The Elephant in the Room
When we moved from London, Ontario, to Muskoka in 2010, several people said to us, “Oh, I could never do that; what if you can’t get a family doctor?” and, “The hospital is 45 minutes away by ambulance. What if you don’t make it?” (then I guess I die?). Understand, we were moving to the Canadian equivalent of The Hamptons, not Outer Mongolia.
As it turned out, we found an excellent doctor in a family medicine practice in Bracebridge and had occasion to be treated at both the local hospitals, at various times, and they were fine (never had to go by ambulance though!).This incident certainly brought home the extent to which some people allow themselves to be held hostage by health care. I know there are many who will never consider a move to Mexico for this reason alone, which is a real shame.
Mexico has a hybrid system of public and private health care. Legal residents are eligible to join the public system (IMSS) which is quite affordable. In addition, there are private care options in large centers and areas with concentrations of expats. Many doctors have been trained in the US and some hospitals are affiliated with, or even owned by, US ones.
When we came down for 3 months in 2019, we bought a travel policy through a Canadian from Toronto who now lives here. (OHIP doesn’t cover you in Mexico, although they could certainly save money by sending patients here!) Actually, he sold us two policies; a 3 month one for Mexico and another one for the 5 day trip through the US which he referred to, tongue-in-cheek, as ‘the valley of the shadow of death’! Plus another 5 day policy later for the trip back.
While here on that visit, my wife tripped and fell on the cobbled streets in the old town and sprained her wrist. (Cobblestone is actually a bourgeois term meaning ‘paved with rocks’; they can be uneven and difficult to walk on!) We went to a brand-new hospital nearby. She saw the doctor twice for consultation, had an x-ray, got a prescription for inflammation and the total cost was $75. We were done in less than an hour and parking was free. We were very impressed. Since the cost was below the deductible on our policy, we didn’t even claim it.
When we were moving down permanently, we obtained a quote from the same broker for resident coverage. In this case, the premium for the two of us was $6000 per year. It would have been our largest single expense by far. The policy had a lifetime coverage limit of $4 million US. This seemed excessive to me; I wouldn’t expect OHIP to spend that much on me, nor would they.
I asked the broker if there was a smaller policy available at less cost. He said there used to be a plan with a $1.5 million US cap, but they discontinued it. Of course they did! Why sell you something appropriate when they can charge more for something you don’t need and will never be able to use? I had a similar situation with my house insurance in Canada, where the coverage was formula driven and about 50% higher than the actual value, although they would never have written me a cheque for the full amount in the event of a total loss.
Our neighbours are Americans who have lived in Mexico for 25 years. I asked them what they do and was told that they self-insure. Another problem with private health insurance is that the companies dictate what they will and will not cover as well as when and where. This is not something Canadians generally think about; you’re sick, you get treated, period.
They told us numerous stories where the insurance company either denied or delayed approval of coverage. The insured had to either pay out of pocket and fight to get it back or forego treatment. I’ve always felt there is no point in having insurance if you can’t depend on it.
We decided that the risk of catastrophic loss due to health care costs was remote and, therefore, tolerable. With the low cost of treatment here, this is particularly true. People routinely assess the trade-off between longevity and quality of life when faced with a terminal illness or condition. Adding cost/benefit considerations to the equation doesn’t seem that much of a stretch to me. If the time comes, we will get as much health care as we can afford, without bankrupting ourselves.
We were referred to an excellent family doctor in the adjacent town. We didn’t have to fill out a health questionnaire, submit to a screening interview or go on a waiting list. We just showed up at his office; he wants us to be his patients. The cost of an office visit is $20. He works half days on Saturday and willingly makes house calls (if you’re as old as I am, you vaguely remember house calls!). Which reminds me, can you even get in to see your doctor in Canada yet or are you still being diagnosed over the phone?
