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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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Wed, 10/12/2011 - 13:49 | 1766441 Fukushima Sam
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...

Wed, 10/12/2011 - 15:47 | 1766918 trav7777
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

Wed, 10/12/2011 - 19:04 | 1767608 malek
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.

Thu, 12/22/2011 - 07:38 | 2003698 glenn17
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.

skin clinic

Wed, 10/12/2011 - 20:27 | 1767894 Tapeworm
Tapeworm's picture

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

Mon, 01/30/2012 - 05:29 | 2108897 glenn17
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.

guaranteed issue life insurance

Wed, 10/12/2011 - 12:45 | 1766232 gaoptimize
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.

Wed, 10/12/2011 - 12:47 | 1766251 barkster
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...

Wed, 10/12/2011 - 12:50 | 1766268 ricksventures
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 !



Wed, 10/12/2011 - 14:05 | 1766501 Bob Sacamano
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. 

Wed, 10/12/2011 - 14:32 | 1766604 FeralSerf
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.

Wed, 10/12/2011 - 16:56 | 1767148 toady
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.

Wed, 10/12/2011 - 14:55 | 1766695 Azannoth
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

Wed, 10/19/2011 - 01:42 | 1787997 shansnv
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.

Fraxel Melbourne

Wed, 10/12/2011 - 12:48 | 1766261 ricksventures
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



Wed, 10/12/2011 - 13:01 | 1766306 Mariposa de Oro
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?

Wed, 10/12/2011 - 14:35 | 1766620 AldousHuxley
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





Wed, 10/12/2011 - 14:41 | 1766639 BigJim
BigJim's picture

Big Brother knows what you need, healthcare included.

Wed, 10/12/2011 - 15:45 | 1766912 AldousHuxley
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.

Wed, 10/12/2011 - 15:24 | 1766841 shano
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.

Wed, 10/12/2011 - 13:38 | 1766417 midtowng
midtowng's picture

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

Wed, 10/12/2011 - 14:01 | 1766464 Buckaroo Banzai
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.

Wed, 10/12/2011 - 15:22 | 1766836 AldousHuxley
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.

Wed, 10/12/2011 - 16:51 | 1767118 myne
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.

Wed, 10/12/2011 - 15:32 | 1766870 theman
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.

Wed, 10/12/2011 - 12:44 | 1766237 TGR
TGR's picture


Wed, 10/12/2011 - 14:58 | 1766715 Azannoth
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 ?

Wed, 10/12/2011 - 20:39 | 1767925 TGR
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.


Wed, 10/12/2011 - 12:45 | 1766242 ricksventures
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


Wed, 10/12/2011 - 14:35 | 1766621 FeralSerf
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.

Wed, 10/12/2011 - 16:40 | 1767062 AldousHuxley
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.



Wed, 10/12/2011 - 12:45 | 1766244 Buzz Fuzzel
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.

Wed, 10/12/2011 - 12:52 | 1766274 docj
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.

Wed, 10/12/2011 - 14:00 | 1766479 Buckaroo Banzai
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.

Wed, 10/12/2011 - 15:27 | 1766849 shano
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)

Wed, 10/12/2011 - 15:51 | 1766928 Jena
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.

Wed, 10/12/2011 - 18:51 | 1767635 malek
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.

Wed, 10/12/2011 - 12:48 | 1766247 docj
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.

Wed, 10/12/2011 - 12:51 | 1766273 shaxmatist
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

Wed, 10/12/2011 - 16:49 | 1767110 AldousHuxley
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.

Wed, 10/12/2011 - 22:21 | 1768142 shaxmatist
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.

Wed, 10/12/2011 - 12:55 | 1766252 shaxmatist
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

Wed, 10/12/2011 - 13:39 | 1766411 defencev
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?

Wed, 10/12/2011 - 14:52 | 1766683 Which is worse ...
Which is worse - bankers or terrorists's picture

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

Wed, 10/12/2011 - 12:47 | 1766254 Apocalicious
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. 

Wed, 10/12/2011 - 13:09 | 1766315 shaxmatist
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.

Wed, 10/12/2011 - 13:10 | 1766329 323
323's picture

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

Wed, 10/12/2011 - 16:17 | 1767000 Dburn
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!

