An emergency tested our Medical plans

Given the group’s demographics, it’s not surprising that health care, along with finances, rank high on the list of preoccupations among San Miguel’s expats, as they realize they are on the last lap around the racetrack. Some planning is in order. At this stage, eightieth birthdays call for special celebration; ninetieth birthdays, well, fireworks and a mariachi.

Most churches have volunteer groups to help congregants confront health care challenges. During the Covid pandemic the local Unitarian group organized a task force to provide information and guidance. Prayers of “joys and concerns” are part of most Sunday services even though, alas, concerns usually outnumber joys and may include an occasional R.I.P.

Not to make light of those gestures, however: Emails, phone calls and hospital visits are immensely comforting to those battling illnesses, accidents or other adversities. They make you feel grateful to live in a close-knit community like San Miguel.

Everyone seems to have their own health care plan. Some people make regular “medical visits” to their home cities and doctors, a ritual not unlike bringing an old car in for routine maintenance and maybe check any strange rattles. At the height of the Covid pandemic quite a few expats flew home to get vaccinated when the latest shots were not available in Mexico fast enough. People afflicted with chronic illnesses might return to the U.S. permanently. Then there are resolute expats who’ve planted their flag in Mexico, even become naturalized citizens, and vow to pursue their fortunes here and rely on the local medical system or insurance plans.

As a last resort, the 24-Hour Association of San Miguel offers subscribers prompt cremation or burial, maybe at the corner of the municipal pantheon reserved for foreigners, as well as processing the necessary paperwork, notifying anyone specified beforehand and other final arrangements.

And so on: Such arrangements are ultimately a matter of personal choice, finances and risk tolerance, beyond any right-or-wrong solutions.

Ever since Stew and I moved to Mexico almost 18 years ago, the availability of medical care has been a topic of discussion between us, particularly with regard to emergencies, and we have weaved a middle path between health care here and in the U.S. We don’t pretend to have all the answers, but when Stew fell and fractured a hip three weeks ago, the pieces of our “what if” plans came together nicely, including ambulance transports; overnight emergency care in San Miguel at Hospital Mac, a newish hospital facility near us; followed by air evacuation, hospitalization and rehabilitation at an orthopedic hospital in San Antonio and a return flight home, also covered by the air-evacuation insurance. We are satisfied with the speed and quality of care he’s received.

During our years here we’ve compiled a list of capable medical providers we trust. Drs. Alvarez, Aguirre, Lim, M. Gordillo and Flores come to mind. Feel free to nominate your favorites in the Comments section at the end of this post.

Unfortunately, we have also run into a clown car of incompetent providers, some too eager to tap into the expats’ credit cards with diagnoses and treatments that were erroneous or beyond their expertise. A friend died from a perforated intestine and subsequent infection as a result of a colonoscopy, a tragic event that was reportedly blamed on her being fat. Stew came this close to an intestinal resection, and reliance on a colostomy bag for several months, based on an egregious misdiagnosis reversed by a second opinion by another doctor—all of this unfolding at around 11 p.m. in an emergency room.

Perhaps malpractice suits, convoluted and rare as they are in Mexico, ought to be less so.

Another factor that motivated us to go north for treatment is that the U.S., at least in our experience, offers far more impressive hospitals and ancillary health care facilities. That shouldn’t surprise: The U.S. spends an astronomical amount on health care—$4.3 trillion in 2021, or $12,900 per person. The next biggest spender is Germany at $7,383 per person. Canada spends $5,905 per capita. The comparable figure for Mexico is $539 per person. (Yesterday the Biden administration announced it will begin price negotiations with pharmaceutical prices for ten drugs covered by Medicare.)

Stew received adequate emergency treatment at Hospital Mac, including X-Rays and an IV, but then spent the night in a mirthless, windowless room with a modern hospital bed but no other amenities than a few sad-looking pieces of furniture, a landscape that didn’t do much to buoy his spirits. There was no comparison to the Baptist Orthopedic Hospital in San Antonio where Stew was subsequently admitted through the emergency room, operated on, hospitalized for three days and then moved to a rehab floor for another three days. Indeed, Baptist’s level of staffing, equipment and bells-and- whistles seemed from another planet.

I can’t vouch that the seeming extravagance of the hospital in San Antonio, where Stew had stayed before for a successful knee-replacement, resulted in superior medical treatment. Maybe it’s a case of appearances, razzle-dazzle and optics. Or possibly a case of the American Medical Industrial Complex piling on at the bottomless trough of money the U.S. spends on health-care. The Texas-size meals he received didn’t hurt.

Whatever: The end result is that we were very satisfied with the treatment Stew received and particularly the final bill—zero— thanks to Medicare. We haven’t even seen a bill yet.

Health care costs in Mexico are dramatically lower than in the U.S. but increased during the pandemic and, I suspect, as a result of the recent uptick in the popularity of American-style private medical insurance. The ER attention and hospitalization for one night at Hospital Mac resulting from Stew’s hip fracture came to US$902. Charges for another knee replacement that Stew had done in 2020 at Angeles Hospital in Querétaro, part of a nationwide private hospital chain, was US$15,000, payable upon admission by credit card, bank transfer, cash or private insurance. That included a three-night hospital stay. Medicare doesn’t cover non-emergency care abroad, despite claims by some expats that they have found a way around those restrictions and smell like fraud to us.

So far so good. In the next post I will talk about the air evacuation from San Miguel to San Antonio, the more surprising part of of our “what is” experience with Stew and his broken hip.