#159 – The Expat Files: Real Stories from Latin America

Automatically transcribed from the original recording; names and wording may contain errors.

[00:03] Hi everybody, I'm Johnny Mueller and you're listening to the expat files living in Latin America. The show that tells you what it's really like to live, work, play and or retire in Latin America. I tell it just like it is, not the version they give you in those glossy travel magazines or the picture they paint for you in those international traveler websites where they're only trying to sell you something. What's it really like for expats living in Latin America? Well if you stick around a while you'll find out. So, let's get started. Now I'd like to talk about something that's near and dear to practically everyone's heart, well everyone that's over 40 years old that is. And that's healthcare insurance. And you know as far as my radio show it's probably in the top 3 of the number of emails that I get. Questions about healthcare and healthcare insurance.

[00:48] Now I mentioned in previous programs that medical costs down here can be anywhere from a quarter to a fifth of what they are in the first world. And that they have first world specialists or at least Latin American doctors that trained up in the first world to get their specialties because very, very few Latin American countries offer specialty degrees in medical training. Though all 20 Latin American countries do have medical schools that turn out basic MDs, you know GPs and family practice doctors. And by the way every neighborhood has its friendly GP or two, you know a little house or a storefront with a little doctor's plaque on the outside of it. Just like the good old days in 1960 America. And there's only a few countries that actually have advanced residency programs turning out neurosurgeons and cardiologists and such and all those other multiple medical specialty degrees that actually are kind of confusing.

[01:35] It seems like they add a couple of new ones to the list every year. And the advanced training and residency programs in countries like Brazil and Argentina and even Chile down in South America, well those programs are pretty much on par with any fellowship or residency training programs that you might find in some of the first world countries. What I mean to say is they're good or on par but not extraordinary. And though there are a lot of quite satisfactory residency programs in South America, they're always lagging just a few years behind the big first world medical universities because they just don't have the big bucks, the big research bucks that first world schools have. Though often when you're in Argentina or Brazil or Chile, if you're at a specialist office and you look at his diplomas which they always display larger than life of course, well you'll find the occasional specialist did his or her specialty degree in Europe, not the United

[02:22] States. In fact it's very rare to find anyone practicing specialty medicine or any kind of GP medicine in South America, for that matter, whoever did his or her training in the United States. Which is another reason why South America seems to be so much more isolated from first world USA and Canada than it is from Europe. And one of the main reasons why as you go south of the border, pass Mexico all the way down through Panama and into Colombia, less and less people on the street speak English, until when you get way down to Argentina and Chile, it's difficult to find anyone who hasn't been to the university or to an expensive private bilingual school who does actually speak pretty good English. Because you know what, except in those high volume tourist areas like Machu Picchu and the Beach Strip in Rio and maybe Cartagena, Colombia, you'll find that the foreign tourists

[03:09] are mainly from Europe and they're speaking French and German and Italian and Portuguese and even Norwegian. And when you get a bunch of European tourists together, you always find that their fallback language is English. Because in Europe, if you're not from an English speaking country, when kids are in grade school and high school, they all take English as a second language. Even the French do, though they don't like to admit it. So when Europeans do get together and their fallback language is English, generally it's very imperfect English with a lot of European accents thrown in the mix. Sometimes even us expats who are used to accents have a hard time understanding that crowd. But imagine you're a high school kid from Brazil or Argentina and you've been taking English and you've got no one to practice on and you run into a tourist from Germany or Austria. Well then of course your fallback language is going to be English and you probably won't

[03:56] be able to understand half the English words the guy says. Because in your high school English class, they don't teach English with a heavy German accent. You get what I mean, right? So anyway, expect to find less and less good English spoken as you move farther and farther south unless you end up in a high volume tourist area. Then you'll have lots of tourists to talk to. And since most of them will be European, good luck with the accents. And that's another thing. The farther south you go down through Latin America, the less you'll find American tourists and the more you'll find European ones. And if there's one thing that's true about North Americans, is that in general we have a very hard time with accents other than our own. And that's why over the last hundred years, British movies, even the great British movies, rarely make a big dent in the US film market. Because it seems the average American moviegoer doesn't like to hear proper English from

