My Healthcare Experiences Living Abroad

Healthcare is big news these days.  Being self-employed, having four kids and having spent significant periods abroad has given me a unique perspective on healthcare in the US and in other countries.

India, 1979.   There was a doctor around every corner and care was immediate.  Despite seeing more doctors in one year* than I had seen in my previous 15, I spent hardly anything.

*Malaria, dysentery, heat exhaustion—I was a 16 year old boy who did not need to take any stinkin’ precautions.

Japan, 1986.  Daughter #1 born.  We paid into the Japanese socialized medical system directly from our salaries.  Private room, caring doctors, insurance coverage for up to 7 days in the hospital.  Government- paid medical leave compensation plus unused hospital days resulted in a payment to us of $4,000.  We never saw a bill–just a check.

Japan, 1987.  Daughter #2 born.  We received ONLY the unused hospital care payment of $2,500.  I thought about complaining…

USA, 1989.  Daughter #3 born.  We had major medical insurance.  Out of pocket cost: $2,500.  What? I got paid for the first two!

USA, 1990.  Daughter #4 born.  Same result as #3 and had to pay $2,500.  Still up by $1,500 on the birth business so stopped while I was ahead.

1990’s to 2005.  When we left the US in 2005 we were paying $500 per month for major medical insurance with a $2,500 yearly deductible per person.  We spent about $5,000 per year out of pocket mostly for dental and orthodontia in addition to our insurance premiums.  We never met the deductible for covered items in our policy.

2005, Mazatlan, Mexico.  Before leaving the US we took out a World Nomads Travel Policy.  Nice people, reasonable cost though I never submitted a claim.  Cheap peace of mind.

Mazatlan, February, 2006:  Maya had chest pains.  We took her two blocks to the public military hospital and within a minute of arrival Maya had a blood pressure cuff on and two doctors attending.  The doctors did an EKG and chest x-ray.  She was diagnosed with mitral valve prolapse which is a common and sometimes uncomfortable heart valve condition but not overly serious.  $75 cash, no paperwork and no further bills.  In and out in 2 hours.

Current.  Buenos Aires, Argentina.  We have the whole family on a private medical plan that now costs $385 per month and covers everything except elective surgery.  The hospitals are modern and the care superb.

We know several non-residents who have received excellent free care from the public hospitals and had few complaints.

Having grown up in a family that did not go to the doctor much due to cost (Dad was self employed), and continuing that pattern with my own family, having healthcare available to me now is an unexpected luxury of moving abroad.  I hope that someday soon everyone in the U.S. can be covered by affordable medical insurance and experience the peace of mind I have in Argentina.

After spending time living overseas where residents (and in some cases non-residents) have free healthcare and free education through college I wonder what I would have worried about if I had access to the same while living in the US.  I am sure I would have thought of something….

Interview: Frank Almeida in Buenos Aires, Argentina

1. How old are you, where are you from, where are you living now and what took you there?

I am 42 years old. I was born in Chicago and lived there most of my life except for the last 10 years, and a couple of years in Mexico when I was a small child. For the past 10 years I have been living in Buenos Aires, and what brought me there was love.

I met my wife on the dance floor of a dance club called Stardust in Chicago (don’t bother to google, I don’t think it’s around anymore. The ones I saw are not it). She was doing her MBA at the University of Chicago. We did not get a chance to talk much, but I guess it was enough to get her attention. I gave her my business card as her friends whisked her away for the evening. Her Argentine friends told her to not waste her time with me since who am I expecting her to chase me by having given her my business card. Luckily she also asked her American friends who told her that I was being gracious by giving her the choice of moving ahead or not. In retrospect, I think she liked the idea of being in the driver’s seat, and seeing how guys are around here, that must have been pretty refreshing.

2. How long have you lived there and how long will you stay?  What keeps you there?

Love brought me here and is keeping me here. I do love it here. Yes, it has its ups and downs but it is an adventure. It is something that is still alien and foreign to me. I am the kind of person that gets bored pretty quickly with just about anything. Argentina is far from being boring. The minute you think you have this place figured out and you fall into complacency the rug gets pulled from under your feet. It is unsettling, but it is not boring and it is challenging.

