Episode Summary
In this episode of The Expat Files, Johnny Mueller explores the healthcare challenges expats face in Latin America, including language barriers, insurance options, and the cost of procedures. He also compares U.S. national debt to that of Latin American countries and discusses U.S. military influence in the region. Finally, he explores the availability of organic produce and the complexities of organic certification.
Johnny begins by addressing the concerns of older expats regarding the cost of medical care in Latin America. He acknowledges that Medicaid and Medicare do not cover expats in the region and highlights the challenges they may face, such as navigating the healthcare system without knowing Spanish. He also discusses the availability of English-speaking doctors, especially in areas off the tourist trail, and provides advice on how expats can communicate effectively with medical staff. Johnny concludes by mentioning a relevant advertisement he saw in a newspaper, showcasing the availability of first-world medical services in the region.
Next, Johnny discusses the availability of laparoscopic surgical techniques in Latin America, highlighting their cost-effectiveness compared to first-world countries. He provides specific examples of procedures like appendectomy and hernia surgery, noting that the costs in Latin America are approximately 15% of those in the US. He also addresses the challenges expats face in obtaining medical insurance, particularly for those over 59 or with pre-existing conditions, and offers practical advice for managing healthcare expenses without insurance.
Johnny then shifts to the financial burden of national debt in the U.S. compared to Latin American countries. He highlights that the U.S. has a significantly higher per capita debt, which would take an average American three years to pay off, while in Latin America, the same debt could be paid off in about half a year. He also touches on the broader implications of U.S. influence in Latin America, particularly in countries like Colombia, which has several U.S. military bases. Johnny expresses concerns about the growing U.S. presence in the region and advises against living in countries with high levels of U.S. influence.
In the next segment, Johnny discusses the hidden military agreements between Chile and the United States, revealing that Chile has allowed US troops to be deployed in the country during emergencies. He highlights the financial and military ties between the two nations, including the US military base in Chile and Chile's participation in US military training programs. He also touches on the topic of organic labeling, explaining the complexities and costs of obtaining organic certification and how it's not commonly found in local markets in Latin America.
Finally, Johnny discusses the availability and cost of organic produce in Latin America, highlighting the differences between certified organic products sold in stores like Whole Foods, Costco, and Walmart, and the more affordable, but often non-certified, produce found in local markets. He explains that while some produce is truly organic, it's often not labeled, and many farmers use fertilizers and insecticides. Johnny advises expats to ask sellers directly about their farming practices and mentions the term 'bono' for fertilizer. He also promotes his expat wisdom seminar.
Topics
Medical care in Latin America, Expatriate life in Latin America, Healthcare accessibility for expats, Language barriers in healthcare, Cost of living for expats, Medical tourism in Latin America, Cost comparison of medical procedures, Expatriate healthcare challenges, Medical insurance for expats, Out-of-pocket healthcare management, National debt comparison, U.S. influence in Latin America
Chapters
00:00:00 Opening 00:00:14 Introduction to the Show and Host 00:00:26 Overview of the Show's Content 00:00:32 Focus on Medical Care Costs 00:00:58 Medicaid and Medicare Coverage in Latin America 00:01:43 Affordability of First-World Medical Care 00:02:37 Availability of English-Speaking Doctors 00:05:46 Relevance of Medical Services for Expats 00:06:44 Cost of Appendectomy in Latin America vs. the US 00:08:59 Insurance Enrollment Age Limits for Expats 00:11:11 Managing Healthcare Costs Without Insurance 00:11:52 A Man Paying Out of Pocket 00:12:30 Moving On to Debt Statistics 00:16:30 Colombia's Growing Appeal and Concerns 00:18:00 Introduction to the topic of Chile's military ties with the US 00:18:55 Discussion of the US military's influence in Chile 00:21:09 Analysis of the potential future implications of US military presence 00:22:05 Introduction to the topic of organic labeling and certification 00:24:28 Availability of Organic Produce in Local Markets 00:24:51 Cost of Organic Produce in the U.S. vs. Direct Sales 00:25:03 Quality and Authenticity of Produce in Large Markets
Transcript
Automatically transcribed from the original recording; names and wording may contain errors.
