An expat’s perspective on health care and immigration


BNH, the hospital in central Bangkok where I have received annual check-ups.

Technically, I am not an immigrant, though I make my home in Cambodia.  I have only a mailing address in the United States.

What I am is a retired expat whose year-to-year visa allows him to reside in Phnom Penh, where my savings go far indeed.  It is a good life, but it is one without a citizen’s rights (such as they are in Cambodia) and without dependable medical care.

Fortunately, I am an expat in excellent health now into his 70s.  Should I develop problems, the quality of my medical care here generally is suspect and its cost would be prohibitive for anything serious.

You see, I am uninsured outside the United States.  Even if coverage were obtainable from a reputable firm at my age — and I don’t think it is — the annual price in the many thousands of dollars basically requires me to self-insure.

Aside from how poor is medical care in the Cambodia and how inadequate are even modern hospitals, however attractive and welcoming, they rarely will treat patients even at death’s door without prepayment.  They gouge everyone for every healthcare practitioner, procedure and prescription.

At the same time, I should say that the French-trained tropical disease specialist I consulted in his own office when I developed a persistent cough last year instantly diagnosed my bacterial pneumonia and recommended an antibiotic that did the trick.  He charged me $30 for the visit.

I also should mention that Institut Pasteur du Cambodge is a totally reliable source of laboratory tests and inoculations.

med_opt1But if I develop a serious illness or suffer major injuries in an accident or crime,  I will be in trouble.  I’d have to catch an hour flight to Bangkok, Singapore or farther for excellent treatment if I am mobile.

If not, a medevac would be necessary, and such a flight to neighboring countries or, in the worst case, to the U.S. would run tens of thousands of dollars.

A 75-year-old woman acquaintance of a friend fell down a flight of stairs last month, and the compound leg fracture of her femur was so complicated that she was unable to travel at all. Instead, her physicians brought in a team from Bangkok.

It didn’t cost her a cent: Her insurance company paid the bills.

I now have my annual physicals in Bangkok, where the hospitals at which primary-care physicians generally work treat me (and everyone else) like a luxury-hotel guest and charge a fraction of what my former physician in Manhattan demands in addition to the expense of lab tests.

In Cambodia, pharmacies do not require prescriptions.  I take a couple of medications to maintain my health, and they are ridiculously inexpensive, often less than the insured prices I would pay in the U.S.

However, I continue to pay an inordinate amount of money for Medicare and supplemental insurance — both of which pay for nothing to patients who are outside the U.S. for more than 90 days — and I do take advantage of the benefits when occasionally I am in New York City for visits.

Were I to buy insurance that would cover me abroad, I certainly would not drop Medicare.

There may well come a day when I would need treatment on a continuing basis, a costly basis or both.  I would be foolish to ignore the possibility of a lengthy illness or, say, a joint replacement.  In those eventualities, I’d probably return “home,” depending on the comparative costs of care and living expenses there or in Bangkok.

Going to the U.S. hardly is a foregone conclusion.

As an expat, I naturally have been following the issues of healthcare and immigration in the U.S. with great interest.  I do not for a moment take for granted how lucky I am to be where I am and to have the healthcare options that are available to me.

As we all know, millions of others are not so lucky.



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