Forums > General > General Forum

Bloviator

May 23, 2007, 5:39 AM

Post #1 of 17 (2503 views)

Shortcut

Medicare or Local Medical Care?

Can't Post | Private Reply

Facing major surgery next month (there is major surgery - anything happening to me - and minor surgery - anything happening to someone else), I spent a good deal of time analyzing the advantages of going NoB (with Medicare) and having the surgery done here ($10K or more US).

It finally got down to three factors. I have a good surgeon at Scripps in San Diego, availability of family, and cost. It will cost a lot less NoB. The disadvantage of having it done here include cost, having to find a trustworthy surgeon, and unfamiliarity with the system here. I'm sure that there are very good medical practitioners of all types in Guadalajara. But it would have been up to me to locate one and then trust myself to his/her care.

The weakness of my Spanish is another factor. I have had several medical situations where I had to do all the communicating in Spanish. That gets a little frightening when I consider that my wellbeing is dependent on my understanding of what is being said in a language with which I have only minimal facility - especially when it comes to technical Spanish used in medicine.

Further, while everyone on the forum says that medical care here is comparable to or better than that NoB, my experiences have led me to believe that, while it may be true, there is also a lot of substandard medical practice here. It can be difficult to winnow out the good from the bad. NoB, I have a support system who can give me accurate information. Here, I do no. I have confidence that Scripps is a quality medical system. Here I don't really know of anything comparable - though I'm sure there is such.

One big advantage of getting service here is that one gets it in a timely manner. When tests indicated a problem a little over a week ago, I was in getting more tests the next day, and when those tests indicated a need for more tests, I was in the following day.

I then called Scripps and was told that the normal wait for service was six to eight weeks. Fortunately, I was able to get in a couple of days later and also able to schedule the surgery within four weeks. The quick consultation was a fortunate fluke and the four week wait was typical - probably a little shorter time than normal.

Of course, probably the most difficult problem of going NoB for medical service is the problem of finding living accommodations. food, and arranging transportation. In SoCal, ten days of hotel living pretty much wipes out the cost advantage of Medicare. Fortunately, I'll be in the hospital part of the time, my wife can stay with family then, and we found a $75 per night motel near the hospital - an almost extinct species in SoCal, where Motel 6s start at $120 per night.

(This post was edited by dlyman6500 on May 23, 2007, 5:42 AM)

jennifer rose

May 23, 2007, 6:31 AM

Post #2 of 17 (2485 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post |

Good analysis of balancing the factors where to go NOB or local for Medicare-eligible health care. The situation differs for everyone, and for many, it's not an easy decision to make.

Now, Medicare is too far off in the future for me, having announced to the off-duty EMTs who just happened to be sitting at a nearby taqueria when they were picking me off the sidewalk last November when I shattered my arm that I was 23 years old. Well, I did let loose with a chain of epithets, causing them to ask "Do you speak English or Spanish?" Replying that I spoke Spanish, I did immediately catch my gross misstatement of my age, correcting myself by adding 30 years. Then the big worry came as I pondered whether I'd remember to speak Spanish when I came out of the anesthesia, so I'm telling myself over and over again, "Remember to speak Spanish," before I under under, as if those in the operating room could care what language a patient's speaking at that point. I came out of it, and indeed I started babbling in Spanish.

My mother lived in Mexico before dying a decade ago, and, even though she had Medicare, she didn't use it, preferring to take her medical care here.

Bloviator

May 23, 2007, 6:38 AM

Post #3 of 17 (2481 views)

Shortcut

Re: [jennifer rose] Medicare or Local Medical Care?

Can't Post | Private Reply

Your comment that everyone has different situations is absolutely true. My posting is not meant to suggest that everyone should do the same. It is just designed to solicit discussion about the topic.

drmike

May 23, 2007, 7:58 AM

Post #4 of 17 (2467 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

What you have hit upon is a delimna that most of us are going to have to decide what is best for each of us individually.

In the US an MD that I worked with for yours, closed his office because his overhead was 88%:
overheads included office space, staffing payroll and benefits, two people to handle insurance claims and rejects, stock medicines, supplies and equipment, taxs, licenses and malpractice insurance!.

With what he had left after paying his direct expenses, he could not pay for his home, retirement, food for his 8 kids, etc. He had been in practice for over 25 years. We've lost him.

