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Planting an offshore medical flag

May 10, 2010
Undisclosed location

I’m going under the knife tomorrow… it’s a little unexpected, but apparently I need a rather urgent surgical procedure performed, and the doctors here have fit me in at their first available time.

To be honest with you, I’m pretty disappointed– no, not because of the operation. These things happen from time to time, and I’m pretty fearless. I’m mostly disappointed because I’m not in much condition at the moment to get on a plane and fly to another country where I would actually prefer to be operated on.

This is all rather ironic, because a couple of my friends had commented, “wow, I bet you’re happy that you just happened to be in the US for this!” Actually, no, I’m dismayed.

First of all, my US insurance company won’t cover the procedure… at least at the moment. If I wait a bit longer until the condition becomes life threatening, then they would cover it. But because I’m not presently terminal, I’m left to cover the costs on my own with cold, hard cash.

I figured this out ahead of time with the friendly folks at my insurance company, so when I went in to see the doctor here, I made him an offer.

“Look,” I said, “I’m paying cash. No insurance companies will be involved. Let’s make a deal.” Happily, he settled with me on a reasonable price, knowing that he would be paid immediately without having to deal with the usual bureaucratic runaround.

The price that we negotiated is just a fraction of the normal price that they bill to the insurance companies; it’s truly unbelievable how much excess doctors are forced to build into their prices simply because they know that they will only be paid a percentage of their invoices.

What’s even more unbelievable, though, is that the ‘reasonable’ price we agreed upon is still multiples more expensive than what I would pay for comparable, if not even higher quality care in the Orient.

This is the second chief reason I’m disappointed– aside from cost, I truly believe that I would receive better care in Asia. As for the operation itself, I’d say the odds are evenly stacked. It’s a simple procedure, and I’d trust a qualified surgeon of any nationality to carry it out without any significant errors.

What I’m more concerned about is the treatment I’ll receive before and after the surgery– the incessant forms they’ll have me fill out, the wasting away in a waiting room, the needless drugs they’ll pump me full of, the ridiculous OSHA and FDA regulations, the speed with which they’ll kick me out to make room for the next patient, etc.

These sorts of things seldom happen to foreigners in overseas hospitals. Overseas, foreigners are in control of their own treatment; they’re actually treated like a vested partner in the doctor/patient relationship instead of like a child, and this is certainly a nice change.

Frankly, this is what being a ‘permanent tourist’ is all about– maintaining that status as a valued customer who should be courted, instead of a regular citizen who will be milked and slowly bled to death… but I digress.

House calls are commonplace overseas… perhaps even more commonplace than they were in America back in the 1950s. It’s nothing for a doctor to swing by the house to check up on you, or even hire a few nurses out for the week to take care of you.

I was dumb enough to mention this to the attending physician; needless to say, he started arguing with me that the quality of treatment in Asia is substandard.

“Oh,” I told him, “so you or one of your colleagues has actually been to the hospitals in Hong Kong, Thailand, and Singapore to judge first hand?”


It always puzzles me how rumor and stigma are perpetuated by the uninformed.

Lastly, having any medical procedure performed in the US has me a bit nervous these days. Nobody really quite knows what the Obama health system will look like (least of all the government), but I’m still concerned about ending up on a list in some government database as a guy ‘who has health insurance but doesn’t use it.’

Yes, I actually think the dastardly practice of negotiating directly with the physician instead of using a government-approved plan is going to land me in hot water with the IRS one of these days…. because, naturally, it falls to the Department of the Treasury to enforce healthcare legislation.

This is one of the other advantages to having medical procedures performed overseas; the records are actually private, and if you want, no one else will ever find out. It’s as close as you can get to dropping off the grid for your medical care without having to sacrifice quality.

To me, medical care is just another overseas flag that we can plant, especially if planned properly. In my case, I just got caught in the wrong place at the wrong time… which is ironic considering that I’m in the US at the moment undergoing treatment.

Look, I’m sure that things will be just fine tomorrow. I have no illusions that the surgeon is somehow unqualified or anything like that… but we all know that medical care is a package deal. And while the medical quality of US treatment may still be among the world’s best, many other countries are quickly closing the gap, and they’re already offering more attractive packages.

I could expand on this more, but if you’re interested, I would consider Dusit Bangkok and Bumrungrad in Thailand, and Raffles in Singapore.