[00:00] South of the border down Mexico way That's where I fell in love when the stars above came up to play and now I wonder Hello there all you expat wannabes. I'm Johnny Mueller and you're listening to the expat files living in Latin America The show that tells you just what it's like to live work play and or retire down here in Latin America It's a mix of the good the bad the ugly and the great and it's all right here. So let's get started Okay now for all you listeners out there who are interested in the cost of medical care down here in Latin America So unless you're a trust fund baby or mr. And mrs. Moneybags You will want to hear this especially since so many older expats are coming down, which means more health problems, right?
[00:49] Hmm senior citizens, huh? Yuck. I'm getting to hate that term. Aren't you? Anyway It's true that when you come down here to Latin America Medicaid and Medicaid will not cover you. How could they why would they in fact? I just got a slew of emails and a couple of voicemails on my expat wisdom.com website on that very subject Oh and by the way, if you don't want to write an email and you feel like speaking your mind You can go to expat wisdom calm and send me a voicemail I think that voicemail option on expat wisdom calm started a month or so ago So if you feel like it just send me a voicemail, but easy on the four-letter words. I'm sensitive, you know Anyway, like I said, I got a slew of emails and a couple voicemails talking about Medicare and Medicaid and how since it's not gonna
[01:35] Be covered if they come down here to Latin America How the heck they supposed to afford first world medical care now I'm beginning to think people who send me messages like that Don't really believe how cheap first world health care is down here And even if they come down and try to check it out for themselves Most of the time they won't be able to navigate their way around hospitals and doctors, etc Unless they can speak good Spanish So you'd get a lot of newbie expats down here that go to the gringo expat bars looking for information on various things Why because drunken tipsy gringos are generally blabber mouths And they're glad to tell you about things like lawyers housing and health care things They don't know too much about and usually pay gringo prices for why because they fail to learn even basic Spanish well, wait a minute. You see Johnny says that it's often a trial to find good first world health care down here
[02:25] If you don't speak Spanish, but he also said a few shows back most good first world style doctors speak English So then that's definitely a contradiction, right Johnny must be losing it. What up with that? Well, it's like this nearly all young modern Latin doctors speak English. That's a hundred percent true However, when you walk into their offices, especially off the gringo tourist trail Where you really get first world work at rock bottom prices The problem there is their receptionist nurses and text probably won't speak a lick of English They'll just know the usual 20 English words that all people off the gringo tourist trail know Beginning with nice to meet you And by the way a long long time ago when I first came down to Latin America Being well off the tourist trail and not knowing a lick of Spanish myself when I heard someone say those magic words in English
[03:15] Nice to meet you. I always felt so relieved only to find out later They answered all my many English questions with those magic words. Nice to meet you So in medical facilities off the gringo tourist trail as far as speaking English the doctor surely will but the nurses and the receptionists And the text won't so if you don't speak Spanish, here's how you approach that you walk into a doctor's office or hospital clinic Whatever and if the receptionist or whoever doesn't speak English ask for the nearest doctor He'll speak English and unlike first world doctors who almost never have extra time to talk to you And they're running on high stress levels and five-minute time segments and all that Latin American doctors will stop what they're doing and come over and have a nice little conversation with you
[04:05] Especially if you're a gringo that's part of your gringo advantage even if you're not their patient even if you when you first walked in they don't know you from Adam and this is especially true off the gringo tourist trail because The doctor will finally have a chance to speak English with a real first world gringo because remember off the gringo tourist trail Doctors do not have gringo patients simply because most of us are in Costa Rica Panama and Mexico Like I said take a walk in any big city in Latin America off the gringo tourist trail And you probably won't see a single gringo all day That is unless you're in the first world hotel or embassy district But those places don't count and I advise you to keep away from them anyway now oddly enough
