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SOVEREIGN MAN

The Truth About Nationalized Healthcare

Nationalized healthcare doesn’t work, and I’ll tell you why:

I hold as my personal mantra in life that governments screw up everything they touch… and this goes for all governments, not just the United States Congress.

As I travel the world looking for great opportunities, I always try to understand the quality and efficiency of the local healthcare system. Sometimes I even go through it myself.  My conclusion? Most, if not all public healthcare systems are broken and drowning in red ink.

I could cite hundreds of examples– the English cancer patient who had his treatment cancelled 48-times in a row; the 25-week waiting period for heart surgery in Sweden; 2-3 year waiting period for simple blood tests in Canada; Cubans dying waiting in the emergency room; Hungarians who have to bribe their doctors for treatment.

The Italians, who run their budget deficit into the ground to pay 10% of GDP in annual healthcare costs, are routinely congratulated by the World Health Organization for quality healthcare… the WHO, of course, is the crack squad of bureaucrats that spent weeks laboring over whether or not to call the H1N1 outbreak a ‘pandemic.’

Meanwhile, the Italian government is in debt over 100% of GDP with an annual budget deficit equal to its healthcare costs. They can’t afford it, and they can’t find anyone to loan them the money to keep it going anymore.

The United States will not be able to afford its healthcare either, notwithstanding the extra ‘surtax’ that the government plans on pinning to the wealthy.  Even the concept of a national surtax is ludicrous– ‘wealth’ varies from place to place.

The $350,000 cut-off for the healthcare tax buys a different standard of living, depending on location; $350,000 is an enormous income in Houston, TX.  In New York City, after-tax, it barely pays the rent.  This is [one of] the same problems with minimum wage, but we won’t go there right now.

I would invite any member of Congress who thinks that the government can efficiently run a national healthcare system to take a tour of any VA hospital in the United States– you know, those places where doctors exposed 10,000 veterans to HIV and the hepatitis virus, and where they routinely botched radiation treatments to cancer patients…

Similarly, waiting lists at VA hospitals can take years… and I can attest from personal experience.  I simply cannot begin to imagine the disastrous inefficiency that will ensue when a national health plan, that no legislator has actually read, is rolled out across America…

In the words of Canadian Supreme Court Chief Justice Beverly McLachlin wrote, “access to a waiting list is not access to healthcare.”

Now, before you eat me alive and tell me that private insurance companies in America are corrupt and perverse, let me cut you off at the pass and tell you that I am inclined to agree. Insurance companies are in business to make money, and they generate the most profits by taking in the highest premiums paying out the fewest claims.

Naturally, the interests of the insurance companies are at odds with the patient.

I am a firm believer that the best and highest value in any situation can be created when interests are aligned. This is why the existing private system is a flawed solution (though a slightly better one than a public system).

So what can you do about it? How can you align interests with your healthcare provider?

Internationalize. Establish direct relationships with hospitals and physicians.

Because I travel so much, people often ask me what I do when I get sick… simple: hope like hell I’m not in the United States.  In Panama, I have a variety of doctors’ personal mobile phone numbers. We are on a first name basis, and I have no problem calling them on Sunday night if I need anything.

My experiences in private Panamanian hospitals have been fantastic. I took a friend to get a full body work up including X-rays, multiple consultations, and pharma… total price tag? Less than $100.

My friend and partner Matt has a heart surgeon on speed dial during the time of year he lives in Buenos Aires; the doctor makes house calls for 150 pesos ($39) to take care of the kids…  a heart surgeon for $39.

More on healthcare in future missives; I would like to open this up to discussion as I’m sure you have personal experiences… please comment to share.

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.

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  • http://www.qwealthreport.com Peter Macfarlane (Q Wealth Report)

    My personal solution is to pay most medical expenses out of pocket, but have insurance coverage for critical situations. The company I use allows deductibles of up to $5000 (so the first $5000 of any claim you have to pay yourself). That weeds out 99% of timewasting hypochondriacs, enabling them to cut a big slice off the premium. Funnily enough the insurance company is in the USA, though it doesn’t cover me there (worldwide excluding USA and Canada is just fine for me, and it cuts another big slice off the premium, while still giving me coverage in top private hospitals everywhere in the world.)