[04:42] the mother country. To the average guy from Cleveland, American English is all he really wants to listen to. And though these days, you see more and more British movies penetrating the market, you still run into people who say they can't watch a British movie because they can't quite understand everything that people are saying. And these aren't just white trash people like X-Pad Eddie, who also doesn't like British movies by the way. In fact, Eddie told me as a kid, the only British movies he and his white trash buddies ever wanted to see were James Bond movies. And for Eddie, the only real James Bond was Sean Connery by the way. Though he is warming up to the new guy, Daniel Craig. And Eddie said when he was in junior high school, he and his white trash buddies didn't give a damn about the British accents. James Bond movies for them were all about the multiple explosions, the wreckage and the hot bond chicks. So Eddie's like most North Americans, he does not watch British movies.

[05:31] But let's get back to the main theme here. So anyway, down in South America, chances are if you go to a medical specialist, he's going to have his specialty degree from either Brazil or Argentina or Chile or a European university. And in that case, usually a German, British or an Italian university. Those seem to be the top three. However, if you're in Mexico or Central America, that is the country south of Mexico, including Guatemala, Belize, Honduras, all the way down through Panama, if you go to a medical specialist, say a plastic surgeon, the great majority of time he'll have either taken his specialty degree in Mexico at Guadalajara, usually, which is the biggest medical school in all of Latin America, except for the Latin American School of Medicine in Havana. And speaking of Cuban medical schools, that big medical school in Havana is huge.

[06:17] It's got four or five thousand students attending at any given time. And for all you people out there who still think that Cuba's got a leg up when it comes to medical treatment and medical care and doctors, I know someone who graduated from there a year ago. And guess what he told me? When you're going to medical school, you get to use the internet, but you only got access to it one hour a week. So people from other departments in that Cuban university have worked out a black and gray market scheme to sell, trade and barter their internet time. Because come on, one hour a week on the internet when you're going to medical school? Would you go to a young physician who went to school under those kind of constraints? I don't think so. And he told me that last year in the medical school, which was his last year, that the electric power would go out in the school about 16 hours a week.

[07:04] Alright, it's understood that Cuba turns out a lot of doctors, and I mean vast quantities of doctors. Last I heard they've got 30,000 doctors practicing outside of their country. And some first world countries don't even have 30,000 doctors total. But remember this, these guys are all trained kind of like 1960's doctors. And maybe that's a good thing, I don't know. If you all remember that Dr. Marcus Welby program with Robert Young that was so famous on TV back then, that's what these guys are like. They are not, I repeat, are not exposed to modern medical technology at all. Closest your average Cuban medical student gets to seeing a CAT scanner is looking at a couple of first world CAT scan models that the school could never afford, projected up on a screen in a classroom on a PowerPoint presentation. And guess what, my doctor friend from Cuba told me it's the rare Cuban medical student

[07:52] that even knows how to do a PowerPoint presentation. Because the students are so poor, they have almost no modern technology. And only maybe 1 out of 20 students has his own computer at home or in his dorm, and that is not connected to the internet. But what the Cuban medical doctors are good at is emergency medicine, trauma and emergency room care. You know, car accidents, broken bones, cuts and punctures, stuff like that. Well I take back the car accident part, because Cuba actually has so few cars that car accidents are rare. Did you know that Cuba only has 40 cars per 1,000 persons? And in the United States it's 1 for 1. For every 1,000 persons there's 1,000 cars. And the only Latin American country that has fewer cars than Cuba is Haiti. 20 cars per 1,000 persons. So if you go to Cuba and rent a car, don't worry about getting in an accident.

[08:38] Chances are you're going to have a hard time finding someone to hit. But maybe that's a good thing. Oh for the good old days, huh? Oh and by the way, those of you who have been emailing me about old vintage cars down in Cuba, asking me questions about that, here's what I can tell you. They say that about 1 in 8 cars in Cuba is an old vintage Plymouth or a Ford or a Mercury or a Dodge, pre Castro stuff, 1958 and older. And you know the Cubans are geniuses at keeping those things together. In fact, poor Latin Americans in general are so resourceful when it comes to old junky cars that they could squeeze an extra 5 or 10 years out of a car that would have already been in a junkyard or in a car crusher up in the first world. It's an everyday occurrence when you're down here in every Latin American country, not just Cuba. To see cars on the road that were virtually extinct even 20 or 30 years ago in the States.