[04:50] Even if you think you spot a gringo or two in a parking lot or across the street Just mosey on over and listen to what kind of conversation that person is having and you'll find 99.9% of the time there died in the wool Latin Americans with a lot of European blood They're Spanish is flawless of course because they were born here so at first glance They look like gringos or Europeans now strangely enough because of the class system down here Almost all of those latins that look like gringos are upper middle class or wealthy so naturally they're more educated than the average Latin So they speak a little English, and it's usually very broken So if you walk up to one of these guys and gals they're usually glad to talk to someone from the first world to in English But anyway in response to those emails and voicemails about so-called senior citizens that might want to come down here as ex-pats
[05:42] Worried that once down here. They'll be cut off from Medicaid and Medicare I just like to read a little quarter page ad I picked on of one of the big Sunday newspapers in El Salvador The headline on this ad says and I'll translate this first world Laparoscopic surgical techniques that leave no scars are available for certain elective procedures It's an ad for a first-world style hospital medical complex, and they're advertising what they call Suheria mini, which means mini surgery, so they're talking about state-of-the-art Laparoscopic surgeries with openings of only three millimeters much less than an eighth of an inch And here's what it says get your elective surgery done without cicatrices Those are scars at our main hospital location
[06:27] It says the following surgeries apply to this kind of technique appendicitis hernia gastric reflux kidney stones ovarian cysts gallbladder surgery Obesity surgery and more and then it goes on to list the costs of some of these surgeries get this it says Appendix surgery appendectomy via the mini laparoscopic technique $1,800 complete that includes your preliminary appointment with a specialist and it includes all hospital costs all medicine at the hospital and all Doctor's fees including follow-up visits. That's a complete price 1,800 US dollars whereas in the US the average cost for a laparoscopic appendectomy is $12,000 do the numbers folks we're talking about
[07:14] 15% of the first world cost for the same operation and remember down here in this case and many cases We're talking about a complete package a one-cost deal Whereas up in the states who knows what kind of additional cost they might pile on when you finally get your bill Alright, so let me go on to another one in this same ad it states the cost of mini surgery on the gallbladder or for a hernia The complete package again, including the hospital charges medicines previous and follow-up appointments with a specialist and All medical doctor fees the package deal 2,000 bucks So then what would your average hernia operation cost up in the first world the cost 12 to 15,000 bucks Again, we're looking at Latin American costs to be around 15% of US costs
[08:03] Even much less in some cases Depending on how many add-on charges there are up in the first world when you get that thing done now I know what seeing is believing and these prices are not out of the ordinary for Latin America They're actually pretty standard. So for all you doubting Thomas's out there I'll scan this very current little blurb here and send it to you But remember it's in Spanish though since medical terms are similar in Spanish and English You'll be able to get most of the drift So if you want to copy just send me an email the expat files at gmail.com or Johnny at expat wisdom Com and I'll shoot it off to you That's it Just remember about half of the expats that come down here to Latin America pick up some kind of medical insurance That generally pay 80% with the 20% co-pay and yes
[08:51] I've seen some fantastic plans that run 50 or 60 bucks a month for full HMO coverage However for those expats who just can't get on a plan For example many of these health care plans have a cutoff enrollment age limit of from 59 to 65 years old But once you're on generally these plans will cover you to age 99 as long as you keep paying the premium Oh and by the way One of the insurance brokers down here told me that when people first sign up for the plan these companies and agents almost Always insist on a credit card or bank automatic withdrawal monthly because like he said Unfortunately, Latins are so negligent in paying their premiums on time that when there is a crisis and they have to use a clinic or a doctor or a hospital many times they find out unfortunately that they're not covered because they missed a payment and
[09:39] He said that usually happens while you're sitting in the hospital emergency room. So then what? That's why so many insurance companies won't even let you sign up unless you do the automatic credit card or bank withdrawal thing Anyway, just note that if you're 59 or older, it'll be difficult to sign up for an insurance plan Now if you're under 59 and you come down here with some big-time pre-existing medical conditions like a previous heart attack Then naturally you'll have trouble getting on a plan too Or for example if you come down here as an expat and you're an injectable diabetic Then you're kind of stuck. I know I know bad pun, huh and most likely won't be able to pick up any local insurance Then everything will be out of pocket
