trend is the same but on top of that I would not go there for serious treatment or surgery: the quality , overall, is no longer there .

Outside plush private hospitals, there have been well documented cases of malpractice in a number of hospitals in Thailand. Let me mention here also that due to his hectic travel schedule, SB usually provides very shallow picture. In particular, if I need serious treatment in Thailand, I would rather opt for Chula University hospital in BKK or Sriracha hospital in Pattaya.

 What people running this website fail to see that SB is biased, very biased against US and it clearly shows in his openly hate posts. How, for the God sake, you can hope to preserve any kind of credibility allowing this kind of publications?

Which is worse - bankers or terrorists's picture

Please stop insulting idiots by comparing them to people who visit this website. 

Apocalicious's picture

I used to have a disgreement with an old floor trader from the CBOE about the required framework for capitalism. He said insurance, I said rule of law and private ownership/property rights. He always argued insurance was necessary to encourage private ownership of risky assets. (Of course, he also traded on coke and doubles from Ceres). I said, no, self-interest encourages ownership of risky assets to increase your wealth. It also ensures YOU pay attention to and mitigate YOUR risks. I argued insurance is the downfall of capitalism because it intermediates the risk taker from the risks, hence increasing inefficiencies and costs for all while raising the total level of risk in the system. Insurance is socialism.

I am wrong upon occasion, perhaps even frequently. I am correct in this instance. 

shaxmatist's picture

Insurance spreads the risk across many different people.. it's a useful tool to free up your capital.. do you really want to have $200,000 in cash "just in case" an emergency comes up? wouldnt you rather pay an insurance premium and put the 200K into something productive like an investment project?

It's not the same as socialism.. insurance is voluntary participation, the person selling you insurance is willingly taking up your risks.. socialism is forced upon you by the state against your will, thats the difference. If you talking about Obamacare type of state-inflicted medical insurance, then I agree with all you said.

323's picture

it wouldn't cost 200,000 without insurance in the picture

Dburn's picture

Insurance is just a very expensive Wholesale card. Get the insurance companies rate but don't fucking count on them paying. They will find a way to slither out of it, especially  if you are an owner of a private health insurance policy or a small company owner. In Indiana they have a law on the books that holders of private insurance should check in their own state. "No Health Insurance Provider is obligated to pay out more than a consumer has paid into the policy."

Of course even that doesn't stop them from claim denial. Lets not forget the ZIRP environment leads to a much greater amount of claim denials as insurance companies can no longer earn money on the float and their absolutely must be a way to make sure the CEOs make billions. 

I figured the best way is to get the cheapest insurance from the largest company with a huge deductible and use it as a wholesale card. I haven't had to use it yet as I tend to have blood tests and such done by a lab with the results sent to me. The broken toes or that sort of thing can be handled at home. Especially if one has not been so protective of Pharmaceutical companies profits and have imported a sufficient amount of medication to cover multiple maladies.

Hell you can even import Chemo.  At 55+ I have no false illusions about the bad shit that  is coming my way. Death is considered an abstract concept until you see friends your age and notable celebrities keeling over left and right. Even the health nuts keel over. All you can hope for is a flash bang and it's over but generally it's some disease that has a cure rate that makes one want to play the odds only to find out they are dying of a hospital infection or are going into cardiac arrest over the size of the discounted bill.

Then you can opt for the smith & Wesson, all purpose, all weather health care plan for 29 Cents and a health maintenance kit for the Smith & Wesson.


America is the greatest. USA USA USA. NOT!

Apocalicious's picture

do you really want to have $200,000 in cash "just in case"

It's not the same as socialism.. insurance is voluntary participation,


You've identified the reason why it is not voluntary. People cannot afford the $200,000, so they MUST pay the monthly $500. This is the same as indentured servitude; it most assuredly is not voluntary in any practical meaning of the word. Besides the point - correctly made below - that the presence of insurance artifically raises the cost to all (as it mathematically must by operating as a middle man). Hence, I wouldn't have to worry about $200,000 if everyone else didn't have insurance, because the disaster risk premium would be much lower. Now, if we all went off insurance overnight, medical costs (and fraud and waste) would collapse overnight, but it is a classic case of prisoner's dilemma. This is why it has never been corrected in any developed country (please see Canada & UK). Health care is only accurately priced in countries where insurance doesn't exist.