There are innovative and alternative treatment options available in Mexico that may not be approved in Canada. For example, our doctor has a number of protocols for treating Covid and we bought Ivermectin at the pharmacia without a prescription for about $15 (the human formulation, not the horse de-wormer!). This was a precaution in case I caught the virus at one of the more than 250 dine-in restaurant meals we’ve enjoyed here in the last 18 months. I didn’t.
The principal benefits of paying for our health care ourselves are no wait times and choice. The hospital we visited when my wife sprained her wrist in 2019, and which so impressed us, has since increased their prices by 3 to 4 times what they were previously. We are told this is because the investors want to recoup their money quickly and they think this strategy will work because of the number of expats with their tolerance for high fees. However, even the US insurance companies are balking at the cost, so it may backfire on them.
The cost increase is not a problem because there are always alternatives. Another neighbour needed a series of tests. She obtained quotes of $4000 and $5000 at the two local ‘Gringo Crystal Palace’ hospitals and, instead, had them done for $1000 at an equally good facility in Guadalajara. Even wealthy Mexicans won’t overpay for health care; that’s not how they got rich in the first place!
One of the things I’ve found interesting is that, as Canadians, we have no idea what health services cost because we don’t pay for them directly. Turns out, most of it isn’t that expensive. Certainly not worth putting up with long wait times and lack of choice. In the New Year, I’ll be due for another colonoscopy. I will go to Guad where I should pay about $800, which I didn’t think was bad at all. Being treated like the customer I am, instead of the ‘system output’ I was in Canada, will be nice too.
My wife has macular degeneration in one eye and had cataract surgery in Canada in 2017. She needs ongoing follow up and we found an excellent opthamologist here. The cost of a check-up is $75. She would go 3 times a year in Canada, covered by OHIP. The doctor here said, “I’ll take your money if you want, but you don’t actually need to come back for a year”.
Last time she went, I also took the opportunity to get a new prescription for glasses. When I get it filled at the optometrist, I will pay less than $250. My last pair of glasses in Canada were over $600 and I even kept the old frames to save money.
Before we came down to visit in 2019, we had made an appointment with our dentist for routine exams when we returned in April 2020. By that time, of course, dentists were locked down. In spite of our impending move, this was not a problem. We don’t have dental insurance, so what we typically paid $400 for in Canada cost $100 when we got to Mexico.
Vets, likewise, were only operating at reduced capacity. As our moving date neared, one of our dogs needed a rabies shot in order to cross borders. Despite explaining our predicament, our vet didn’t have an available appointment and was unwilling to make room. The receptionist even argued that, since we would be crossing into Mexico on June 30th and the old vaccination didn’t expire until July 2nd, there wasn’t a problem. You explain that to a border agent! An influential friend offered to intercede with his vet, even offering to pay more, but to no avail.
My wife went online and made an appointment at a vet clinic in Laredo. When we arrived, the technician met us in the parking lot due to the restrictions in place at the time, took the dog inside and we were done in 10 minutes. As you might guess, they didn’t even look at the dogs’ paperwork at the border!
We have an excellent vet here who also works half days on Saturday and makes house calls. Clinic visits and shots cost less and she even prescribes the exact same flea and tick medication that we used in Canada, same box and everything, but it costs half as much.
Years ago, I had a growth like a wart on my face near my eye. I looked like a medieval peasant in a Monty Python skit! Over a period of a year, I was referred to 3 different specialists before a plastic surgeon spent 15 minutes removing it in a treatment room at the hospital.
Part of the reason it took a year was due to funding caps in place to limit demand. I remember thinking at the time, “I pay $600 to get my car tuned up. I would gladly have paid that amount a year ago to get this fixed. Surely it can’t cost more than that, can it?”. I currently have a similar looking growth on my wrist. Next week, I’m going straight to the dermatologist. She will remove it that day for less than $100.
It seems to me that many people in Canada have a complete mental block about paying for anything health related. However, in my experience, there is absolutely no need to be a slave to health care. Take a chance and live large; you have nothing to lose but your chains!