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Millions of Americans Flood into Mexico for Health Care (truthout.org)
79 points by howard941 29 days ago | hide | past | web | favorite | 65 comments

The rhetoric in this article is disingenuous. Regardless of your political persuasion, there is an enormous difference between someone walking across the border for a single day to purchase a good or service in another country and an economic refugee seeking permanent or semi-permanent resettlement in a host nation.

Americans heading for Cancun are not "vacation refugees" either.

We have socialized health care, so you may think that you spend some dollars on the Mexican economy but, the American Caravan distorts our markets and drive prices up.

All kinds of foreign tourists drive prices up for a lot of things, but nevertheless they really bring money to Mexican economy.

But tourists drive prices up for markets that aren't regulated like hotels or restaurants, Healthcare is regulated and we will probably see some kind of legislation towards this issue with the new Mexican government, it probably will make it even cheaper for you guys to come here but you will have to enroll on our socialized healthcare.

You are mistaken - I was assured by many sources in the media that immigration, even temporary, has no down-sides.

This is an article about medical tourism.

Its the same article no matter which country people are traveling to. The fact that it is about Mexico or Latin America at all enables political comparisons for perspective.

Its an irony or tragedy when people can't get care in their host country with stronger infrastructure in other places.

>This is an article about medical tourism.

Precisely. Which is why I found the article's repeated attempts to conflate refugees and tourists to be so transparently disingenuous. Those political comparisons are completely orthogonal.

It has been more than a little educational to ride the F5 key and watch the karma on my original post bounce like a pogo stick!

Analogies compare to dissimilar things with common attributes, and it is up to you to figure out what the common attributes are. Not the dissimilarities.

I think there is some utility to these comparisons, as they are orthogonal, the hyperbole drives the point home.

> Its an irony or tragedy when people can't get care in their host country with stronger infrastructure in other places.

Except that that isn't really it. It's that it's more subsidized in one place than the other. If it's $200 here and $100 there, and it's exactly the same thing, who doesn't want to save $100? That's true even for people who can afford the price here.

Probably what Mexico should be doing is charging separate prices to foreign nationals.

Mexico isn’t charging anything- it’s the individual providers setting up shop in a border town to cater to American patients.

They can and do charge more but competition drives prices down.

I don't know enough about the healthcare system in Mexico to tell you exactly why the prices are lower there, but it's likely to be one of two things.

One is they have some kind of government funding or other subsidies for healthcare providers there, in which case they should look for a way to direct their funding to their own population and not rich foreigners looking for lower prices.

The other is that the regulatory environment in the US creates unnecessary costs that don't exist in Mexico and people are naturally taking advantage of the lower overhead. That actually seems pretty plausible given what the regulations look like in the US. But in that case Mexico doesn't need to do anything and everyone who can should try to get their healthcare in Mexico, until such time as the US providers lose so much business that they actually lobby for something to be done about the wasteful regulatory overhead in the US which is making them uncompetitive.

I am from Central Europe and I opt for a private doctor (meaning I pay for all of it) and while it is insanely cheaper here compared to the US trust me that the "free healthcare" is a myth in a sense it is not a silver bullet.

No system is perfect and, no, there is no silver bullet.

But US health care costs more as a % of GDP, and doesn't lead to appreciably better outcomes.

I'm told that most of the cost is the US will treat people longer who are going to die in a short time. Someone who will die in 2 weeks can have their life extended to 4 weeks with expensive care... Of course the costs are much higher and outcomes don't change much. For normal care (meaning you are expected to live a good life for a long time latter) costs are more in line.

When I'd go to the doctor in Italy, I'd basically go the waiting room and take a number. When it was your turn (some doctors were pretty fast - 10/15 minute wait - others were slow) you'd go in and see the doctor. No other staff needed.

Compare and contrast with a US doctor who has a number of support staff, one of whom is probably full time doing nothing but insurance paperwork.

IDK all the details, but when the US looks more bureaucratic than Italy of all places... something isn't right.

Of course it's definitely a complicated system and more expensive end of life care is probably part of it too.

I think some of those staff are there because doctors are highly compensated in the US. The staff is there to maximize the utilization of the doctor's time.

Or because they need to maximize the doctor’s time so he can stay highly compensated.

It's a combination of many different factors that all add up. Off the top of my head:

- End of life care in the US is indeed a lot more extensive than in other countries.

- As davidw said, administrative overhead throughout healthcare is ridiculously inflated due to the nature of having to deal with insurance companies and billing. This is both people and software.

