This is a question that often seems strange to us Europeans who have grown up in societies with advanced social health programmes, but is a very real cause for concern for Americans who are thinking of sailing off into the horizon.
Imagine you have grown up in a country where the government taxes vegetables 1000% – where a carrot costs $10 and a veggie stir-fry could easily run to $100. On top of that imagine if that same government and media also managed to convince you that vegetables elsewhere in the world were sub-standard and even dangerous to consume. What do you imagine would be the first question you asked people who left your country and traveled abroad to live on a boat? Probably something like “how do you eat?”, “where do you get your vegetables?”” How do you afford to live?” or something like that.
I mention this because we (along with many European sailors) are often perplexed by, and sometimes a little dismissive of, the attention our American cousins seem to focus on the subject of health insurance. For those that don’t understand why this is, under no circumstances should you get sick in the US.
US citizens have been so grossly overcharged for so long for health care that they have come to accept it as normal. Furthermore, the American medical machine tries to justify this by claiming to be (contrary to the figures) far superior to anywhere else. Years of this propaganda have had their effect – many American sailors we meet have policies that involve immediate repatriation to the US should they become ill, which suggests that at least some have bought the idea that health care outside the US is sub-standard or even dangerous.
The good news is that health care around the world is a lot better than many have been lead to believe, often better than the US and much better than any of our parents had anywhere.
In my 20+ years of being on the move, I have been treated in Kenya (malaria), Uganda (dengue fever) Malawi (wisdom teeth), Zimbabwe (facial and rib trauma), UK (head trauma and dengue), Spain (leg trauma), Mexico (kidney infection), and now Fiji (dentistry). Some of these treatments required several days in a hospital bed – others over a week.
Self treatment can cure most minor things and is very economical. Our entire drug cabinet pictured here cost less than $50 and was available on prescription once we paid for a doctor’s consultation to help define our on board needs. The consultation and prescription cost $4
All the treatments I have received have been exemplary. I paid cash for all of them and added up together they come to less than $1500. In the same period, the average American would have spent at least $69,000 in premiums (or just shy of $175,000 for a family policy).
When my (then) girlfriend fell down the stairs at Flagler beach (Florida) and chipped a bone, the bill came $16,000 and the service was no better than anywhere else in the world. When I did more or less the same thing in Spain, the bill was just over 100 Euros. Most sea gypsies we have met will relate similar experiences.
Jasna and I are both confessed Americanphiles. With the obvious exception of that weird Alaskan governer or that Trump bloke with the wig, we always hit it off with the Yanks and it seems a shame that the fear of getting sick or injured whilst uninsured and abroad seems to be holding so many of them back from joining us out here on the big blue.
Sailing is a healthy lifestyle and your health will improve immeasurably just by eating well, living with less stress and not driving every day. So if the fear of not being insured is stopping you realising your dream, worry not. If you can shut out the voices of the ‘what if’ brigade and stop wondering why nobody else is paying $10 for a carrot, you will be a lot closer to reality, health and happiness than the fantastically over-insured, over fed and over stressed.
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I just wanted to point out that the cost as outlined by Rick is just for the insurance premium it’s self. There are other costs too! There is a “deductible” an amount the insurance company says you MUST pay as a minimum, there are “co-pays”, which is a portion of the doctors office visit, and then there are non-covered costs for care outside of the hospital or doctors office. These can vary a lot.
To give a non-US citizen some idea, I broke my leg a couple of years ago.
In addition to the $350.00 US monthly costs for the insurance premium, I also had to meet my “deductible” of $500.00 AND pay for 6 visits to the doctor for “check up” etc at a cost of $35.00 per visit. I also had to cover 1/2 the cost of the leg splint and such things as ice packs, a shower seat and a trolley to help me get around. My out of pocket expenses were just about $1500. And of course, that costs does not include the insurance premium in the first place! This does not include the actual bill sent to the insurance company, I believe that was somewhere in the $15,000 dollar range.
No, please don’t get sick in the US. We have a crazy system here that is not about health and well being. Its just about profit.
Thanks for that Suzette – it seems the case for ignoring health insurance is stronger than I had guessed.
It’s good to know that general care is cheaper out of the US. I think you misunderstand American health insurance anxieties, though. It’s not about paying for routine care, it’s about being personally responsible for major health crises. My understanding is that European or Canadian sea gypsies who develop cancer, say, can fly home for treatment that’s covered by their national health plan. Americans lacking insurance would have to pay from their savings and if they’re not sufficient the hospital will take your boat and other property as well. All of which you probably need to live, or were counting on bequeathing to your family.
Hi Wesley,
Thanks for those rather good points. I hear what you are saying. Perhaps it would be more accurate to say that health cover is not unnecessary, but available at a fraction of the cost elsewhere. Even paying for a major illness is often cheaper than US premiums. My mother recently died of cancer in the UK after a month in the the hospital. The UK has free health care, but if she had had to foot that bill herself in Mexico or Fiji, then the bill would have been less than a thousand dollars which can be as little as couple of month’s premiums in the US, so it pays to self insure by simply putting the premiums aside in a high interest account (something we expand on in the book, but in relation to boat insurance). It only becomes a bankrupcy issue if you return, uninsured, to the US for treatment. So it is certainly a difficult question, but only an open and shut case if you believe health care is substandard anywhere outside the US, which is simply not true.
Cheers,
Rick
You should expect to see a lot more Americans out on the seas now that “that Trump bloke with the wig” is running the show and removing some of the healthcare the citizens did have. The ‘Get Real, Get Gone’ mantra may end up being a survival tactic instead of a dream.
If The Orange One prompts more of our American cousins to join us out here, we will find ourselves in the surprising position of having something to thank him for. Didn’t see that coming!
Just a quick update on this article. The only exception I have to our “no insurance policy” is a scuba diving insurance. We often travel in countries with no Hyperbaric Chamber, which means that in case of accident, I’d have no choice but fly out to get treatment. So I do have the basic DAN insurance, which I strongly recommend to all of cruisers planning to do any diving. My annual premium is 50$, so it really is a no brainer. ? More info on DAN here https://www.diversalertnetwork.org/insurance/dive/
happy bubbles everyone ?
Gret article. Super sad Americal Medical System!! ?