[09:27] And I mean cars that up in the first world are not only not worth lifting a finger to restore but not even worth the scrap metal to haul them to the junkyard. Like for example, the other day I saw an old Datsun B110, now that's got to be from the late 1960s and it was in perfect condition and with a really nice paint job on it too. I mean, who would go through that trouble in the first world? Forget about it. Only in Latin America. And that's why up in the first world, the idea of buying a $500 or $1,000 car faded away a long time ago. Like VHS and cassette players. You know, a $500 car would have been a decent set of wheels back in mind in Expat Eddie's high school days. Well down here in Latin America, those kind of cars are everywhere. In fact, a year or so ago, Expat Eddie bought a Nissan station wagon, a beater to haul

[10:12] his dogs back and forth to the vet and also for his restaurant manager to run errands in the sleazy part of town. And on the outside it was completely sunbaked and ruined. With about 150 scratches on each door from parking lot dings and the car had about 180,000 kilometers on it. But guess what? Eddie took it to a mechanic, the guy said the motor was great and so was the transmission and Eddie bought the thing for $700. And that was a little over a year ago and he's still running, no problems and he's never had it in the shop. And Eddie doesn't use it. He has a couple of elegant expensive cars that he drives. The exact thing that I don't recommend first world people drive down here. But expensive German cars are one of Expat Eddie's extravagant tastes and practically his only extravagant taste. And he's got the money for it. But he's also a target everywhere he drives those cars. For crooks and cops who want bribed money.

[11:00] But he puts up with it because all his life he wanted to drive cars like that and he never had the money in the states to get away with it so now that he does, he's fulfilling that little dream of his. But I'll also tell you that down here in Latin America having cars like that is big baggage. But you know that because I've talked about that on a lot of my past shows. Anyway, I've got to get back to that medical insurance thing but just to finish up on that Cuban car business I'm getting so many emails about. I want you to think about this for a second. It's tough enough trying to keep your vintage car in the United States cleaned and spit polished and all cherry right? And perfectly stock because you know that's the only way it really holds value over the years. It's got to be perfectly stock. And like I said, it's hard enough even if you live in the states and have all the original parts available on the internet and you could have them shipped FedEx in 48 hours. And now you take a trip down to Cuba for example and you see these beautiful vintage cars passing

[11:49] by every so often. And sure some of them look a little weather worn with some dings in them and stuff but a lot of them look in pristine condition. Most of them look like they're ready for the auction house in the states. That is until you lift up the hood. Because you see having a car like that in Cuba poses problems that you can't even imagine that you'd have up in the first world. Like for example, what if you blow a piston or a rod or a transmission or throw a bearing? And you can forget about spare parts dealers and classified ads or yellow pages. This is Cuba man. They don't have yellow pages in Cuba, they never did. Yellow pages are strictly advertising for pure dyed in the wool capitalists right? Which makes you wonder when the Castro brothers finally fall and Cuba does get opened up to globalization will they go through that yellow pages stage or not? Or will they skip that and transition right into Craigslist?

[12:36] Or Julio's list or Paco's list whatever they decide to call it. Anyway Cuba itself is like a big island sized garage sale. A swap meet, a flea market, a garage sale, whatever you want to call it. That's what Cuba is. The world's biggest unofficial flea market. And if you take any one of those beautiful vintage cars and look under the hood you won't be able to recognize what car you're dealing with because you'll find a Ford V8 with a Czech carburetor and Polish or Hungarian pistons and dozens of other parts that came from Soviet blocked cars and trucks. Even pieces of reworked metal from tanks, planes, guns and cannon. All from abandoned or stolen Soviet era stuff of course. And here's something you didn't know. If you have a 1950 Chrysler the pistons of a Soviet GAZ-51 truck will fit it just fine. Which kind of begs the question, did the Ruskies steal the plans for that motor from Detroit?