As a member of the US Medical Establishment, I can say we have much to be proud of, but even more to be completely ashamed of. We love to spout statistics concerning how modern our healthcare is, but in reallity the statistics are for the toys the docs play with, about the # of Rx's written each. They don't generally tell about the poeple killed by wrong medications, or those dieing from having the wrong organ removed, or dying while waiting for an appointment, or dieing by contracting MRSA while a patient in the hospital.. Our poor rate of infant survival in this countryis below many of the "third world" countries.

The Doctor I told about earlier in the essay, sold out his soul to become a "hospitalist" to work for a corporation as a hospital doctor. Hospitalists will see patients while in the hospital and upon discharging the patients have no follow up with them. The patient then goes to his original doctor for follow up. So now we have two doctors treating us both in the hospital and another one outside who was not involved with the care you refceived in the hospital. This is Very confusing and dangerous. I do not see it getting better, I've retired my license in April, very confusing and will lead to more mistakes within our System. I'll take my chances with the Mexican system.

You are correct in weighing out the challenges and needs and then deciding what is your best course.

And in the meantime, the politicians, insurance techs will decide if you may have the opportunity/priviledge to see a doctor for 15 minutes, corporate rats, AMA, Pharmaceuticals decide what type of healthcare will we have and how much they should pay them selves in bonuses,stock options and buy-outs.

The people remain silent. For what I do not know. The American Health care system is not dead but most of the aware people realize it is on "life support".
Dr. Mike

http://www.smarthealthchoices.blogspot.com

There are hundreds of paths up the mountain,
all leading in the same direction,
so it doesn't matter which path you take.
The only one wasting time is the one
who runs around and around the mountain,
telling everyone that his or her path is wrong.

Hindu teaching

(This post was edited by drmike on May 23, 2007, 8:46 AM)

Don

May 23, 2007, 8:35 AM

Post #5 of 17 (2450 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

Last year I returned to the U.S. for major medical surgery. I used Medicare and in the S.F. Bay area there are many major hospitals and doctors that accept Medicare patients. I was there for nine months and lodgings was not a problem for us as we stayed at our daughter's.home that has an extra room.
I didn't have to weigh the thought of where I could get the best medical treatment. My primary care doctor here in Mexico, the ex director of the military hospital in Guadalajara and surrouding states. insisted I return to the U.S. for treatment. They could perform the surgery here in Mexico, but the problem here was finding an organ donor. I had a liver transplant.
So any decision you make, depends not only on the availability of a quality surgeon, but on type of treatment needed and medical needs.

Georgia

May 24, 2007, 7:23 AM

Post #6 of 17 (2345 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

It is a good idea to have this discussion. I think your observation about language is important. I have been seen by a doctor whose English was quite good, but I realized he was saying and using only the words he knew in English, leaving other stuff out. Since I have spoken Spanish all my life, this problem, for me, was (a) recognizable (b) treatable. But it would seem to me prudent to have with you during a hospital stay here someone who is very comfortable with the language and who is not afraid to ask questions when uncertainties arise.

I recently had some cosmetic surgery done to correct a very sagging eyelid. (Actually, now that I think about it, it shouldn't be described as cosmetic: it greatly improved my field of vision... whahoo!) The surgeon I chose ... a deliberation that took more than a year .. was based on my observations of others who had had similar surgeries. His English was impeccable and complete. So, since I have an American name, he assumed I did not speak Spanish. So, we spoke English exclusively with one another. Apparently, while I was under anesthesia there was a great deal of Spanish conversation going on ... and, anesthesia notwithstanding.... awareness of that does leak in on some level. I woke up speaking Spanish to the surgeon. He was very surprised. I told him he was an amazing surgeon because he had surgically implanted this "ability" to speak a new language. He was very amused, and probably spent the night wondering what he had said in front of me while he was speaking Spanish. So, Jennifer, not to worry about losing it.

But, for those who don't speak any Spanish, and whose doctors are not totally fluent in English, who are contemplating a stay in a hospital where the staff won't speak English: considering being in a culture where you are comfortable can actually be a life saving decision. You can communicate to anyone when you think there is a problem and you can understand the questions and responses. It certainly would reduce the stress involved, and that has to help recovery too I would think.

Of course, many doctors in the United States, are themselves foreigners and their English is a bit ... um... random.

Life is a crapshoot, isn't it?

Bloviator

May 24, 2007, 8:42 AM

Post #7 of 17 (2324 views)

Shortcut

Re: [Georgia] Medicare or Local Medical Care?

Can't Post | Private Reply

Great story. When I had my eye surgery, I dealt with one of the doctors in Spanish. I was, however, very grateful that I had the backup of the other doctor to speak English with, just in case I missed something in our Spanish conversation.