    I don’t visit the USA myself but an American friend who lives there and shares my philosophy said he always pays doctors in cash, and they are always happy to give him a substantial discount, typically 50% or more, for that. The doctors are happy to get paid immediately and not to have to deal with insurance companies. So that’s worth knowing if you never thought professional fees were negotiable (everything in life is negotiable, of course!)

  • http://www.InvestLetters.com Roger

    Simon,

    Don’t you want to mention your former coworker Bud Conrad’s $100,000 broken arm?

    A guy I know on another forum has lived in Columbia & Panama and says Panama health care is superior to the U.S. also.

    Roger.

  • Brian Collins

    I lived international all during the 1970′s. Fortunately I was young and stayed relatively healthy and my company had private insurance so we bypassed the national health system. The countries were Nigeria, Lebanon, Greece, Saudi Arabia, Scotland and later on Russia in the 1990′s. I was very fortunate. The locals really had it bad.
    Proposing a National Health Care System simply shows ignorance or arrogance on the part of the current administration. I believe that they just want to ram this down our throats just to show us they can do it!
    Fortunately some members of their own party will try to torpedo this deal.

    I have a lot of doctor friends that will probably hang it up if thei becomes law.

    Brian

  • Ken

    I have an entirely different point of view if I need a doctor and I am overseas. I get home as soon as possible.
    I had a bad experience with dentistry in Portugal. Another bad dental experience in Saudia Arabia. I had food poisoning in Jordan and the hospital did nothing other than trying to stop me up. Got back to the USA and was given tests to see if I had any of the 7 bacteria that can make you very, very sick if not dead.
    If the 3 most important words in real estate are location, location, location, then the 3 most important words in socialized medicine are wait, wait, wait. We get the best quality health care in the world and we are about to lose it.

  • michael

    are there not some health care systems in east asia in which the health care professionals are paid for the days a patient is well?

    the philosophy is based upon prevention versus symptomatic relief.

  • Joe (Bombara)

    I would love to see the U.S. system go back to a direct patient pay for service nationwide as the rule, not the exception. Of course, save the insurance for the catastrophic stuff.

  • Marat

    Being from Russia I can express my frustration about Russian health care system. Even that I used a type where you buy a yearly insurance. Free medical care still exist as well but customer service is at the level of Soviet times meaning NO customer service at all. Price for an insurance for me (corporate rate) was around 1000$ per year in 2006 (last year i purchased it) and was very comprehensive as i remember. Using non free medical services gives much better choice of hospitals where you could go but still in many of them level of customer service is unacceptable even for a person not spoiled by much better treatment (like med system in US, which i really enjoy exept the price i have to pay).
    So I have to conclude that i probably would prefer to get sick in US rather than in Russia where human is traditionally being treated like piece of crap. Though i know i will pay much higher price.

  • http://PaulWH@comcast.net Paul

    I remind myself that U.S. congress members get free health care for life — and it’s not the kind they’re yelping about providing to the public, rather it’s, well, first class. So “throw the bums out” doesn’t work; congressmen are counter-incented to do anything smart, e.g. bow out.

  • Arial

    Simon I love your letters. And good points! I am 72 years old–old enough to remember before Medicare. I lived in Miami, Florida, a large city even then, where doctors made house calls. If you could not afford to pay they would treat you anyway. After all, they didn’t have all the government paperwork and red tape back then. I had asthma. Our doctor came in the night with oxygen and when they asked what we owed him he answered with a question, “Can you afford to pay?” That was back when people were proud of it if their family had “never been on relief” and they paid if they possibly could. If you didn’t have a doctor then, you could go to the county hospital for free. Oh there was a long wait, all right, because when it’s free there are people who will take their kid in with a runny nose. But the medical care was very good in the U.S. But then came Medicare and the government got involved. Now you can hardly afford a doctor if you have no insurance. My mother was with me for 12 years and I saw doctors almost fight over who was going to order tests for her that I still think were not necessary. When she was in the hospital, three doctors came to see her every day–her GP, her diagnostician, and her surgeon. All at $90 a pop. Of course the system is now broke, as all government systems always end up being.