[13:25] And get this, last time I was in Cuba when I was filling up my rental car at the gas station. A big old heavy metal Cadillac pulls in and guess what? The guy starts putting diesel into his gas tank and he did that because under the hood he had a four cylinder Mercedes diesel engine that he cobbled out of a 1950s fork truck. And here's what another Cuban guy told me. He said that since they only make about 25 bucks a month they don't have money for hydraulic fluid or transmission fluid or special lithium greases or anything like that. So instead, mechanics have experimented over the years with various household concoctions and they have their own recipes, secret recipes, that are handed down from father to son, from mechanic to mechanic. For example they'll make hydraulic fluid from shampoo and use the liquid from soap dispensers

[14:10] from high end hotel bathrooms. You know, from those soap dispensing machines? They say there's a big market for that stuff on the black market, that and hotel toilet paper and they'll mix that up with burnt cooking oil and coconut extract and an oasterizer. And since average Cuban families don't have a blender or an oasterizer, they make a deal with a friend or family member who's a cook or restaurant worker in a big hotel and he does the job for him with a commercial blender when no one's around. Man, I'd hate to be the guy to get the next smoothie out of that blender. But let's get back to doctors, medicine, hospital and medical insurance. It's about time, huh? And speaking of Latin American doctors, did you know that when you go to medical school in Latin America, at any one of the universities that offers a medical doctor GP program, you don't go to pre-med or undergraduate.

[14:56] What you do is you go directly from high school into medical school. Down here you skip that whole first four years of undergraduate studies. No pre-med or pre-dent or anything like that. Now you gotta be wondering why is that? Which by the way means that any young doctor that you meet that's just graduated is going to be four years younger than the average doctor who graduates in the first world. Anyway, one of the professors at a medical school in Columbia explained it to me this way. He said, up in the first world, about 30% of the kids up there who graduate from high school go on to college and about half the people attending an undergraduate university in the first world end up graduating. So about 15% of the young adult population graduates from college up in the first world. Now most of those people would prefer to go on for an advanced degree because they know it pays more and they know getting a medical degree is practically a guarantee to live

[15:45] the good life that is if you qualify can actually get into the school and then eventually graduate. Well it turns out that in the first world going into a pre-med program is kind of the qualifier in order for you to be able to apply to medical school at all. I mean imagine if you didn't have to go to pre-med or pre-dent and you could apply and go directly into medical or dental school right after high school. There'd be a virtual stampede of applicants I guarantee you. But down here in Latin America the reason why they're able to get away with it, that is skip the pre-dent and pre-med process, is because less than 5% of all eligible young people go to college and less than 2% ever graduate. So in fact down here the only competition you really have when you're applying to medical school is your grade point which has to be pretty high of course and your ability to fork up the dough to go to medical school. Which by the way is ridiculously cheap except believe it or not in Mexico.

[16:35] Because so many US students that couldn't get into a US medical school get accepted down there just on the basis of having the dough. And they pay the foreign student rate which is double or triple what the locals pay. Because of that the gringo dollar has contaminated that system too. It's kind of like the Cancun and the Costa Rica effect you know. However in the rest of Latin America if you're a local medical school is ridiculously cheap and since such a small number of people are qualified to get in there's really no competition. There's nobody fighting for spaces or calling in favors like they do up in the first world. And even though it's really dirt cheap down here if you're not above middle class by Latin American standards you won't be able to afford the tuition. So that's a great barrier to otherwise qualified people too. Since there's no such thing as student loans down here either. Now just imagine if that situation existed up in the first world.

[17:23] How many people would not like to go to college or take an advanced degree if guaranteed student loans did not exist up there. I'd say at least half the people I knew when I was going to university up in the first world they wouldn't have gone to college without the benefit of student loans. But the student loan fiasco well that's another sore subject but I won't get into that. So anyway you might be wondering then how come so many Central American doctors go to the United States or Europe to get their medical specialty degree. Specialists I'm talking now. Not GPs you'll never see a GP that went to a US school down here. I can assure you that unless he's donating his time for free with Doctors Without Borders or something like that. So anyway up in the first world it turns out there's an actual shortage of doctors entering residency specialty programs up there. And nowadays more than half of those spots are filled by foreign doctors who graduated

[18:10] with a GP degree in their own country. And not only that every first world medical school has some kind of exchange program to accept specialty residency students from Latin American countries. So the bottom line is don't ever be worried if you need a high quality first world trained specialist down here. They're all over the place. But now back to expats and Latin American health insurance programs. Now there's three options of course for expats down here like me. You could either go naked and have no plan at all. Which means you pay the price when you get sick and have to go to the doctor or the hospital. But even going naked you're only paying about 20 to 25 percent of first world costs. And that's why a lot of expats choose that option. And that's when you're off the high volume tourist trail. When you're on that tourist trail like in Cancuna Costa Rica and Panama for example. Well you may have heard that there's a lot of medical tourism in those areas.