[10:24] But like one long-term expat told me he's an overweight longtime diabetic with many vascular complications And he says for what he pays with his out-of-pocket costs down here for his medicines and syringes and doctors appointments and all That on a yearly basis. He tells me now He was worried too when he first came down But what he pays wouldn't even cover the deductible much less the premium for the insurance that his younger brother has up in Texas Not to mention he says his brother's premium is about seven grand a year So what my friend this injectable diabetic down here in Latin America does is he just puts 2,000 bucks a year into what he calls his little medical savings account and he uses that for his out-of-pocket Expenses and he says he's been doing that for five years now, and he's still got
[11:11] $6,000 in there. So it's building up for that big-time rainy day I guess he laughs and says that six grand is good for a stroke or two So this expat in his late 50s overweight injectable diabetic with circulatory problems Bad us style diet, of course. He hasn't got religion on that yet You know drinks about a half a gallon of diet Mountain Dew every day. Yep. They've got that crap down here, too courtesy of Walmart and Costco, of course Anyway, he says in the past five years with all his pharmacy supplies, etc and medicines doctor's visits, too He's shelled out only about four thousand bucks, which is eight hundred bucks a year. Remember This is a guy who's going raw. No insurance at all. He's paying out of his pocket So there's a perfect case in point, you know last I saw him
[12:00] He was doing pretty good, but he knows things are gonna get worse I said if they do you just go back to Texas is always Obamacare Then he just stared at me for a second and gave me a look like the Joker on Batman and laughed and laughed and laughed He said I'll give up meat cheese ice cream even God before I become a slave to that system again Then I said well, what about your brother and he said him? He's thick as a brick He's nothing but a slave living in an electronic prison and he doesn't even know it Okay, that said let's move on if you remember a couple of shows ago We were talking about the gross federal debt per person in the u.s Which is somewhere around fifty nine thousand dollars a person Versus the average gross national debt per person in Latin American countries with a few countries up there around five or six thousand dollars
[12:50] per person and most around a thousand dollars per person and after that show aired I got a few emails including this one from Gary. He says Johnny about that public debt thing you were talking about You know you have to compare the average salary per month or year in That country and go beyond just the numbers for example in the USA What's the average worker salary something like 30 to 40 K per year versus Central America, which is around? 3600 so it's about the same ratio one and a half to two years To pay off their share of the individual's country debt for both So then let me stop here and address that now Gary this just proves that Statistics can be manipulated any way you want them
[13:38] You've got some good arguments there, but I'm gonna blow a hole in them first of all you're saying that your conclusion is both up there in the states and down here a Person's fractional share of his country's national debt is about the same You're saying it's one and a half to two times a person's annual income But you know using a person's average income is like apples and oranges when you compare the u.s. To Latin America Why the average household income in the u.s. Is about 50 grand a year and the average household in the u.s. Has 2.6 persons meaning that breaks down to $19,000 per each member of the family so in the u.s. By that standard it would take three years for each person to pay Down his portion of the national debt around 59,000 bucks
[14:24] Whereas in Latin America, although the average working person makes about $350 a month the average household income is about double that about $700 a month That's because everyone in the family even mom and the kids Contribute to the household income or else they wouldn't be able to make ends meet since what they call the canasta Basilica down here the average monthly amount needed to pay for everything you needed that month food water electricity Transportation etc runs about $700 a month now since the average latin household has four members in it That means the average yearly income generated per person is 2,100 bucks and with the average National debt of most latin countries hovering at around a thousand bucks per person