    I now live in South America. I fell there and did serious damage to my face. I was taken to the emergency room of the private hospital. I saw one doctor, they called a plastic surgeon from home (it was on Sunday) and he spent two hours in surgery sewing me up. You cannot see the scar today. The bill for everything including ER, two doctors, a couple hours in treatment and a call back visit? $600 I couldn’t be more pleased. For those who have had bad experiences in Latin America, over 300,000 people in America die every year from doctor’s areas. It isn’t perfect in the U.S. either, and it’s a LOT more expensive@

  • Arial

    Sorry, I meant over 300,000 people in America die every year from doctor’s ERRORS!

  • Ying
  • Avid Observer

    “2-3 year waiting period for simple blood tests in Canada”… Simon, are you just making this up?
    Here in Canada my blood tests, and any other tests for that matter, never take longer than a week – and I’ve never heard of anyone having a problem with this.
    “Cubans dying waiting in the emergency room”… People are dying waiting in emergency rooms all over the world, what’s so special about that? People in emergency rooms are often near death, so even a 5-10 minute back-up in a busy place can result in death. The fact is, Cuba has a universal health care system that’s far better (on average) than in the U.S. Furthermore, Cuba has more qualified medical doctors per capita than any other country in the Americas.
    Simon, please stick with the facts and don’t squander your credibility.

  • Christine

    There is a reason why the US was ranked #39 in healthcare…. I have traveled in many Asian countries and I must say the treatments in the hospitals are so much better (Bangkok was the best); not to mention they are so clean. I highly doubt that the patients at those hospitals get as much Staph infections as the patients in the US hospitals. Not to mention that 800,000 people die each year in the US from Medical Errors, how crazy is this?

  • Mike

    My wife went to the ER in Santiago, Chile for stomach pains..in less than two hours she was in the OR with 4 specialists. Laprascopic surgery to remove a rupturing tumor (ovarian cancer), 3 days in private room, 5 days recovery, followup, lab work, and discussion with 4 doctors. On time appointments, excellent compassionate service. US cost $130,000…total bill in Chile…$8,500.

    She has no sign of cancer now after harsh chemo and another surgery.

    Chile saved her life, and we are a big fan of that country…

  • Gerald

    Simon, it seems that the interests of the insurance company are not “at odds with the patient”. The insurance company has an interest in keeping the insured healthy and getting the sick well. The government on the other hand has an interest in increasing sickness in order to enlarge their “health” programs.

    At the same time, we are not helpless blobs invaded by forces (i.e. germs) beyond our control. I live (essentially) a biologically correct life —and do not and will not get sick. Why should I pay for individuals who chose a lifestyle that leads to sickness?

    I have and want no health insurance. Accident insurance is another matter.

    Thanks Simon!

    Gerald

  • William Riggs

    We used to have problems with retirement plans. They were called defined benefit plans and employers promised the benefits regardless of the cost. Medicare is a benefit plan. The doctors and hospitals must provide services to get the payments. When the government lowers the payments, the doctors and hospitals must provide more services to get enough payments to stay in business. The only incentive is to bill for more services.

    We solved the retirement plan problem with a change to defined contribution plans like 401K plans. Now the employer deposits what they can afford and it is up to each of us to manage the money and make it grow to provide our retirement. These plans are managed by private investment firms who compete to offer the most service for the least amount of fees.

    We spent over $600 billion last year just on Medicare. That is enough to pay $200/month for every man, woman and child in America. If each person had that premium and could choose which private insurance plan to direct it to, we could all choose the benefits that suited us. The insurers would have every incentive to provide all the services that keep us from getting sick while trying to limit use of expensive therapies when cheaper ones could do the job. By being able to change providers easily and quickly, the plans must keep us happy to attract and retain the maximum number of participants. If employers or individuals want to provide enhanced benefits, they can do so. No one needs to pay more taxes. Employers probably save billions in reduced benefit costs. Everyone wins. The goal of healthcare reform is not to insure everyone or to limit benefits. It is to control the costs that are eating us alive. By changing to a defined contribution plan, the government can budget its annual premium costs for everyone and we all make our plans from there. How democratic!