- Drugs generally cost a lot more than they do elsewhere in the world due to a lack of regulation on costs and the need of pharmaceutical companies to recoup their development costs by charging Americans more than they can make elsewhere.

- Without a single payer system, billing is completely ridiculous and leads to hospitals way overcharging for services, knowing that insurance companies will negotiate it back down.

- Hospitals are required by law to treat everyone, even uninsured and homeless people who will never be able to pay for their care, so they have to charge more to everyone else to compensate.

- The profession of doctor in the US is a weird semi-monopoly setup with artificial constraints on how many new doctors enter the market each year. As a result, you end up with people spending a good chunk of their lives studying to be a doctor, regardless of what kind, and taking on huge debt until they become a "real" doctor. The end result is that the profession makes a lot more money than it does in other countries.

- Because healthcare in the US is so expensive even with insurance (the amount you have to pay before your insurance kicks in can easily be thousands of dollars a year), many Americans don't use healthcare for preventive care and thus health issues that would be cheap to prevent become expensive to treat later.

- Hospitals in the US are mostly private and for-profit, with margins in the 6-8% range. That's money going to executives and shareholders rather than to actual healthcare.

> The end result is that the profession makes a lot more money than it does in other countries.

I don't doubt that, but it's worth pointing out that they make good money - as they should - in other places too. My wife has a family friend in Italy, who has a ski house up in the mountains a motorboat on the Po river delta and regularly goes on fancy vacations. And that's as a general practitioner. I think most of us want doctors to be well compensated for the service they perform and would be wary of a system where that's not the case.

Yes, but it's generally specialists in other countries making a lot. See [1]. US-based GPs make a lot more because they go through almost the same amount of time and effort as specialists.

[1] https://journal.practicelink.com/vital-stats/physician-compe...

U.S. Healthcare is more expensive because every single step along the way costs more.

This blog series[1] by healthcare professionals goes through it all. The primary culprits are: more expensive inpatient care, more expensive outpatient care, more expensive drugs, higher administrative costs, higher insurance costs, higher health investment costs, higher disease prevalence costs, and higher defensive medicine costs.


Sidenote, this is a good argument for talking to your loved ones about palliative care and what you'd want in end of life scenarios.

I am French living in Switzerland, sorry but private health care is a scam. Switzerland choose to privatize insurance because it would be supposedly better and cheaper. 10-15% inflation a year on premiums.

I am glad it works for you it just does not work for me and I'd rather manage my own resources than having the state have a say in that.

> I opt for a private doctor

curious. why?

Socialized systems can engage in agressive cost-cutting, meaning that the poor use the public system and the better off private system. Thats how it is in argentina as well.

Because I want to be treated like a human not a nuisance or just a mere number.

I do not have the time to wait and I do not have the nerves getting misdiagnosed.I do not have the luxury of wasting time and my own resources being treated by someone that does not care. Dont take me wrong I do not think that the private doctor cares about me.He cares about me because I am a paying customer.

I do not want the doctor acting like I am 5. I do not need an authoritative figure that acts like a bureaucrat. I want a person that gives me an honest, objective assessment.

I want to be able to talk to my doctor about things that matter to me and I do not need to make a visit every time I need to ask something. I would rather shoot him an e-mail get his opinion and act accordingly. I do not want to waste time going to the doctor getting some generic drugs.

I want the doctor to be professional, giving me you know options regardless of whether they are covered by an insurance or not.

And also because I really do not want to visit doctors. I do not want to plan it. I do not want to spend half a day going from one doctor to another. I want an exact appointment and I want the doctor not waste his time gossiping with patients and nurses. He has the right for break but not every 20 minutes especially when he has people waiting for him.

The amount of money I spend on healthcare with my taxes is MUCH higher than what I spend a year. And now I do not have any sense of solidarity with the rest of the country. I could not care less. To me this kind of taxation is nothing but a theft.

"private paid healthcare" is also a myth in the same sense, so this isn't a useful line of analysis to distinguish the two.

I am a Canadian and I have traveled to Mexico for dental care multiple times. It worked out way cheaper cheaper, and I got some nice vacations out of it. I have heard horror stories but my experience has been great.

For those unaware, Canadians do not have universal dental care. It can be very expensive here, when the Canadian dollar was stronger I knew people traveling to the USA.

I lost a few teeth because of lack of dental insurance in Canada. Some companies provide it as a benefit, but they're far and few in between.

It's not too surprising, either: since you have universal healthcare, a lot more companies don't provide insurance (which would be complementary). In the US, it's definitely not the norm to have dental insurance, but it is to have insurance as a benefit, at which point dental is just an add-on for companies to provide (I'm obviously oversimplifying).