Wed, 10/12/2011 - 14:43 | 1766646 Apocalicious
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.

Wed, 10/12/2011 - 14:44 | 1766654 Apocalicious
Apocalicious's picture

correctly made *above*

Wed, 10/12/2011 - 22:27 | 1768160 shaxmatist
shaxmatist's picture

People cannot afford the $200,000, so they MUST pay the monthly $500.

Well you do have the option of not paying the 500 and not setting aside the 200K..

and if the emergency comes, you face it uncovered, go to a herbalist or something, or fly to Thailand, or go to the ER and pretend to be an illegal immigrant who doesnt speak english.

Wed, 10/12/2011 - 16:50 | 1767114 FeralSerf
FeralSerf's picture

<<. . .insurance is voluntary participation,. . .>>

What planet are you from?  Here in America, car insurance, motorcycle insurance, health insurance, fire insurance, flood insurance is all effectively mandatory.  The FIRE industries rule America for their own benefit.   There is little wealth to go around for anyone else anymore.

Insurance is compulsory, tax advantaged gambling.

Wed, 10/12/2011 - 12:48 | 1766260 printmemoney
printmemoney's picture

Why don't you use one of your 155 passports or ids at the united states emergency rooms?  Then discard it and replace it with another when you're traveling to Hong Kong to pay no premium on spot gold.  Oh, I know why....because you're full of shit.

Wed, 10/12/2011 - 12:51 | 1766266 Henry Chinaski
Henry Chinaski's picture

Most Americans want to avoid paying for their own medical care at all costs. 

Wed, 10/12/2011 - 12:52 | 1766267 The Alarmist
The Alarmist's picture

Not to mention that Bangkok is the number one destination for sex-change operations nowadays.

BTW, why bother even having insurance for the US? Just walk into the ER like illegals, show them your foreign drivers licence, say "Huh?" if they ask for a social security number, and let your former fellow citizens pick up the tab for the few thousand or so you might be willing to pay.

BTW 2, my catastrophic overseas cover which covers me in the US costs EUR 6 per year.

Wed, 10/12/2011 - 12:53 | 1766278 Taint Boil
Taint Boil's picture



We had a baby in a different country $2.5K C-section and $500 for circumcision. Easy as pie. Actually had to pay the doctors with cash and watched them count it out in front of us - funny

Wed, 10/12/2011 - 13:50 | 1766443 Marigold
Marigold's picture

Shame you were not able to pay for it with one of your 14 credit cards. Such a snotty upper-class comment of having to witness the doctors count out cash in front of you. How the hell to you think business is conducted.

Fri, 10/21/2011 - 09:53 | 1796774 Taint Boil
Taint Boil's picture

Huh ?????

Wed, 10/12/2011 - 13:02 | 1766297 dwdollar
dwdollar's picture

Last time I used the ER a Mexican migrant worker was holding up the check in nurse for a boil on his ass. He had a translator and the nurse was having difficulty understanding the translator. When I checked in I was bleeding significantly from the nose due to a partially severed left nostril (from a fall, something went up my nose and came out the wrong way).  Luckily, by the time they saw me (30-45 minutes later), I was nearly clotted. Basically, my nose fixed itself since I was careful to hold it correctly. By the time they saw me all they did was an iodine wipe.  Later, I had an argument with the doctor when I refused a vaccine. The American medical system is a sad fucking joke.

Wed, 10/12/2011 - 13:00 | 1766302 PaperBear
PaperBear's picture

More and more people will go into bankruptcy if they are forced by law to purchase expensive private health insurance they cannot afford. You don’t have to be a rocket scientist or a super duper economist to figure this one out.

Wed, 10/12/2011 - 13:02 | 1766309 PaperBear
PaperBear's picture

Oh wait, student debt is not discharged under a bankruptcy in America. So say hello to debtors prison, America.

Wed, 10/12/2011 - 13:07 | 1766325 GeneMarchbanks
GeneMarchbanks's picture

'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.'

Let me guess, it burns when you pee. Yeah, look, here's a plan for you: be more careful with your erections.