    Also, this morning on Fox News they interviewed Bobby Jindal, the governor of Louisiana. He is the first politician to mention the costs of lawsuits. Doctors spend billions of dollars each year on malpractice insurance. They make us spend billions more for tests that they feel they must order to document their diagnosis in case we sue. Unless the government finds a way to limit the awards in malpractice suits, any reform will be less than successful. This has spawned an entire industry within the legal profession and it must be contained some way going forward.

  • Pierre Kleinsmith

    How about this for a headline, “Doctors on strike”. Could be considered hilarious in any other country, but doesn’t shock a South African. Regarding your article, I honestly don’t know how to define a broken healthcare system as my countrymen are such nags, but when I end up in a situation needing care it just falls into my lap.

    I have a family that routinely gets sick on weekends or late Friday afternoons. My eldest (3 years old – yes yes I’m a kid also) has a swolen face this past Saturday and complains of his ear all Sunday – we take him to a doctor (not our doctor) on Sunday afternoon for under $30 – fully paid by medical aid of course (prescription were about $50). We waited maybe 5 minutes for treatment. I’m purely doing the USD numbers so you guys can understand even though the Rand terms would be considered pretty costly around here.

    Our medical bills are purely the costs of the insurance even though it did go slightly over during my wife’s two pregnancies where we ran out of consultation fees too early. Monthly costs $140 for a family of 4, half of which are paid for by my company. And I swear that nobody has ever had to wait in any emergency room.

    Two months ago my mom calls me up and says her face is swollen from a tablet she had been taking (legally, I swear, she’s a Jehovah’s Witness might I add) – she has no cover – so I pick her up and take her to a public facility and voila within an hour she’s done. I can never understand how people complain so much. Maybe I’m just lucky or have transport to go to the right public facility. Obviously our private/public system is less broken than in other countries.

    My wife and I have considered other places on the planet and I am yet to find compelling reasons why we need to move. Crime sucks in this place, but I understand criminals, so moving to another place would probably cause complacency to set in and then I’ll get mugged. Then there’s the healthcare systems that seem to be broken everywhere else.

    Now for the Doctor’s strike. Some public doctor’s, mostly interns in their final practice year, get a measly $6/hour from the state… Finished rubbing your eyes? Yes your read right. Fifty five rands per hour and they’re capped at 40 hours overtime even though they tend to work around 80 hours overtime per month. This is while the factcats in government sit shoving pieces of paper to each other and using their computers to amass bonus points in their solitaire league. My favourite placard during all this crap was “Doctors are suffering; Patients are dying; Government is sleeping”. This strike went on for 3 weeks. I can understand why our doctors are leaving for “greener” (read European) pastures. The money is better and they are very sought after.

    Anyway, my point is, if you want great “cheap” healthcare, South Africa is a good bet. And I’ll give you a free ride through our countryside when you’re done. No I’m not a travel agent, just a happy Capetonian who loves driving, and even though I fear the next spike in the petrol price, I enjoy spending time with people who are interested in newsletters like this one.

    Simon, keep up the good work. I look forward to reading your missive every single day.

  • Steven Brooks

    Every time I or my wife have needed health care while traveling outside the US, it has been as easy as walking into a pharmacy in Patagonia, into a clinic in New Zealand, another pharmacy in Barcelona, pharmacies in Mexico and on and on. Pharmacists in other countries often can dispense medicine without a doctor’s script and are often doctors themselves.

    A friend of mine is a heart surgeon. He has relocated to Uruguay permanently and he is in his late forties. Why? “More freedom and better, cheaper health care.” That’s what he chooses for himself. That’s with a private pay system – though public health is available and used mostly by the poor.

    Last comment – I take sub-lingual allergy antigens. It is the only thing that has worked to ease my asthma. They are made up at a compounding pharmacy and provided to me by mail in little bottles with nine weekly doses. FDA is working to put compounding pharmacies out of business.