I've never worked for a company in the US that didn't provide dental (even though I know it is common-ish), but in Canada I only worked for a few in the same field who did provide it.

Extended insurance is not free; your employer has to pay that, and it comes out of your salary, effectively.

"Insurance" for recurring items like dental cleanings, massages and whatnot isn't "insurance" in the regular sense of the word; it is pure overhead.

It's gamed so that the insurance company makes money, otherwise why would they do this. You pay them $5 so they give you back $4 and send you to the dentist, massage, or whatever.

There are yearly limits, and you cannot get any left over cash back that you have not used!

Since I started contracting, I put away 300-something dollars each month into a health insurance bank account, and then I go to the darned dentist as I would under extended health insurance. Whatever is left over in that account is mine.

I have a basic emergency insurance for 300-something per year, that doesn't cover any routine, recurring services. It will cover emergency dental, like having teeth broken in an accident.

Anyone who doesn't have coverage, but otherwise has a good job, yet doesn't go to the dentist because of "I don't have coverage" is purely a victim of psychology, not of any actual economic circumstances.

> Extended insurance is not free; your employer has to pay that

Maybe, except now I make more money than any company that doesn't have such insurance would offer me, AND I have the insurance. So it's all win. My employer didn't have an option for "if you don't take the dental insurance we'll give you more money".

With the exception of working at a University with no coverage, everywhere I have worked (before I started consulting) provided dental coverage. However it was often $1500-2000 per year max which is very easy to use up.

So how much would a regular cleaning and filling in a cavity cost in Canada without insurance?

It depends. In Alberta they have a "Fee guide" which is what people with insurance will get reimbursed for. Some dentists follow the guide, some do not. It's frustrating because they do not like to tell you the price until its over.

Last time I was at dentist here was x-rays + cleaning and it was around $400. I had a root canal which was $1200 and a crown made which was around $2200.

In the US generally the x-ray and cleaning is well covered if you have insurance. However as move towards the complicated procedures, the costs do go up.

I had my big toe have surgery done when I lived on the border in California, a LONG time ago. It was a 25 minute drive from my house and a friend used the doctor prior.

1) US Doctor wanted $600 and in Mexico it was $85. Everything went well and I was happy I did it in Mexico.

2) I had to buy my needles and all other medicine that was used on me. Cost me $15. Weird buy that stuff, but back then people were afraid of used needles and cheap meds.

3) I also bought my antibiotics off the shelf and got 500 pills for $8. Meds in Mexico are so much cheaper.

The article focuses on dental care specifically, not healthcare in general.

Most dental plans don’t cover much at all beyond regular check-ups, cleaning, X-rays and fillings. Beyond that, patients are expected to fork over much of the cost of large but common procedures like crowns, root canals and implants.

One of the reasons dental care is so expensive in the United States is insurance.

Another cost for US dentists is malpractice insurance, which is not required in Mexico.

Dental work in Mexico is on average two-thirds less than in the US and customers may save 80 percent or more on some costly operations.

I've gotten a cleaning in Nuevo Laredo 10-15 years ago while in school. It was very straightforward and I'd do it again if the circumstances warranted.

> Another cost for US dentists is malpractice insurance, which is not required in Mexico.

Sad that this article perpetuates this myth about costs. Malpractice insurance for a dentist is about $3000/year. At $250/month the malpractice insurance is paid off after the first couple of patients on the first day of the month.

Another way to look at it: The average revenue for a dental practice seems to fall somewhere between $500000-$700000. So even if malpractice insurance were $5000/year, that would still be less than 1% of revenue.

In the supposedly grossly litigious United States, it should raise some eye brows that a professional who is widely feared for causing pain and discomfort, who's interventions are often destined to fail sooner rather than later, pays so little.

>The government provides basically tuition-free education. “When we get out of school, we have to pay the government, but we do it by one year of free service, and that’s it,” Miguel Ibarreche of the Sani Dental Group...

Can anyone speak about this as a model for college tuition?

Americans call it ROTC - free college but you have to march around campus for 4 years, and do (5 years?) when you graduate. GI bill also pays college tuition in exchange for military service. some NGOs like Peace Corps and possibly Teach for America will also provide tuition reimbursement.

Changing the model to adopt more civilian alternatives would remove a big incentive to join the military, so I doubt thats going to happen anytime soon, they're already having a historically hard time recruiting.

While that's valid, it's possible an outside organization could do that themselves. IANAL, so there may be regulations in place relating to apprenticeships, etc. on the matter, but it seems like trade organizations could do this.

