Koh Samed, Thailand
Like major US corporations, outsourcing has improved our bottom line.
The dramatically increasing cost of US-based medical care, which continues unabated — we had an 18 percent increase in our catastrophe health insurance policy this year despite official government agencies assurances there is no inflation — forced us to search the global marketplace for an alternative.
We were shocked to find that not only was healthcare inexpensive in Asia, the service is many times better.
We have been traveling to Thailand for five years to attend Bumrungrad Hospital, a US-accredited medical facility in Bangkok because American medical care is not only financially out of reach, the care we can afford, is poor.
Our decision was driven by the short-term corporate thinking which dominates Wall Street and the relentless drive by US corporations, including the medical insurance industry, to put increased profits and benefits to executives and shareholders ahead of paying customers.
Wendell Potter, a former health insurance communications vice president and author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans, says look no further than the Medical Loss Ratio (MLR), which is the measurement of the share of premium revenue spent on actual health care, to see that medical insurance companies are earning record profits.
“In 1993, the leading insurers used about 95 percent of premium dollars on medical benefits, according to the consulting firm of Pricewaterhouse Coopers,” wrote Potter. The merger wave and the new philosophy about health insurance pushed MLRs down sharply, so that by 2007 the number was 81 percent.”
Health insurance in America is unaffordable for middle- and working-class Americans. The Kaiser Commission on Medicaid and the Uninsured says while the median household income in the US is $50,000 per year, the average cost of a family health insurance policy rose to $12,106 in 2007 and to $13,375 by 2009.
As a Canadian, all those US movie and TV references about the fear of losing health insurance, which meant nothing to me before I moved here are today a reality. My biggest fear in the US is not a terrorist attack, it’s being seriously injured in a car, bus or truck collision and surviving.
In America, except for 18 months as employees of Schneider National, where we had a company subsidized health insurance plan — a fuller service plan for the price of a high-deductible catastrophe plan on the individual market — we’ve always been business owners, supposedly the drivers of the economy, hiring more people than major corporations, but unable to access affordable health insurance.
The cost is prohibitive because we have no group, like Schneider with its 1,000+ drivers, to negotiate the prices down. The way around this is to join a business group we’ve never heard of and pay $40 to $60 a year reducing the cost of premiums somewhat, for the same poor service
Our first encounter with the US system was positive. Greg bought his first medical insurance in 2000, costing about $200 a month. He got a shard of glass in his eye. I followed him through the Manhattan Eye Hospital with a notepad, writing down every word a doctor, nurse or administrator uttered asking each step of the way: “This is an emergency right?” If anyone determined it not an emergency we would have paid a $300 emergency room fee. That was a high point in medical insurance system for us, the whole incident was covered. It’s been downhill for service, uphill for pricing and confusion every since.
The price goes up sharply every year. We have adjusted either the coverage or the deductible. In 2003 we canceled our last full-service medical plan when the premium rose to $629 per month for the two of us, a whopping $7,548 a year, not much less than our $1000 apartment rent. The service was abysmal. A day at the clinic to get a blood test, the technicians leaving giant bruises, four months of phone calls to get my health records to secure a life insurance policy and $629 was not the only fee. There was an additional $20 co-pay to have a doctor’s office visit to get a referral to the gynecologist and another $20 at the gynecologist.
We switched to high deductible catastrophe plans. The first was $310 a month and a $5,150 deductible EACH per year when needed, before the insurance kicks in. We call it our hit-by-a-truck policy. We hoped that if we didn’t have the good fortune to die, we will at least not end up destitute. When the premium jumped the following year there was a different “catastrophe” plan, $399 a month or $4,788 per year with a $4,500 deductible, each. A year later that plan increased 16%, so we did what many do, accepted a higher deductible to get a lower monthly premium. Many opt out and pray.
Potter says health insurance companies have merged, re-merged and emerged behemoths using “their enormous size to engage in anticompetitive behavior, rig the system to impose unaffordable premium increases and deliver massive and growing profits for themselves and their shareholders.
“As premiums have skyrocketed, insurers have cut benefits, increased out-of-pocket costs for workers and shed millions of enrollees who can’t afford insurance. Americans have been left to pay more while getting less and less.
One year ago, the American Medical Association issued its annual report on the state of competition in the health insurance industry. In 24 of 43 states surveyed, the two largest insurers had a combined market share of 70 per cent or more. “Among the 313 metropolitan markets, as astonishing 99 percent were “highly concentrated” under Department of Justice guidelines, up from 94 percent the year before,” Potter writes.
In 2005 we decided there had to be a better way. What if we continued with the hit-by-a-truck plan for a catastrophe and took our desire for a regular checkup, an ounce-of-prevention is better than a pound-of-cure we believe, and enjoy the same kind of physical that our elected officials receive free at taxpayers’ cost, offshore.
We’d known about Bumrungrad for a long time. Backpackers in Asia recommended the hospital when in need of medical treatment. It catered to expatriate business people, foreign executives and diplomats — the woman who owned the spa we visited last week told us that her parents travel from Hong Kong to Bangkok for check ups at Bumrungrad.
We know this is not an option for everyone. We do not have small children, we do not have any health issues or chronic conditions, we do not engage in risky behavior, skydiving, parasailing or jaywalking. But if we needed a procedure we have no hesitation in trusting these doctors. Three years ago, to celebrate my 50th birthday, the doctors at Bumrungrad handled my colonoscopy.
Thanks to the Internet I made all the arrangements online, booking two Over 40 Comprehensive Medical exams. We walked away from our day of testing with a folder of the results and a digital record held by the hospital should a doctor anywhere in the world need anything 24/7, 365 days a year. The cost for two, in 2005 thanks to a high US dollar, about $800 US.
In a dozen years living in the US, we have seen only one doctor twice, because we went to complain when we couldn’t access records to apply for term life insurance. Plus every time we change insurance it means a different doctor. We have had the same doctor for three of our four visits to Bangkok.
She seemed to recognize us this time. If she didn’t, all it took was a few minutes flipping throu
gh our digital health chart to bring her up to speed on our health the past five years.
Our Wellness Tour always starts the same way. With a massage.
Next, head-to-toe wellness, Asian-style.