    No insurance company has ever covered this treatment for me. However they will pay for me to drive over an hour each way, wait in a waiting room and receive a shot. Add up the doctor’s visit, cost of the shot (which doesn’t work as well) and ignoring my time it still costs 10 times more. I’ve battled with them over this issue.

    My doctor tells me they fall back on Medicare rules, which do not recognize the treatment, as their justification. Here’s the punch line – The antigens that I take are the only treatment for my allergic ailment acceptable for payment by the British public health system. This treatment has been widely recognized elsewhere for years. I could go on …

    If you want to understand what government health care will be like, ask any doctor who dares to prescribe any treatment not recognized by the FDA (which protects big pharma the way the FED protects wall street banks). These courageous doctors are subject to harassment by the government for procedures that are commonplace outside the US.

  • Betty Gray

    In 2007, I was in a car that went off a 300 ft. cliff. I was taken to Chirique Hospital in David, Chiriqui, Rep. de Panama. My back was broken
    at 11th thorasic vertibrae, I had 9 broken ribs, ane a punctured plueral membrane. I was in intensive care for three weeks. The nurses seemed to know what I needed to the point that I wondered if they could read my mind. I would think that I was thirsty and they were there with water or juice. I cannot imagine better nursing care. They kept me cool even when they were cold; that is, my comfort was more important to them than their own comfort.

    My husband died a few hours after the accident. One day I was teary, I
    was not allowed to cry because of the broken ribs. The doctors were afraid
    of the damage that might occure if I moved my chest. My nurse that day was so concerned that after her shift was over, she went home and got a prayer, returned to the hospital and read it to me!

    My nuerosurgeon said that i was the most damaged patient he had ever cared for. He said because of my broken ribs, I was like a chicken neck; there was nothing to keep me together. I had six doctors who were really outstanding, especially my neurosurgeon and my pulmonologist. My hospital bill was $59,000 including all surgery fees.

  • La Grange

    Simon

    Please stay away from that old, boring, rabid sociopathy that Casey and Gallant martyr their credibility on. Did you read Casey’s rant on McNamara’s death – utterly incredible (as in credibility killing).

    Good Lord man, I thought you might be different there for a moment. For every weird quote you give there are a million examples of the opposite (including many hundreds of my own experience in the UK).

    It would be sad if I don’t fit into your market niche and I have to bail out, but your advice so far, while good, is not worth being bludgeoned from time to time by the weird views of the Gallants of the world.

  • http://www.manystonesgifts.com Ring Huggins

    Hi, Well all that is fine if you can afford to fly to Panama!

    Ring in Texas

  • ICR

    Wow. Some of you people are really getting bent out of shape… thanks for the entertinment though. simon- youre a better man than me, I wouldn’t be able to ignore the flak. Thanks for the missive, and I love casey and ‘gallant’. Also, please pass on the polish citizenship info if you could, thanks.

  • raysgirl1

    When my husband was diagnosed with Alzheimers being tested by neurologists and having xrays and scans of his brain, we decided to get his name on a list at the local VA hospital system for the Alzheimer’s wing should he need it.
    After filling out the paper work and waiting for months, we were informed that they couldn’t put his name on the list until VA doctors verified his diagnosis. By the time they informed me that an appointment had been made to see the VA doctors (which took about a year and a half) he was dead in a private nursing home.

  • Jai

    During a decade living in Asia, total medical expenses (no insurance, cash only) came to less than US$200, plus some urgent dental work at HK$1900 (@US$250).

    One trip to a “low-cost” walk-in clinic in January for a cold that turned into bronchitis: $300, and since I had no insurance, they kept me there for half-an-hour while somebody phoned my bank to ensure my check was good; plus nearly $100 for prescriptions. About a decade’s-worth of care in Asia spent in one morning.

    Plus over an hour wait in an absolutely empty waiting room to be seen, and 3 more waits in the examing room. Total time wasted: nearly 4 hours just to be told what I already knew – bronchitis – and get a prescription written. I never once waited more than 5 minutes to be seen anywhere in Asia.