Wed, 10/12/2011 - 13:11 | 1766335 sleepingbeauty
sleepingbeauty's picture

Why is it, that even when I agree with Mr. Black, I feel like throwing the compy across the room. Maybe it's his annoying condescending attitude. Not everything American is garbage and not everything abroad is great.

Wed, 10/12/2011 - 18:59 | 1767654 malek
malek's picture

It seems his starting point of view is the typical American who believes everything in the US is great and everything abroad is garbage.

Wed, 10/12/2011 - 13:21 | 1766361 nah
nah's picture

what kills me is that 2/3 of healthcare goes to old folks


and they want to tax 14-25yr olds with 'government madated private insurance lolz'


cuz doctors know theres know way their day to day patients can navagate the existing healthcare price structure of their own means


so to keep salaries up most care facilities are 'non-profit lolz'


and its all so unafordable heathcare is busier than they would otherwise be... and one day your kids will be able to enjoy it too

Wed, 10/12/2011 - 13:25 | 1766373 youngman
youngman's picture

I live in Colombia...great medical, dental, optical..and hookers also

Wed, 10/12/2011 - 13:26 | 1766374 Marigold
Marigold's picture

This post is spot on. I live in Bangkok and can only say the quality of the hospitals and doctors is outstanding. You will be seen by a specialist within 15 mins. I know of several people from Europe who come to Thailand for their treatment including dental. A visit to any of the major hospitals in Bangkok is a truly international experience. I believe over 16,000 Canadians came to Thailand last year for treatment inclusive of major surgery..Medical tourism is big business here and no it not all about the above smirky comments of trans sexuals and by the way they have a right to life as well . So you fucked up Yanks your days in the sunshine are over and get used to earning a lot less because your corporations and banksters have sold you out and get used to your new life on plantation Obamaville.

Wed, 10/12/2011 - 13:29 | 1766385 Sneeze
Sneeze's picture

Simon should do an experiment in Thailand... Cut the two fingers he writes his posts with off, and see if the doctors can put him back together.

Yet another Indiana Black and the macbook B-movie his trust fund struggled to pay for. 

The next time my kids need some anti-biotics I will be sure to whisk them off to Pantagonia for some sheep herding and excellent health care.

Wed, 10/12/2011 - 17:00 | 1767164 FeralSerf
FeralSerf's picture

And you should do the same experiment in America to validate the competency of American health care.   Let us know how it comes out.

Wed, 10/12/2011 - 23:51 | 1768360 Sneeze
Sneeze's picture

Good point, they seemed to have fucked up an abortion your mom had a few years back.

Wed, 10/12/2011 - 13:57 | 1766462 adr
adr's picture

The problem is the increase in health care costs are arbitrary and go up just for the hell of it. I really want to sit down with the asshole that generates the numbers and find out why they charge what they do. Most procedures have doubled or tripled in cost over the past five years and there isn't any basis for the increase. I think the cost increase is nothing more than a tax to pay for the $250 million medical centers going up in every city. Hospitals are being run like investment firms ripping off patients and the government.

$250 for a 10 minute appointment to get prescribed $5 of antibiotics. FUCK YOU!!!

I had a kidney stone 7 years ago and the bill was $3500. I had one two months ago and the bill was $8200. They let me sit there an extra two hours before I got discharged just to pad the bill. $1500 an hour for an ER bed, fuck you.

The bill for the normal birth of my son, $38k. They actually charged for the recovery room twice. My newborn son was charged and my wife. FUCK YOU!!!

Why does this happen? Because we are forced to have insurance. Get rid of insurance and the cost problem goes away. The problem is the medical industry has now built itself up on overcharging 1000% or more. Without the bullshit it wuld collaspe and we wouldn't have a health care system anymore.

Malpractice insurance is a bullshit excuse. Equipment cost is a bullshit excuse. Lawsuits are a bullshit excuse. The American medical industry has been taken over by obsessive greed.  Anyone that thinks otherwise go ask a doctor how much an over the counter Tylenol costs you at a hospital. THE ANSWER IS $150-$200 A PILL!!!

I told my sister in law nurse that I'm turning her doctor's office in for insurance fraud. She told me they bill the insurance company at the rate for the doctor even if you are only seen by a nurse becuase the reimbursement rate for a doctor is 80% and the nurse rate is only 65%.