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About the author: Simon Black is an international investor, entrepreneur, permanent traveler, free man, and founder of Sovereign Man. His free daily e-letter and crash course is about using the experiences from his life and travels to help you achieve more freedom.

Comments on this entry are closed.

  • RichMc


    Our thoughts & prayers are with you for a successful surgery & speedy

  • http://www.hopandjaunt.com Aly

    I would have to agree with you 100% on this issue. Having grown up as an expat around the world my parents would only half jokingly tell us “don’t get sick or hurt while we’re in the US.” I might also add that several South American countries have pretty good medical care. Many of the Drs. used by the upper echelon of Argentina were trained in the US and the patient care we saw there was out-standing. Colombia is the place to go for cosmetic and dental surgery, with even the occasional US celebs going down for their ‘secret’ boob jobs.
    Hope everything works out for you, and for a speedy recovery!

  • linda allen

    Will be thinking of you Simon, and keeping you in my prayers and thoughts for a successful, non-eventful sojourn in the hospital… and a very speedy recovery.
    I can only imagine your dismay at having to succumb to the knife in a US Hospital.. even though i have never had the first hand experience, i know the US Medical system leaves far to be admired.. I believe you, that the pre and post op care in most Asian hospitals is far superior.. my personal experience is with the French Health Care system in Paris. Its well known by WHO to be in the top medical care systems in the world.. state of the art treatment.. and dedicated physicians.. So know that all your loyal readers will be thinking of you …Dont eat the Food.. which i know you will avoid like the plague…find a thai woman to come in and give you a massage, Breathe…and before you know it … you’ll be back on a plane to some exotic locale..!! Serena….

    • Anonymous

      Last August I fractured my ulna (clean break) in a remote Cambodia jungle area unmarked on any maps. After explaining my situation via email to approximately 15 clinics in S.E. Asia (including two that Simon mentioned above) I choose an Australian doctor with Harvard credentials at a public hospital in Singapore for less than 1/6th the cost of the procedure in the U.S.A. (where I hold citizenship…for now). Although I did not stress urgency in requesting a reply, most emails were returned within 24 hours with a reply from the actual physician who would be performing the procedure detailing the procedure, exact cost, and follow-up procedures. The entire process was beyond spectacular and the push-ups and pull-ups I did earlier today in Hong Kong reaffirm the excellent care I received. As a bonus two weeks later GST refunds arrived in my mail drop box (in another country a considerable distance away) even though I had not filled out the paperwork.

      Off topic, but recently I have been to Cisco Certis (Singapore), The Storage Limited (Hong Kong), the heart of the riots in Bangkok last month, numerous cities and beaches in Malaysia, and I’ve found an excellent tailor in Hong Kong. Within the last 18 months Argentina, Uruguay, and about 12 countries in Europe. Without cutting corners in the past 12 months I’ve spent about the same as the yearly property tax of the house I last lived in while in the U.S.A. There are numerous global opportunities and I’m happy to share them via email with other members of the community.

      Simon, great call on the TED spread. Here’s to a speedy recovery. Cheers!

      • V

        Actually I’d like to add the very best hospital in Southeast Asia, in terms of cost, modern equipment and skilled doctors is FV Hospital in Saigon.

        It is a joint French-Vietnam hospital (read French) funded by the French government as a gift to Vietnam, with an aim of providing “the latest and best medical care and facilities” to the Vietnamese at locally affordable prices.

        I’ve had treatment there, and it’s damn cheap, damn efficient, and very well-equipped and staffed. No need for insurance at those prices.

      • V

        Oh and one other thing, please drop the term ‘Orient’. No offence meant, just some friendly advice – but it’s pretty anachronistic, antiquated, bordering on offensive in some quarters, and really does little more to suggest a lack of understanding of Asia in general.


  • Don

    “It always puzzles me how rumor and stigma are perpetuated by the uninformed.”

    I’m not sure calling the doctor about to cut into you “uninformed” is a “best practice.” ;-)

    Get well soon, Simon.