    BTW, tried to find health insurance since employer does not provide. Cheapest plan found in this state was $963/month (choice of insurance or rent) & covered nothing ($5k deductible); with only $2000 deductible and 20% copay, $1350/month (do without rent + car + car insurance). For one person: no vision; no dental; no prescriptions. Exact same plans for couple: $1070; $1510, respectively. Codswallop!

  • http://www.doctorsonstrike.com Dr. Gregory L. Garamoni

    Pierre Kleinsmith asked, “How about this for a headline, “Doctors on strike”. Well, as the founder and executive director of Doctors on Strike for Freedom in Medicine, let me talk about the possibility of this happening in the USA.

    The Declaration of Independence formally acknowledged that human beings are endowed with certain inalienable rights, that among these are life, liberty and the pursuit of happiness, that government was instituted to secure these rights–not violate them, and that government itself derives its powers from the consent of the governed.

    As human beings, patients and doctors have the right to make private health care decisions without governmental interference. As traders in a free market, we have the right to voluntarily negotiate mutually acceptable terms and conditions in our dealings with one another.

    ObamaCare is an immoral, unconstitutional violation of individual rights. Washington politicians are poised to inject a lethal dose of statism into the very brain of our healthcare system–the independent practice of medicine in which doctors and patients have the inalienable right to make private healthcare decisions informed by the professional training and experience of the doctor and tailored to the unique needs of the patient.

    Consistent with these moral and constitutional principles, we at Doctors on Strike oppose, and urge Congress to vote against, legislation that provides for any:

    Public plan option,

    Mandates that force individuals to buy insurance coverage,

    Mandates that force employers to provide insurance coverage,

    Surcharges that force some groups to pay for the healthcare of other groups,

    Mandates that force doctors to participate in public plans.

    Sign the Petition to Protect Doctor-Patient Rights at http://www.doctorsonstrike.com/petitiontoprotectdoctor-patientrights.html to urge Congress to preserve, protect, and defend the rights of doctors and patients in any healthcare reform bills under deliberation.

    P.S. I miss the old days when I worked for PepsiCo International and had the opportunity to travel around the world and live in Greece for three years. While there I was told by a doctor that they needed to do exploratory surgery to determine the cause of the excruciating pain in my gut. I went home to see my family doc, who injected Novocain into my stomach muscle and the pain went away–I had torn a muscle. This story has nothing to do with anything, but thought I’d just chime in here.

    • EGC

      If US physicians claim they are “free market”, they will disband the AMA union/cartel which restricts supply of US physicians in order to ensure low unemployment & high pay for its members.  They would be fine with a “free market” allowing unlimited visas for any foreigner that passes the relevant US and English-language exams.  These foreign physicians could start their own solo business/practice, or work for an employer like a hospital, which would be “free” to negotiate whatever salary they agree on, even if it’s “low”.  If such a policy would ever happen, you would see many USians lament, “we need foreigners, not enough Americans are willing to do the physician job” if the “free market” had lowered the lower end salary of cardiologists to $40K.

      A few people are true Libertian/”free market” types.  otoh many or most are hypocritical “Free Market for thee, cartel/oligopoly for ME” types.

  • Bill Moore

    Someone would have a best seller if they (w/ decent credentials) would write an accurate book about good Latin American and/or Asian health care – naming hospitals, specialties, doctors, direct costs, travel arrangements, recuperation and the like so “ordinary” Americans could avail themselves of what wealthy Americans routinely do. Perhaps a good book is out there and I
    just don’t know it.

  • TM C

    We really agree with this synopsis. After reading the comments I think most of us agree with you. If you do have names of Doctors in Panama and BA I would love for you to share. We travel to David and Panama City regularly. It was good to hear the story of the hospital in David. We will be spending lots of time in Uruguay so a Doctors number there would be useful if the person commenting would be willing to share. And the number from BA as well, Simon. I think the person asking for a book with references is a Great idea. But when he says it’s only for the wealthy I have a friend who travels, Cheaply, whenever she needs surgery to either Singapore or Thailand. She had a terrrible experience in the US and says hospitals are WAY better overseas. She is on a strict budget. She may not have personal doctors numbers but still gets wonderful care without them. That sounds good to me.
    Thanks keep on doing what you’re doing, we appreciate it.

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