[18:58] And yes it's true and they get a lot of business. But however cheap you might think it is in Panama or Costa Rica. When you go down on a flight to get your knee replaced or your boobs done. Or you're really dying for a Liberace or a Mickey Rourke facelift. Well just know that in Costa Rica and Panama and those places on the tourist trail. You are going to get a pretty hefty discount. You're going to pay about 50 percent of what you'd pay in the first world. But you can do a hell of a lot better than that believe me. So anyway if you go naked insurance wise and pay cash as you go. If you end up in a decent private hospital for five days. You're looking at 1960's prices. Now I just looked this up and it says that the average cost for a five day stay in a US hospital is anywhere from 10,000 to 25,000 dollars. Man I don't even want to think about that. And let's say that down here in Latin America you're in a private hospital for the same

[19:45] five days for the same treatment and you're paying anywhere from 2,500 to 4 or 5,000 dollars. That's a lot less but it's not chicken feed. So why not get health insurance. And you know 10 or 15 years ago there just weren't any health insurance policies to be had. Not for expats anyway. There was just no market or demand for them. But you see now that all the transnationals are down here and all those franchises like McDonald's, Wendy's and Subway and Office Depot have landed in such a big way. They're offering their executive employees health insurance plans. Just like they do up in the first world. And competition in the field has brought prices down to ridiculously low levels. Now listen to this. I've had a health insurance HMO type plan and I was paying about a thousand dollars a year, not a month, to get 80% coverage of all the hospitals and clinics on my plan.

[20:33] And I had a 20% copayment. And anytime I went to see a specialist for a checkup or for whatever reason I paid him or her 12 dollars. And there were maybe 50 or 60 GPs and specialists on my plan. Now the problem with this insurance company was the fact that when you reach 70 years old they cut you off. They just ejected you from the plan. Which was always a bit worrisome to me thinking, well you know when I get to be that old, what do I do then? And even though I'd be eligible for Medicare and Medicaid, those plans are not going to cover you down here. You'd have to go back up to the states to get any treatment. And by the time I'm 70, I'll bet you my Social Security check that I don't get a Social Security check anymore. And you won't either because the United States will have long since gone into receivership and collapsed. And China and India will probably pick up the pieces and buy all the national parks and stuff at a fire sale.

[21:19] Anyway that was the problem with this one plan. That 70 year old limit. But just recently, a lot of the big banks throughout Latin America have been offering health insurance if you have an account with that bank. And guess what? That's the only prerequisite. And it seems like every big bank is offering that kind of plan these days. When you walk in there's a big poster that says, join our full coverage health plan and pay monthly, only X amount of pesos or bolivars or limperas per month. Okay so I investigated this thing and guess what? These insurance deals are unbelievable, even for Latin America. Now get this, if you belong to one of these banks and you sign up for one of these health care insurance plans, they don't even require a physical or a blood test or anything. You just sign up, pay your first quota and you're in. But that's not the best part. The best part is that it goes until age 99.

[22:07] And though the policy says they have the option to increase the fee when you renew, it's so cheap that even if they increase to 10% a year, it's really peanuts. Just remember that the monthly payment for this HMO insurance is 40 bucks, which is about $500 a year. And here's the amazing thing. You can go to a large group of hospitals, doctors and clinics, all of them first world style private hospitals and clinics, and here's what the payout is. If you go for ambulatory treatment and consult a medical specialist, it'll cost you $3 out of your pocket. If you go for lab tests of any kind, it costs you $10 out of your pocket. And an emergency room visit, no matter how long you're there, 45 bucks out of your pocket. Now here's the most unbelievable kicker of all. If you get hospitalized from one to three days, you pay 50 bucks out of your pocket.

