Sunday, August 30, 2009

Need health Care? Emigrate

A few years back, when I was between tours as a correspondent in Asia my son asked me what I would do if I got sick, not having at the time an employer or any kind of private health insurance. Almost without thinking, I said I’d fly to Hong Kong, assuming I was well enough to get on an airplane.

On more sober reflection, I decided that this offhand remark had real possibilities. Hong Kong does not have universal health coverage, like many other countries, but it does have an excellent public hospital system. After living there for 16 years I was a permanent resident and thus eligible to use these services.

As Americans wrestle with health care, as the public debate gets more contentious, as the likelihood of the Congress enacting any kind of meaningful public health care fades, people need to think about their options. Here is my modest proposal: emigrate. In other words, move to another country that offers better health care.

Certainly, there are plenty of countries to choose from. Almost every developed country in the planet has some forms of universal coverage. What about New Zealand? It is a nice, green country, about the size of Britain with only 4 million people, very welcoming to immigrants, low crime and stunning views.

It also has a universal health care system generally paid for through taxation. Treatments are usually free or at least subsidized. There is also an option to obtain private medical insurance too. The New Zealand system is, in fact, very similar to that in Britain.

For several years I’ve been living in Japan, where I am covered by Japan’s universal national health insurance policy. All residents are covered without regard to medical preconditions or actuarial risk. The premium is graduated to the ability to pay. I just returned from my annual check-up, which is free, being paid for by the city I live in.

Of course, there is an option closer to home: move to Canada. A few years ago a friend of mine with some serious health problems, told me he was thinking of emigrating to Canada because of its comprehensive health care system. At the time I was rather shocked to hear him; now that I’m older it doesn’t seem so shocking.

One country to avoid is the People’s Republic of China. It seems to me that of the major countries in the world, China most closely resembles the U.S. in its health care policies. This seems counter-intuitive. Aren’t communist countries supposed to provide free health care?

How many times do you hear that Cuba or China or whomever may be repressive but at least the health care is free? The repressive part about China is true, but the medical care is not free.
China used to have a rudimentary free health care system. It was part of what we call the cradle-to-grave welfare and what the Chinese call the “iron rice bowl”. But with the market reforms begun in 1978 the iron rice bowl is broken, and hasn’t really been repaired. Most Chinese have to pay for their health care out of their pocket.

There is, of course, a catch. It isn’t usually enough just to visit these countries to be covered by their national plans. You have to become a citizen, or at least obtain long term residency. That means, at the least, of undergoing the hassle of obtaining a work permit to live in the country long enough to obtain residency.

This of course, does not negate the possibilities of “medical tourism”. That is, flying to another country on a tourist visa and checking into the hospital there. You have to pay the fee up front, but it is often a fraction of the cost of the same kind of care in the U.S. Thailand is a particularly attractive destination for elective surgeries of all kinds. So too are South Korea and even India.

I lived in Hong Kong in the years that led up to the handover of the former British colony to China in 1997. During those years thousands of middle-class Hong Kongers moved to Canada, Australia and to some extent the U.S. to obtain citizenship, denoted by obtaining a Canadian, Australian, etc. passport.

They had no real desire to actually live in those countries, and having obtained the coveted passport, they then returned to Hong Kong and resumed their normal lives. They looked on their shiny new travel documents as a kind of “insurance policy,” insurance that they had a bolt hole to go to should things turn out bad post 1997.

Perhaps one can view Canada, and possibly some other countries, as a new kind of bolt hole for medically disadvantaged Americans. In that case the idea of a foreign passport as a kind of “insurance policy” may take on a different kind of meaning.


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