But it is also a warm place. I can’t imagine another country being so kid friendly. I can take my kids to just about any restaurant without fear of getting attitude by waiters or cold hateful stares from other patrons. Kids are allowed and expected to be kids. Funny enough, most of the time the kids do rise to the situation and behave themselves.

Having said all this, my car just got broken into for the second time and right in front of my shop. Every single car I have owned has been broken into. I shouldn’t be so glowing about Argentina, but you have to take it into the greater context of what it is like to live here.

We have a close knit family that helps each other out, we all live near one another, having access to a maid is fantastic and don’t get me started on the bidet!

3. What do you do to make a living?

My wife and I created Argentina’s first gourmet cookie factory Sugar & Spice. Honestly, the country did not have anyone filling this niche. Any gourmet cookies you found were of the imported variety and they weren’t actually gourmet cookies. Our brand of cookies and baked goodies can be found in the best supermarkets of the country as well as in your local wine stores, gourmet shops, cheese stores, department stores, boutique hotels, and they even serve them in some medical centers. We also provide cookies to Aroma Cafe, Starbucks, McCafé, Munchi’s, Freddo, Jumbo Supermarkets, The Barbie Store, and currently talking to some others to expand that list.

Our factory also has a store front where you can come by and purchase our regular line as well as some things that are exclusively available at our shop. Sometimes we experiment and currently we have mocha biscotti and we have a very deluxe version of our panettone with chocolate for example.

I also have a blog that I write, but I don’t make a living out of it. I did it mostly to help my website get some presence. Before I started it, I could not find my website on any search engine.

4. Describe your average weekday and weekend day.

In the morning we chase the kids around to get them dressed, and ready for school. We then take them ourselves. My days are actually different from one day to another. We have a couple of new products, which leads to a bunch of new clients so I have to carry around a binder with separations for each client with the current open situations that I need to move on, otherwise I would get lost with what has to be done with whom and when. I am feeling pretty overwhelmed these days.

Since June this country’s economy has slowed down. Every retailer is complaining and their sales have decreased substantially. It is a crisis and I don’t even know if the papers are writing about it as such. We are definitely feeling it and the only thing that could or would be saving us are the new products that we are launching as well as the beginning of the holiday season.

Having said that I have to send e-mails, try to get meetings, go to meetings that are either sales meetings or price negotiation meetings or new product meetings, etc. It is basically hectic and confusing.

5. What skills have you learned while living abroad?

I think that I have learnd how to stand up for myself much more effectively. You have to be much more proactive here and not be afraid to be confrontational when the situation arises. I don’t mean you have to go yelling at people, but they do borrow from the Italian tendency to get all hot and bothered one minute and then completely cool down the next. If you stand your ground, you earn respect. You have to remember the cooling down part.

6. What are you missing (professionally) by not being in your home country?

This one is difficult. I was never in this industry back home so I don’t know. I do get the sense that it is not as formal here so things are bit more laid back. But I am going to have to say that I don’t know on this one. Is that allowed? Can I not know something?

However, last week I was waiting around for a potential new client in their office. They had me (and several others) waiting around for 5 hours. I had to walk into his office and not show my irritation. That was some nice acting.

Right after that I had another meeting with a current client and this time, after 1 hour I asked the receptionist if the guy was really in (because he normally does not leave me waiting so long) and she said that he was. I waited for an hour more and then told her that I couldn’t wait anymore. The next day he calls me and apologizes for the receptionist. He was at home sick and she basically flat out lied to me or did not know what the hell she was talking about. I have to hold that one in. When I saw her after that, she recognized me and her attitude was much better about calling him for me, but I couldn’t say anything to her. I have to keep being nice and friendly.

7. If you could live anywhere, where would that be and why?

I like it here, I really do; so Argentina would be my first choice. I think I would need to travel a bit more to come up with a good response. I also loved Italy’s country side; I also loved France; London would have been great in my younger years I think, but I did not feel the love for it. I also did not get to vacation that much. I have been there twice, once for work.

I also love Mexico, but I don’t know if I would like to live there and work there. Maybe if my work was in the States while living there. However, I do have that love for the place when I visit there and I miss it terribly.

8. What is your favorite gadget that makes your work life abroad better?

I have several. My MacBook Pro is awesome and paired with my iPod touch I am in techie heaven. I would love to equip my home with more Apple products. Some day when I have more money maybe.