[22:56] If you get hospitalized from four to seven days, it's $100 out of your pocket. And if you get hospitalized for eight days or more, you're going to pay $200 out of your pocket. It's very simple and easy to understand with a couple of little extras. Like for example, it says if you have any kind of cardiac surgery, it'll cost you a one time, 500 bucks. And when you're pregnant and you're going to have the baby, it's going to cost you 25 bucks out of your pocket. And over that 40 bucks you pay a month, if you want your whole family on the plan, you'll have to kick in 20 or 30 more bucks a month. And with the family plan, you can have up to six dependents. Now like any medical HMO insurance plan, they have a maximum monetary amount, and at first it seems awful low, but when you remember that down here, doctor and hospital and clinic charges are 20 to 25% of first world charges, you're right in the ballpark.

[23:45] Now listen to this. For example, with this policy in plan, it says that your lifetime individual coverage is $200,000 US dollars, which does seem awful low now, doesn't it? But because of the low prices down here, it's equivalent to about a million dollars worth of coverage in the states. So don't let that scare you. And as far as the yearly maximum, they have a $25,000 yearly limit, which in first world terms works out to a little over $100,000 in coverage per year. And also they have a maximum limit in dollars for each hospitalization event, which is about $12,000 which works out to about $60,000 if you're talking about first world equivalent charges. And of course, like any insurance company, they have a pretty big waiting period before you get into the plan full time and get 100% coverage. For example, it says if you need any kind of surgery, you have to be in the plan seven

[24:33] months before the coverage kicks in. And for maternity benefits to kick in, you have to be on the plan 13 months. Now plans like that you can find in every big city in Latin America, every city over maybe 500,000 people. And by the way, Latin America is really the place to be if you need a full time nurse or caretaker. Because you know up in the states, if you had a nurse come in every day full time, you know what that would cost? At least $40,000 a year. And even an LPN or nurse's aide is going to cost you $20,000 or more. But down here in Latin America, they're paying LPNs and nurse's aides $300 to $400 a month, which is under $5,000 a year. And you're only going to pay $500 a month for an RN with a degree, and that's only about $6,000 a year. And I know if you hired a full time RN to come into your house up in the states, you're

[25:18] looking at about $50,000 a year or more. And of course, down here in Latin America, no insurance companies are going to pay for nursing care at home. They only cover the basic things like hospitals, doctors, medical tests, and clinical visits. But I'll tell you what, if I was in a wheelchair, this is the place I'd want to be. Because down here, LPNs and nurse's aides often live in the house of a constant care patient. Because like I mentioned in past shows, every middle and upper class house down here has a maid's quarters with a shower and a sink and usually an outside entrance. And I also mentioned that most people making $800 a month or more, which is poverty wages in the states of course, but it's not poverty wages down here because they have a cleaning lady, a live in cleaning lady. And that's what that servant's quarters is for. Often you'll find those servant's quarters even in tiny 800 square foot cracker box houses.

[26:07] Well oftentimes you'll see down here that older folks in their 70s and 80s have a live in nurse's aide slash cleaning lady. In other words, she'll do just about everything around the house, including all the laundry, the dishes, the cooking, and the cleaning, and she'll take care of an invalid in a wheelchair 24-7. And that's just part of the job description. And quite common down here with the middle and upper classes when they've got some older folks in the family who don't get around too well anymore. And you know the question comes up a lot, what happens if you have some kind of strange disease or genetic defect and they don't have the most modern latest and greatest tools and technology to take care of you down here? Well all I can say is if you have some kind of rare disease or genetic defect, I wouldn't count on getting any kind of special treatment like that down here. Because although hospitals and doctors can be first world in every way, no one's really

[26:54] doing any experimental treatment down here. All that kind of research and development goes on in those big research hospitals up in the United States like Johns Hopkins and the Mayo Clinic. That's still one area where the US excels, but not down here in Latin America. And though you'll occasionally read about some new drug or treatment coming out of a hospital or research facility in Argentina, Brazil, Chile, or Colombia, you have to realize that there's very little of that going on down here because they just don't have the money for the equipment that it takes. I mean it takes quite a few millions of dollars to outfit a research lab like that. Even a used electron microscope could cost $100,000 unless you get one Soviet surplus in Cuba. You've been listening to The Exped Files, living in Latin America, coming to you each

[27:42] week from somewhere south of the border. And don't forget you can email me on anything at all about Latin America, The Exped Files at gmail.com. Once again, The Exped Files at gmail.com. See you next time. Nos vemos!