My wife's daughter has found out about robotics for surgery. Evidently my surgeon is not going to use robotics. I'm catching much flack from wife and daughter for that reason. Of course, I'd have to change doctors and hospitals to change the system and probably go on a long waiting list, but that seems to be irrelevant.

I have assuaged their concerns by explaining that the robot that does the surgery is controlled by a surgeon in Bangladesh using a computer and assisted by a nurse in the Phillipines who only speaks Tagalog.

I sure hope my surgeon can implant the Spanish language facility in me.

Rolly

May 24, 2007, 9:12 AM

Post #8 of 17 (2311 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

My experience with a major medical event in Mexico was completely positive, and I will certainly use local facilities again if (when) the need should arise. Of course, I live next door to a major city, and that certainly makes a difference.

I won't repeat the story here because I posted it earlier: http://www.mexconnected.com/...i?post=105437#105437

Rolly Pirate

Bloviator

May 24, 2007, 10:14 AM

Post #9 of 17 (2299 views)

Shortcut

Re: [Rolly] Medicare or Local Medical Care?

Can't Post | Private Reply

Many people share your feelings and have shared your experiences. I respect your and their experience. I suspect you have IMSS. That very much alters the variables.

I am being very careful in this statement: One of the local doctors has been called by a friend "The Killer Doctor." Another friend assures me that he killed her mother. Another is "he Witch Doctor." Maybe we just have found the wrong doctors. It can be a problem finding the superior medical services that we know are here.

The WD, however, has cured my torn rotator cuff that I had for several years NoB.

Rolly

May 24, 2007, 1:41 PM

Post #10 of 17 (2277 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

No, I do not have IMSS; I was refused coverage. I am self insured.

Rolly Pirate

Bill in NC

May 28, 2007, 6:58 AM

Post #11 of 17 (2127 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

All I could think when I saw the title was "it's nice to have a choice."

Mom never qualified for Medicare (too young, & as a homemaker, she didn't have enough work credits)

Mexico was a godsend for the custodial care she needed for the last 6 years of her illness until she died late last year

(not Alzheimer's, but a rarer dementia which hits as early as your 40s)

Bloviator

May 28, 2007, 1:12 PM

Post #12 of 17 (2092 views)

Shortcut

Re: [Rolly] Medicare or Local Medical Care?

Can't Post | Private Reply

Rolly, I'm sure you cover this in your excellent postings, but is there an age limit on IMSS?

We were in a couple of villages on the west side of Lake Patzcuaro last week. I saw an IMSS clinic in each. I don't think I'd like to depend on either.

Rolly

May 28, 2007, 1:35 PM

Post #13 of 17 (2087 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

I do not know if there is an age limit for IMSS insurance.

Rolly Pirate

Don

May 29, 2007, 9:16 PM

Post #14 of 17 (2006 views)

Shortcut

Re: [dlyman6500] Medicare or Local Medical Care?

Can't Post | Private Reply

IMSS is a good back up for major medical problems and is priced right for the wife and I. Our cost is about $600 U.S. per year. We use a private physcian in Mexico for our medical care and pay as we go, but having a major local backup like IMSS is great. I started it when I was 62 and am still covered at age 70. I also have full coverage in the U.S. which paid for itself with my usage last year. I don't feel bad about the money paid for insurance coverage as it more than paid for itself last year and gives us peace of mind.

NinaNina

May 30, 2007, 9:25 PM

Post #15 of 17 (1947 views)

Shortcut

Re: [Don] Medicare or Local Medical Care?

Can't Post | Private Reply

Would supplementary private insurance in Mexico also be considered worth it, or do you prefer the pay-as-you-go for minor things/IMSS as back-up arrangement? I'd also be interested in hearing opinions about medical coverage for young children, if any parents want to weigh in on the topic.

Don

May 30, 2007, 9:36 PM

Post #16 of 17 (1943 views)

Shortcut

Re: [NinaNina] Medicare or Local Medical Care?

Can't Post | Private Reply

Everyone has to look at their needs to see which way they should go. My needs turn into something major, so the way I went, was best for me.

waltw

May 31, 2007, 12:36 PM

Post #17 of 17 (1885 views)

Shortcut

Re: [NinaNina] Medicare or Local Medical Care?

Can't Post | Private Reply

We have private, Medical insurance via my employer but fortunately, haven't had to use it yet. It only covers hospitalization/major medical, etc.

In Oaxaca, for the "small stuff" we see the physician that has an office adjoining the pharmacy "Similares"
The cost? A little under $2.50 US per visit.