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.

About the author

James (aka Simon Black) is an international investor, entrepreneur, and founder of Sovereign Man. His free daily e-letter Notes from the Field is about using the experiences from his life and travels to help you achieve more freedom, make more money, keep more of it, and protect it all from bankrupt governments.

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