[15:10] That means the average person could pay off his portion of the national debt in a half a year Whereas if you're living in the u.s. It would take you six times as long to pay off Your portion of the national debt about three years Even when you balance it against personal or household income the average American is six times more Indebted to the state than the average latin american is to his now Of course, there are a half a dozen other ways to make sense of this But anyway, you add it up United States citizens are in a huge debt hole They'll never be able to get out of Confucius say when hole too deep throw away a shovel But that ain't gonna happen or as a very famous carpenter once said no matter how many times I cut this board
[15:56] It's still too short. And if you're guessing right now that carpenter was Karen or Jesus. Nope. It was curly Howard and Note when you throw in Argentina Chile and Mexico countries that have a much higher national debt per capita ratio Don't forget that those countries have much higher average wages than most of the rest of Latin America, too For example, the average wage in Colombia is around 700 bucks a month Double that of most of the other Latin countries and the country has more than double the average latin per capita country debt And by the way, speaking of Colombia People are always asking what the state of Colombia is today. Is it a good place to work play live retire and or hang out? Well, I can tell you that unfortunately It's getting a lot of traction lately in retirement rags and international living because of that the gringos in
[16:47] Europeans aren't trickling in like they used to they're kind of opening up the tap and flooding in especially to the big cities like Medellin Cali and Bogota so unfortunately in the last year and a half or so prices have been jacking up In fact in many places prices are at or near first world levels Now when you're out in the boonies out in the countryside things are a bit different You still can get very low prices on local produce, etc However, the thing that bothers me most about Colombia is that they've got seven count of seven US Military bases. So if you're like me you want to stay as far away as possible from that kind of US influence So then as far as avoiding the tentacles of US big brother personally, I'd visit but I wouldn't want to live in Colombia, Costa Rica
[17:34] Panama Chile or Mexico simply because there are just too many gringos and way too much US influence altogether Now that's not to say the US hasn't got its big brother foot in the door all over the place in Latin America for example until recently the US has operated 22 US military bases in Latin America a Total of 800 worldwide now, there are two more one in Chile and one in Argentina So all of you who are thinking how nice and calm and democratic Chile is Here's something else that scares me so much. I'd never want to move to Chile. Listen to this It's something that's been kept pretty much out of the press and most Chileans don't even know about it. Let me paraphrase this article Chilean defense officials and US Southern Command
[18:21] Signed an agreement to allow US troops to be deployed in Chile whenever quote The Chilean army finds itself overwhelmed by some emergency situation for example natural disasters or any other such calamities or when international aid with military components are required or when quote national emergency scenarios prompt a state of exception and suspension of constitutional guarantees Whoa, the long tentacles of big brother, huh? and you know Chile's one of the few countries in Latin America that has a decent enough infrastructure to Organize first world big brother crap like that. Now you tell me what you think about this
[19:10] Did you know that in the last six years the US government has funneled over 45 million dollars in Military and police aid to Chile and here all along we thought little Chile was so laid-back Unpretentious and unassuming didn't wait. So then what is your 45 million dollars buy in Chile? Well, here's the list joint military exercises troop exchanges Chilean participation in US National Guard training. Hmm. And this is key Did you know that little Chile has spent almost one billion dollars over the last 20 years purchasing US Military equipment did for Ted, huh and scariest of all in that 20 years Chile has sent
[19:55] 4,000 soldiers to the US Army's School of the Americas. You might remember that long-standing school of terrorism in Panama Well, you know, it had such a rotten reputation. They actually changed the name now It's called Western Hemisphere Institute for security cooperation like that, huh? Oh and I saved the best for last What do you think of this? 90 miles northwest of the capital of Chile, San Diego There's a base funded by the US military's Southern Command Authorized under the Obama regime where there's a large eight building complex that's used Specifically as a training prop for mock urban battles. Yep. Mock urban battles Now what's that all about? Just what it says mock urban battles just in case, huh?