I have also just bought a magicjack so that helps me to keep in touch with my friends and family in the States. Yeah, the website looks awful, but the thing works.

9. Do you have a favorite book that inspired you to travel or consider a different way of living?

Nope, never researched it or planned on it. However, I am going to read The New Global Student.

10. Other than yours, do you have a favorite expat blog?

Actually there are so many. I have them all side-linked on my blog and I have them on my Googlereader. I might have some on one and not on the other. I have to get that better organized.

The Advantage of Being Illiterate

I am a pretty angst-y guy, always have been.  Anxious to please, absolutely hated getting yelled at and spent far too much time anticipating and worrying about people’s reactions.  I once broke out in hives for 24 hours when I was twelve for something I DIDN’T say to a girl.

Then I got married (different girl—broke out in a rash on our honeymoon) and had four kids in short order.  There is nothing like having kids to open the world of fear wide open and give you an enormous number of problems to anticipate and try to solve before they materialize.

I finally determined that 95% of the things I worried about never came to pass.  And, for the other 5%, I somehow was prepared for those situations on a “just-in-time” basis.  So really, it did no good to worry about them in advance either.

I would like to say the belief above helped me worry less, but it did not.  Maybe it is just something that will be with me forever, like a birthmark or overly-sensitive skin.

However, I worry less since I moved abroad.  I know, it sounds counter-intuitive, move someplace where everything is different and where you have no support and have no idea was is going on around you.  But really, the act of moving abroad, as long as you do it simply, is totally liberating.

It is hard to worry if you don’t know what you are supposed to worry about.  And, if you are functionally illiterate, your ignorance of things to worry about stops you from worrying about the 95% of things that will NEVER happen.

The few things you need to worry about you still worry about and that is a good thing because it allows you to focus on protecting them.  Money, passport, credit cards, keys?  Check, check, check.

If you have made your business virtual before moving overseas then all your worry can be relegated to your laptop.  Laptop open, take care of business.  Laptop closed, the day has ended and you can worry again tomorrow.

Something happens with geographical distance (even in this age of immediate communication via internet) and it is just harder to worry about business if it is far away.  Even harder if your life abroad is full and exciting and distracts you from day to day business concerns.

I hope to learn Spanish well some day, but in the meantime, I will continue to enjoy not knowing about all the bad things that probably will not happen to me.

 

Audio Interview with Maya Frost

Since internet was installed in our apartment just yesterday morning, Maya did the following interview from a favorite cafe, Piacere, on the corner of Guruchaga and Paraguay.  Quiet booths, fast connection AND plug-ins right at the table!  Luckily for us, Piacere is open until 1am and serves ice cold liters of Stella Artois (for the tech staff).

Summit Series for Families hosts a weekly live interview and rarely have I seen Maya enjoy doing an interview more, thanks Julia!–and frankly neither have I, thanks Stella!

The following piece is from the SSFF blog but you can just click here to go directly to the audio link.

If you’ve ever dreamed of slowing down, selling all your stuff and moving abroad, Maya Frost can tell you how to do it.  If the fact that you’ve got kids makes it seem like it might be a bad idea, she’ll give you some very convincing arguments why it’s not.  And if you’re the parent of a teenager and you’re interested in ideas that can help your student stay motivated and excited about learning, instead of bogged down in the stress and competition of SAT scores and AP classes, you need to read her book if you haven’t already.

The new Global Student, Skip the SAT, Save Thousands on Tuition, and Get a Truly International Education is a valuable resource for anyone who is ready to take control of their own education.  Maya joined us last night (at 10:00 pm from Buenos Aires!) to discuss her book and her family’s experiences since they left their suburban home in 2005.

Her book includes the stories of students from all across the country who have packed their bags, moved abroad and embraced new cultures and languages.  The self confidence, cultural awareness, flexibility and language skills gained from this “bold school” approach is what makes these kids stand out in a crowded job market.   Her book is not about traveling with a group of American students abroad for a single semester, to enjoy an international “party” but rather a practical alternative to the stress and limitations of going the traditional high school route.

The New Global Student encourages you to question the logic of your current path and provides creative options for finishing high school early, beginning your college classes ahead of time and skipping the SAT in the process.

Link to audio page here.

