Wednesday, March 5, 2014


We started coming regularly to Mexico nearly a decade ago when we bought our home and used it for winter vacations. We noticed what looked like a good emergency room on the road to the airport in case we needed one. That's it in the picture. This was our health plan, and it was probably okay.

Our visits got longer, the law of averages began enforcing itself and one or another of us occasionally came down with a bug. We located doctors and found we could see a good one here for not much more than the co-pay would have been back home. That became our new health plan, and it was still probably okay.

Time went by, and we stopped thinking much about it. Our visits grew from weeks to months to substantial fractions of a year, but there was a lot of other stuff to think about and many life adjustments to make. 

We had doctors in Mexico, doctors in New Mexico, and for special occasions we still had doctors in New York. We had Medicare to insure me and the AP health plan for Pam and Elizabeth. If we needed expensive treatment, we told ourselves we’d get it in the U.S.

You could argue that this wasn’t smart when we were spending any more than a month  here. But two years ago when we began living here in earnest for six months at a stretch, it became magical thinking.

Our foolishness didn’t dawn on us until last year when a high school classmate of Pam’s who lives here permanently had a heart attack.

The quality of health care in Puerto Vallarta is quite good, with the right advice on choosing providers. You can get absolutely reliable help on every medical specialty from a gringa who has carved out a valuable niche for herself as a sort of health care concierge to the expat community.

Medical and dental tourism is a growing mainstay of the local economy. In fact, I’m pretty sure that if even your dog needed major surgery, you could save the cost of your plane ticket and beachfront hotel by having it done here at no increased risk to the dog. Our vet practiced in Los Angeles for several years before returning to Mexico.

The caveat is that while office visits here are a bargain, anything that requires surgery and/or hospitalization for a human being is not, especially at hospitals that cater to foreigners. Pam’s old chum had to cough up about $20,000 in cash to get himself back on his beloved golf course.

We suddenly realized how terribly exposed we were to any injury or illness so serious that we couldn’t get home for covered treatment. 

Naturally, the insurance industry was waiting for us, although in my case not exactly with open arms. A close friend here represents what she says are the only two reliable carriers in the country. One of them wouldn’t touch me with my benign schwannoma. The other would, but only with an exclusion for tumor-related care.

Since I’m past 65, I could get a $5,000 deductible policy that covers me for the most likely medical catastrophes at less than $100 a month.. I’m not sure why, but the price for Pam and Elizabeth is way higher. We decided to cover me now and wait till next year when Pam’s premium drops before dealing with the rest of us. 

A few weeks after my new insurance card arrived, the New York Times ran a piece on Americans living abroad who can’t find enough coverage at a reasonable cost, even in single-payer countries like France.

Why is it that every time I find myself on the cutting edge, the blade is facing the wrong way?

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