[20:44] So is there something we should be feeling good about here? You want to be isn't gonna be is thinking about going to Chile Are you feeling safer now? I guess the only good news about that is the fact that in the next year or two Smart people in the know anyway believe there's gonna be such a huge crack in the economic fabric up in the United States As well as Europe and the rest of the first world that big brother just won't have the time the money or the personnel To put the clamps down within its own borders and crack the whip in Latin America, too So Chile skip it, but where was I? Oh, yeah We were talking about Gary's earlier email the one about the indebtedness of everyone to his country's national debt Anyway after finishing up on that subject he ends up changing gears and talking about
[21:29] Strawberries of all things and I know why because in a recent past show I talked about going to one of those Gigantic produce markets where went off the gringo tourist trail you could get huge Strawberries for 40 cents a pound so referring back to that Gary asked are the strawberries organic To be organic or not to be organic that is Gary's question Well, there's certified organic with a label or a sticker Then you can be 99% sure then there's so-called organic because the guy who's selling it to you says it is hmm You did know of course that the term organic just means a compound with carbon atoms in it, right? You'd know that if you ever took organic chemistry So then these days the term organic has been all perverted since anything that's alive and grows at all is
[22:20] Technically organic that said to get produce certified with stickers and tags etc The grower really has to jump through a lot of hoops Well, first of all, you have to comply with USDA organic standards and get this each processing plant and each company that handles your product Before it's packaged must complete its own organic system plan Whatever that is then you must submit your organic system plan to your certifying official agent and prepare to be Visited by that agent for site inspections on top of that it costs money to get certified organic certification runs around 1,500 bucks initial application fee 275 bucks site inspection fee materials, etc 500 bucks expedited certification fee
[23:08] 1475 bucks and annual certification fee based on the gross organic production value usually between 400 and $1,500 for a small farm or small processor as you can tell I just read that from a document and then it goes on to Say after your site inspection is complete the USDA approval process may take anywhere from six to ten weeks Oh and just as an aside here I know someone that was looking into setting up an organic coconut plantation And he told me that in some cases it takes from two to four years From the time you plant your trees and harvest the first crop the same with cacao That's chocolate pecan macadamia and avocado and he said he gave up on it when he heard about all that red tape anyway I guarantee you that when you come down here to Latin America and you go to one of these big central markets
[23:58] you won't see one single label that says certified organic because most of that produce coming in daily and Arriving at those hundreds of little kiosks comes from small local truck farms or people that own tiny plots of land Now believe me when you go to these markets and you see who's selling this produce You'll realize in a second that most of these people are just scraping by and that 99.9% of them don't even know what organic or organic labeling even means Sure You can go into some of these nicer neighborhoods and find various cloned versions of Whole Foods Etc where they actually stock certified organic products on their shelves mostly imported and you can go to Costco or Walmart And they'll have some of the usual suspects that say certified organic on them, too
[24:45] And for that of course like in the states you'll probably pay double or triple the price that the farmer would charge if you got it Direct from him or at one of his little kiosks in the Central Market So then what about those 40 cents a pound gigantic strawberries? In fact, what about all that great produce you see in these gigantic markets? Well, I'm sure that a lot of it's not exactly organic Probably half of the stuff there has had some nitrogen based fertilizer thrown on it And I know for a fact that some of the fruits have been sprayed with some kind of insecticide because they certainly sell bags of it At farmers co-ops, etc But also I'd say about half of the produce is truly organic. It's just not labeled However, not only is there almost no demand for it Not to mention 99% of Latins don't know what the hell it is
[25:32] Anyway, and finally because most of these guys and gals are living on the edge There's just no way that a small truck farmer is gonna dish out that kind of money to get a special label like that So if you really are a stickler about pure unadulterated organic You can either go to the Whole Foods clone or Costco or Walmart and pay too much or Go to one of these big central markets, whatever and ask the seller What kind of fertilizer they use and if they spray the crop they won't lie to you Since like I said, most people are totally ignorant about what organic is and wouldn't give a damn anyway So bottom line if you're not sure just ask and by the way down here, they call fertilizer a bono. That's a bono You know, like there's a bono in u2 or for that matter shares dead ex-husband sunny
[26:21] Who was also a bono? So then with just a little bit of spanish you could ask the person who's selling the strawberries if they use a bono Which is natural fertilizer like chicken Which you can buy in 50 and 100 pound sacks in almost all agricultural supply stores And if they say they're not using a bono natural, they're probably using that pelletized nitrogen fertilizer That's the stuff that politicians give away about a week before voting time And as far as spraying insecticides just ask who's ever selling the stuff if they Spray con insecticidea spray in spanish is esprey nearly the same and insecticide insecticidea
[27:08] How hard is that? Oh and one last thing don't forget about my july 2015 expat wisdom seminar in central america You won't want to miss this one. Just go to expat wisdom.com and on the main page You'll see a link that says latin american seminar click on that for full details Sign up before may 1st because that's when the price goes up 500 per person. So do get in on the early bird discount You've been listening to the expat files living in latin america coming to you twice a week from somewhere south of the border Email me the expat files at gmail.com And don't forget to check out expat wisdom.com to sign up for your free reports on latin america See you next time nos vemos
[27:59] Ah