Ahh rampant fraud, you got to love it.

Wed, 10/12/2011 - 14:13 | 1766530 porrannor
porrannor's picture

We are suckers in so many ways... problem in this country is not just economy and definitely not jobs... the problem is much broader and deeper then that... there are so many fraudulent ponzi schemes ingrained into the social, political and economical structure.. I don't even know where to begin... social security, medical care and health insurance, taxes, benefits... and many, many more.... 

Wed, 10/12/2011 - 15:39 | 1766892 AldousHuxley
AldousHuxley's picture

Because stupid Americans say stupid shit like "Doctors deserve all that money because they saved my life"

Well Doctors don't invent cures or new pills, they just do what they learned from a book. When you pay more to the car mechanic than the car engineer, you are disincentiving innovation. Without medical lobbysts, doctors are nothing more than butchers.


Ask yourself why does doctors need so much education and how much of that book knowledge do they retain after 5 years and how much do they use it in practice? I'm sure if bunch of garbage truck drivers formed a union and bargained with the state that only those with professional license can drive garbage trucks after spending $300K and 10 years in garbabge truck driving schools where only top grads make it, and they lobby with federal government to limit garbage truck driver supply to onyl a few thousand a year, they can also charge $1000/hour to pick up your garbage. Then they will start wearing special uniforms and build fancy garbage trucks off of tax payers dime and "save" your streets from stinking once in a while to justify non-free market pricing of their services. Then because services are priced so high, you will need garbage removal insurance and even that is priced out, so government will tax you more to subsizide it and you will feel glad that you paid for such bs insurance because whe you see the bill, the garbage truck driver charged you $10,000 to pick up your garbage while insurance covered 90% so you only had to pay $1000 out of pocket.

Stupid Americans who still think everything in America is the best will start defending them saying "garbage truck drivers deserve all that money because they saved my street".

Wed, 10/12/2011 - 14:02 | 1766491 Charlie the Chump
Charlie the Chump's picture

Of course a good alternative for US sufferers would be Cuba, excellent care, free, shame you can't pop over there like us Brits.

The Chump family favourite is Singapore, great health care system, all citizens have their own budget which they can spend where they abd their advisers deem most efficacious, they can top up if they want and have the funds and the really poor pay nothing.

Whatever you do over there DO NOT follow the Obama route - just look at the Command economy of the National Health Service over here, swallowing increasing cash for no real gain (apart from an increase in General Practioners / Consultants salaries of over 35%!).

Wed, 10/12/2011 - 14:02 | 1766493 porrannor
porrannor's picture

This constitutes an incredible business opportunity. A cruise ship converted into a gigantic, high quality hospital/clinic parked outside of the territorial waters. Why hasn't it been done yet?

Wed, 10/12/2011 - 20:56 | 1767974 Tompooz
Tompooz's picture

It will be done. But getting good rotation schedules for doctors and their families will not be trivial. The cost may not make it economical compared to medical tourism.

Other business opportunities are dedicated hospitals and recovery resorts for medical tourists in english speaking countries like the Philippines.  For some reason Simon Black ignores the Philippines.  I always do my dental work there--it pays for the holiday.


Wed, 10/12/2011 - 14:02 | 1766494 Which is worse ...
Which is worse - bankers or terrorists's picture

I broke my foot when I lived in Dubai. Emergency room visit, X-ray, cast all cost $7. Emiratis pay zero. 

Wed, 10/12/2011 - 14:06 | 1766505 youngman
youngman's picture

When you add 40 million illegals with no insurance and use the emergency room as a clinic....your costs are going up....but hey..they say the price of cabbage is low because of the illegals picking you save there I guess....the schools, foodstamps, housing, medical...that is someone elses USA is stupid

Wed, 10/12/2011 - 14:25 | 1766580 porrannor
porrannor's picture

Unfortunetally, you are right. We are dumbest of all... the irony is we think we are soooooo... smart. After all we are going to elect Obama or Cain and hope all will change.. we are stupid to no end .....