    By the way, if you happen to be at Mayo Clinic, I’ll stop in and see you. Want me to bring you some reading material? ;-)

  • Alex Kovach

    Wishing you a full and speedy recovery from sunny California (where it’s pouring rain at this very moment)…. Your assesment of the US Health “care” racket is right on; I worked in health care administration for ten years in the US so I do have some first hand experience upon which to base my opinion. I’ll take your word on the health care available in the orient… Get well soon, I look forward to reading your Notes From The Field daily…

  • Chuck B

    Get well soon Simon.

    On the topic of health care; what are your thoughts and recommendations for carrying international health insurance?

    • Rick

      Simon, I have the same question as Chuck. What kind of insurance do you hold?
      I’m happy to pay cash during my visits to hospitals in Asia but I spend half of my time in Europe and I’m a bit concerned about ending up in a car accident over here. I’m a EU citizen but I don’t pay any taxes in Europe and I hold no insurance so I don’t expect cheap treatments.

      • bill

        Mentioned this elsewhere, but will expand. I had a good (but expensive) policy with HTH Worldwide. Family of 4 with high deductible ($10K) was over $850 per month.

        Live in Panama and just switched to BUPA which is a LatAm plan. Cut my premiums to about $250 per month. Can use most good private hospitals in Panama and the U.S.

  • Leland

    “Overseas, foreigners are in control of their own treatment; they’re actually treated like a vested partner in the doctor/patient relationship instead of like a child ….”

    Personally, I think that most doctors (and dentists) here in the USA treat their patients more like livestock than children.

  • Jai

    Good luck and best wishes for a very speedy recovery – and a speedy plane to your next destination!

  • http://www.TTFatLoss.com craig b

    Get well soon Mr. Black.

    Craig B

  • John Potts

    Simon — I am very concerned to hear of your current experience with the U.S. medical system. I send you my encouragement even if you don’t need it. I have been avoiding the very thing that you are experiencing at the present time. As you know I have had plenty of experience in the last 5 years with the treatment my wife received until she died last October. I have not seen a doctor myself in over 10 years. I have been delaying the process for myself, but now feel that I should do something. Therefore I’m very interested in traveling to some other country for medical services and look forward to your thoughts on that after you get to feeling better. Good luck. My thoughts are with you. John 5/10/10

  • sdca

    Um, it speaks volumes that many if not most, locals in said countries ‘abroad’ cannot receive this top quality care-only foreigners flush with cash or the wealthy elite can. The locals cannot afford it. This is not a small factor when considering ‘the whole package’. If 99% of a population cannot get access to the country’s basic services such as clean water, electricity, health tx, ambulatory and fire dept services,etc.,it has a long way to go. Even if in Thailand, that number is more like 80% who cannot, it’s still 3rd world for a reason.

    It’s a bit immature and short sighted to frame things out of context. Context is everything, and if one can afford and chooses to avoid the US, wonderful. Of course, there is wonderful care available in most countries around the world. In fact, many were trained in US or Canadian hospitals. Duh.
    [Though Mexico and other countries have fantastic medical schools, as well, I know].

    I’m not pro-US on anything. I just think when it comes down to it, it’s probably 50/50 with these matters. And I am unimpressed with the fact that I can pay some Joe pennies to wait on me hand and foot like a neo- colonialist. Sure, I’m giving them work, and taking care of myself when I’m sick, but to frame that as ‘evidence’ of the superiority of their healthcare system, is silly, to me.

    I’ve lived in Africa and Asia for extended periods, and have many expat friends in various fields, so I get what’s being said. I just find some of the arguments silly. The more I think about it, continue to travel, and see, the more convinced I am that the US is not as doomed as everyone says. And this is coming from someone who has spent most of her adult life trying to not be in the U.S.

    BTW, Simon, there are many rural states where house calls are still a regular ocurrence for primary care physicians. Maine, Colorado, Wyoming, etc-some areas see one physician for miles, and he/she still does house calls. But you are right on one major point: The US has a disease care system, not a healthcare system, and this is a major flaw. At the same time, healthcare is not spa care, and having attendant massage you when you are sick is wonderful but not indicative of superior healthcare.

    Time will tell, and I look forward to seeing what’s in store. I personally would also love to a see a world where each country is seen for it’s strengths, and with the acceptance that change happens, and it does not mean demise, necessarily.

    All that said, of course I wish Simon the absolute best in care and recovery.