We offer you a scholarship, in exchange you agree to X hours of work over the first Y months after you graduate.

I've been thinking of taking a trip south of the border to get the teeth fixed up, turns out it isn't so good for them to not go to a dentist since '92. Talked to a few folks who've done it and they were happy with the costs and quality of work.

Since my socialized healthcare (through the VA) doesn't do even emergency dental it's starting to become a pressing issue if I want to save my teeth so why not?

As a mexican living in the US couldn't agree more.

Need an ultra sound? Wait for 3-4 weeks. Want an MRI? Wait for 2-3 months.

Why can't I get immediate care when I need it without having to step on the emergency room and pay (probably) thousand(s) USD?

As a Canadian Expat living in the USA I have never had to wait for any kind of Medical attention. I could get an MRI or Ultrasound in 30 minutes in DFW. My doctor can call ahead to the hospital and by the time I arrive they will be ready for me.

When I lived in Canada I waited 8 months to see a Neurologist for a slipped disk in my neck. During my visit he asked how long I waited because it had healed on its own, I told him 8 months and he shook his head and apologized.

In Canada you need to game the urgency of your ailment.

Your mileage varies everywhere.

The reason they are going to Mexico are for dental care, not doctor care. They are also going because of the cost and lack of insurance, not of the wait times. The wait time for dentistry in the US is just north of 8 minutes[0]. Also, your numbers seems off by an order of magnitude. MRI wait times are 2-4 weeks [1]. Couldn't find any stats on ultrasonography.

[0] - https://www.beckershospitalreview.com/hospital-physician-rel... [1] - https://cornellsun.com/2018/02/08/mri-wait-times-must-be-sho...

I've never had to wait for an MRI or ultrasound in the US.

Really? I just waited 5 months for colonoscopy in Boston. I have a pretty good health insurance. This was the earliest slot I could find in Greater Boston area (Boston, Cambridge, Sommerville etc.)

Nice deceptive picture of the traffic trying to get into the US.

What exactly is deceptive about it?

From the article: "According to Mayor Christian Camacho, up to 6,000 dental refugees make their way to Los Algodones every day in the temperate season between Thanksgiving and March."

That is just one border town in Mexico...

The picture is of the Mexican side of the crossing.

The article is about Americans going to Mexico for cheaper healthcare options. It gives an accurate picture of that situation, and the title is an accurate indication of what the article covers.

It is not about the separate issue of "traffic trying to get into the US", so even if that happens to be your primary concern, attacking it for not covering that seems rather nonsensical to me.

The article and headline is about people "flooding into" mexico for dental care. The photo with the article shows people trying to get into the us. There isn't traffic or a wait going into mexico. It was an editorial choice to show that picture.

Well, everyone going over has to come back eventually...


Debate about the semantics of "American" lacks substance; there are broadly understood contexts in which "America" refers to the USA. E.g. the 'A' in ASCII or ANSI, "anti-American sentiment" (not aimed at Mexicans at all) and such. Trump's "Make America great!" isn't understood as "make all of North, Central and South America great". This "America == USA" synecdoche is international; it transcends cultures and appears in many languages, not only English.

Counterpoint, pretty much all of what we call Latin America does not differentiate semantically between North and South America in common discourse - they refer to themselves as "Americans" living in "America", where USA happens to be an "American" country.

Outside of that part of the world, you're largely correct, "America" == "USA"

You're on HN, do you think you're saying anything we all don't know to be technically true?


Maybe the wall is not so much about keeping people out, but also about keeping people in? and monetize the doors either way?

Huh? Americans needing healthcare are walking into Mexico? And outside the standard ports of exit/entry?

Land border is a legal port of entry/exit that thousands of people cross everyday in this country.

There are 328 official legal points of entry into the United States where documentation is required. 9-11 changed a lot of things in the US, and this is one of them. Border patrol agents (of any nationality) are not fun to spend time with. Also immigration attorneys are expensive.

That's my point. The wall would be there to physically enforce specific mandatory points of entry.

And I don't find it far-fetched now that Trump would make friends financially benefit from the wall construction first, then from future private-handling of ports of entrance.

An older relative lives in San Diego. Badly neglected his teeth, and later in life needed implants for all 28.

A few years after having the work done in Tijuana, decay was discovered at the roots. All 28 have now been replaced, by a stateside specialist, and his retirement savings are considerably depleted.

Hmm. Local, factual anecdote, actionable information -- downvoted. What sort of HNer would do such a thing?

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