Wed, 10/12/2011 - 16:52 | 1767123 AldousHuxley
AldousHuxley's picture

it is like a blue collar manufacturing worker who shops at walmart to save fifty cents. Few years later, the manufacturer goes out of business and he loses his job. yeah 50 cent savings won't help you much when you are unemployeed.


illegals save consumers few dollars while, they eat up thousands of taxes in social services. The only profit goes to business owners who abuse this system and when the community turns into a mexican ghetto, these corporate owners are flying their private jets to gated communities while you are left to put up with "diversity".

Wed, 10/12/2011 - 14:12 | 1766527 randomdrift
randomdrift's picture

When I taught at a University in Canada, during the early 1990's, i used their health care system. As an American, I was not part of their socialized health insurance program but paid cash. It cost $25 for an office visit and I could be seen right away, instead of having to wait like all Canadians had to do. Prescription drugs were also amazingly inexpensive.

However, their socialized medical system doesn't work very well for Canadians. Many of them come to the US for treatment.

Wed, 10/12/2011 - 17:51 | 1767369 beatus12
beatus12's picture

Randomdrift, I live in canada now and have lived in the states

as well as asia because of my profession so feel I can add to

the conversation IMHO. We also have med professionals

in the extended family so I speak from that perspective

also. I don't think many people do go outside the country

because I can't ever recall meeting or

knowing anyone doing so in 40 plus years. The system is

largely very appreciated but it has it's challenges for sure.

The next wave in human health for the future I believe is the

individual not more expensive rubbish.  Education, prevention

and most importantly personal responsibility. For example,

70pc of ER visits are for alcohol, smoking, obesity related

illness and careless driving. What can you do? Educate

yourself, manage your weight, seek help for obsessive

behaviours, check your blood pressure, make time to

excerise everyday if possible etc. Best to improve

our systems on the local level and fight injusticies. It

always bothers me to read of people not having access

to affordable care and the abuse by others.








Wed, 10/12/2011 - 14:18 | 1766561 gwar5
gwar5's picture

Oh my, we know Pattaya well, brother Simon.  Good choice. What a party place!! (beware the ladyboys, some require a TSA pat down)


I know the hospital you speak of, very nice indeed. I have poked around the Costa Rican and Nicaraguan medical facilities to make friends and investigate (just in case) where I want my carcass to be taken in case of bad luck. But high quality is the rule, not the exception, in Thailand. 

Interesting option: I know some individuals who have judgement-proofed themselves, meaning they have firewalled their assets and go bare, including health insurance. On paper they are indigents. Ergo, they neither pay for health insurance, health care, nor worry about the rising cost of premiums. They have no assets legally available for any lawyers to seize -- for any claims, so lawyers don't even bother filing. That's how they beat a litiginous society and the health care racket.

When asked about the morality of it: They say the law guarantees they get to be treated and when illegal aliens are not treated better than American citizens, they'll reconsider.  Meantime they just give the middle finger to the broken system.




Wed, 10/12/2011 - 15:12 | 1766787 Marco
Marco's picture

How exactly do they do that? Who is the legal owner of their assets?

Thu, 10/13/2011 - 02:41 | 1768616 phyuckyiu
phyuckyiu's picture

A -Non- Discretionary trust is a good start. Make it discretionary, where you pick how much you can have per month, and the ex wife's lawyers and the hospital lawyers have your ass.

Sat, 10/22/2011 - 09:05 | 1799785 Marco
Marco's picture

Seems to me extremely unlikely you will be able to declare personal bankruptcy with the insured monthly income. AFAICS they will be as likely to put a liens on most of your trust fund income as they are at getting your assets out right if you had personal ownership.

Wed, 10/12/2011 - 14:36 | 1766623 aerial view
aerial view's picture

Big Picture: U.S. healthcare system costs primarily due to:

Insurance companies which simply push paper and collect money

HMOs/PPOs, etc which make CEOs very wealthy

Free care for illegals and poor

A pay per visit system would drastically cut down most of these costs and force people to become more responsible with their health: "an ounce of prevention is (really) worth a pound of cure".