    • Joel

      sdca, you’re certainly wrong about Thailand! I have Thai friends upcountry in Isaan provence. They are dirt poor but have easy access to health care. There is a doctor’s office next to a public school 100 meters from their house. When they are in town, they can quickly get care there too! I’ve seen it with my own eyes…

  • redpill

    Good Luck, Mr. Black.

  • Bob

    First – best wishes.

    I love my Canadian healthcare system. Last year I had, based on your description, a more significant surgery about this time last year. I had a great surgeon, someone who even had occasion to treat a former U.S. president. My surgery ran into some complications and I spent 30+ hrs in a step-down unit.

    The professional care I got was second to none! Wonderfully professional and caring staff – tons of kudoos! I observed this level of care for all the patients around me. I was neither ignored nor overly fussed over.

    Now for the best part – $0, nodda, ziltch! The entire procedure including pre and post – $0, nodda, ziltch! I filled out half a dozen forms. I voluntarily sent chocolates and a fruit basket. We live a distance away so I got my wife a room in the hotel nearby.

    Yes I pay higher taxes but when the chips were down the system worked and worked wonderfully. Not having to worry about costs and/or insurance when you health is down is well worth what I pay.

  • Llewyth

    Buona guarigione bello!

  • Hal


    Take care. Our good wishes are with you. I had a surgery recently, also in the States, and thought the staff was quite caring (this is surprisingly important) and knowledgeable (also a good quality). I hope the same for you.


  • lf

    As someone who had personal experience with Bumrungrad, I have to comfirm a high quality of care. Though the treatment was not cheap, it is still was twice cheaper than in US and the quality was excellent. Get well soon, Simon.

  • Reney

    Sincere blessings for a successful procedure and prompt recovery. We’ll miss your wisdom over the next few days but I’m sure it’ll be twice as comforting when you come back. All the best. RLC

  • http://timetoleave.net/ Bob Stone

    At the recent Casey conference in Vegas, Bud Conrad told about how he’d recently gone to a US hospital after breaking his arm, the tab was around $100k.

    A few years ago I stayed at a hospital near the Iranian border (in Armenia) for a month, not for treatment but as a sort of hotel guest. The highly-experienced surgeon who owned it was charging $200 for abdominal surgery, which included a week stay but did not include food or firewood. He uses ketamine as the general aesthetic, so you get a cool death experience too. Nice deal.

  • Anita

    Sad to hear that, wish you a good recovery Simon, good luck

  • http://www.thaicountrylife.com thaikarl

    i wish you good success and healing. i’m curious tho, is it only americans who are so cagey about medical treatments? we say “i’m going under the knife, nothing major, just has to get done” which begs the question in everyone’s mind: what is being cut and why? i can understand if you require haemorrhoid surgery it might be a little embarrassing to detail, but i’ve notice from friends and family that they hide what is being done surgically as closely as they hide their salaries/wages. thus when it comes to quality of procedures, and costs, there is nothing to compare to also.

    @SDCA – true, 80% of the people here in thailand could not afford the private hospitals that simon mentions, but that doesn’t mean they don’t get cared for. they might have to wait all day in the goverment hospital to get seen, but if they need care and operations, they get it. i spent 24 hours in the government hospital emergency room in bangkok with typhoid (there, i said it). i was one of three rows of beds in one big room, but i got IV’s, antibiotics, blood work, food and watchful care. the bill was $35.00 US. i contracted the bug from a very bad food choice on my part in cambodia. i shudder to think what would have happened to me if i got food poisoning in the states.

  • Samir

    Hi Simon,

    Get well soon


  • Herb

    I’ve considered Bumrumgrad too. My family is full of aunts who are nurses and p.a.’s, so they were a little shocked when I told them about an article I read in Outside about how Bumrumgrad has such great care that they supposedly will fly you back should your surgery result have gone awry to fix it for free. I haven’t tried them yet myself. But I would if I needed major surgery.

  • Nathaniel

    Simon, may you heal and recover quickly. I missed this blog and finally read it on the 29th.
    My experience with several surgeries: when uninsured, the fee can be pennies on the dollar when the surgeon is willing to do the procedure in his office using a local anesthetic, thereby avoiding the hospital room, O.R., recovery room, anesthesiologist, and other attendants the insurance requires.
    These were not major surgeries, or the Dr. would not have worked with me. I would rather avoid being put to sleep.

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