Wed, 10/12/2011 - 15:22 | 1766837 infinity8
infinity8's picture

This is a real hot button topic for me. The American Health Insurance System is, simply, criminal. Too many people equate health insurance with health care - they must be fortunate to not have had anything serious to deal with health-wise. Talk about redistribution of dollars - premiums paid by people and their employers that go to overpriced healthcare for someone else. And, even if you have "good" health insurance, that does NOT translate into proper healthcare necessarily. If anything, lots of unnecessary bullshit will be ordered if you have "good" insurance. If you don't have insurance and something happens, you will be billed astromical amounts - no discounts for you! - no rules about maybe just charging the average of what the provider has contracted with the's for, oh hell no. I could go on forever but, my idea is that everyone should have access to an HSA, even individuals. If you're going to force me to cough out, then let it be on reserve for when I need health CARE - and people could spend those actual dollars with whatever provider they CHOOSE. If employers wanted to kick in $$ as a benefit, great. 

Wed, 10/12/2011 - 15:57 | 1766952 aerial view
aerial view's picture

good points. The system must be totally redesigned without lobbyists from the pharmaceutical, insurance and healthcare (HMOs) industry.


Wed, 10/12/2011 - 20:55 | 1767973 Tapeworm
Tapeworm's picture

Exactly Infinity8, where else does one have to commonly pay double for the same good or service if one tenders cash?

Wed, 10/12/2011 - 14:57 | 1766705 deKevelioc
deKevelioc'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."

Yeah, and what about those errant asteroids, too.  It must be terrible to live with so much fear.  I bet you're watching the Discovery Channel and counting all the Black Swans that could hit you at ANY MOMENT.  In fact, you may be afraid of being "locked up abroad" too.  Stay home; you've been domesticated.

Wed, 10/12/2011 - 21:29 | 1768050 Papasmurf
Papasmurf's picture

You will be so proud of your savings when you end up needing a simple procedure such as catherter blood sampling from an organ at a hosptial cost of $25,000.  And that is just the beginning of the diagnosis for some diseases.

Wed, 10/12/2011 - 21:55 | 1768099 rhs
rhs's picture

Everything he says is well-known to all ex pats. Most  of us carry either travel insurance or an international policy which covers us around the world but only in emergencies or for 14 days or something like that when we are in the US. This is very cheap and easy to use. I live in Chongqing, China, and Peiple's Hospital #3 has direct billing to my insurance company. It doesn't get any easier than that. The only other time i used the insurance was when I once went over my $250/year deductuble all over southern and central Africa. I faxed the receipts and got a physical check to my US mailing address in about two weeks. The insurance company has translaters. Besides that, the hospitals are more than happy to have you pay one amount, then give you a bill for triple that to turn in. As long as the charges are deamed reasonable, you get the money. As for collecting malpractice almost anywhere, a previous commenter is right. No way.

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Mon, 12/26/2011 - 09:08 | 2011576 PiranhaEatingGo...
PiranhaEatingGoldfish's picture

I know that what he is saying here is true. As an American in China, I thought all doctors were quacks and the thought of surgery in China scared the hell out of me. But in April of this year I had to get a tumor (thankfully benign) removed from my liver. I was referred to a hospital that is attached to a university in Shenyang. The doctor was a teacher who specialized in liver operations. I was in the hospital for 9 days and had to pay extra for a private room so my wife could stay with me. My final bill after surgery, anesthetic, room charge, doctors fees and 9 days of medicine was $3,160. I couldn't believe how freakin cheap it was. and the most expensive was the nine days of medicine. The doctor and his interns spoke pretty good English and more importantly they were professional and caring. The experience made me change one of the last facets of my imperial Western thinking.

The only facet that remains is about education and that one will never change, cause I've seen too many Chinese students to have any positive opinion about the education system at all. In fact, all my students who were good at questioning and critical thinking were that way due to their vast disgust of what they called a "system of tests that does nothing to prepare you for anything useful in life."

I'm with Simon here and have to say that the Westernized healthcare system is too damn expensive, usually doesn't actually help that many people that really need it (the people who are poor) and rarely worth the costs.

Wed, 02/22/2012 - 02:18 | 2183625 shawn002
shawn002's picture

really its true that medicine and health care facilities are costly today


Wed, 02/22/2012 - 08:10 | 2184167 shawn002
shawn002's picture

well health care cost will affect the budget and health too.


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