Interview: Jed Rothenberg in Buenos Aires

1. Where are you from, where are you living now and what took you there?

Greensboro, NC, Buenos Aires, Argentina and a desire for change. I was tired of facing a materialistic rat race and knew there was more to life. I wanted adventure, to broaden my perceptions of life, to live somewhere where I had only dreamed of going one day.

2. How long have you lived there and how long will you stay? What keeps you there?

5 years…only time will tell. A growing business, a beautiful girlfriend, a lifestyle that is full of new surprises even to present day.

3. What do you do to make a living?

A tourism web site, LandingPadBA. Ad sales, commissions, we’re about 50% of the way to our minimum monthly revenue goals after 9 months of hard work. Ahead of schedule!

4. Describe your average weekday and weekend day.

Roll out of bed at 8:30 am, drink coffee, smoke the morning cigarette, watch morning news. Check emails and start working on daily, weekly and monthly projects and developments. 10 am take shower, more emails, meetings, calls, break for lunch. Walk around block, chat with baker, deli guy, chino cashier- return and make sub. Random tasks and spinning plates, chat with roommates/partners. 8 pm start slowing down, watch Simpsons, finish emails, meet up with girlfriend for dinner….

Weekend: Roll out of bed at 11:30, watch news, drink coffee and have tostados, get yelled at for smoking morning cigarette by girlfriend. Shower and off to local market for veggies, meats, fruits, etc. Drop off goods and prep lunch and then off to the park with the lady. Play cards, drink mate, enjoy the sun. Out to eat for dinner at 9:30 pm and then movies or bar. Return home at 2 or 3 and repeat.

5. What skills have you learned while living abroad?

Patience and to laugh at myself even harder.

6. What are you missing (professionally) by not being in your home country?

The big bucks, that’s about it.

7. If you could live anywhere, where would that be and why?

Either Brazil or India. The food being the main draw, closely followed by a beach then a different language and culture, both of which I have always found interesting.

8. What is your favorite gadget that makes your work life abroad better?

iPod.

9. Do you have a favorite book that inspired you to travel or consider a different way of living?

On the Road, Jack Kerouac

10. Other than yours, do you have a favorite expat blog?

I always liked: http://buenosairesperception.blogspot.com/ Met these guys a while back because they had a picture up on their page of the ugliest building in Buenos Aires…it was mine.

No Matter How Hard it Gets 85% of Expats Choose to Stay Living Abroad

…..according to HSBC’s Expat Explorer survey, 85% of expats choose to stay living abroad.  This speaks volumes about the famed expat lifestyle and how much better off people find themselves to be when they relocate overseas.

Read the complete story here.

Switching from the “No Dad” to the “Yes Dad”

Even before I was forty I had a reputation in the neighborhood as the curmudgeonly dad who always said “no”.  This was a little odd because I was very lenient with my kids regarding things that did not require money or transportation supplied by me.

If they wanted to go by themselves downtown on the train with a friend or a sister I was OK with that.  If they wanted to ride their bikes to their cousin’s house in the next town over that was fine with me.  If they wanted to bathe elephants in crocodile-infested rivers in Nepal, I was going to go right along with it (OK, I went in with them).

But, ask me if they can go with friends to a moronic movie at the metroplex that cost $10 per kid and I was bound to say “no”. Go shopping at the mall?  “No”. Attend four different birthday parties in a month($20 gift required for each party)?  “Uh-uh.”  $75 spa day with girlfriends?  “Nunca”. Trip to the city in a car driven by someone’s teenage sister?  “Are you insane?”

Yeah, a real hardass.

I did not enjoy saying no but I also was not going to have my kids get used to consumption habits that were unsustainable and devoid of any educational value.

Purchasing goods and services traditionally has been done out of necessity and for pleasure.  However, in the American teenage world of today it seems that most of the activities that I said “no” to were activities done out of habit or boredom.

“Mom, I am bored, can we go to the mall?”

“Mom, I am thirsty, can we go to Starbucks?”.

“Hey, let’s hang out together, do you want to go to the movies?”

“Dad, can I go to the under-age club?  BTW, you will have to pick me up at 11pm and I will need to buy some skanky clothes so I don’t look like a loser….”

If I had only one kid it would not have been such a big deal but having four kids close in age amplified the requests and costs and made me standardize what I felt was valuable and what I felt was not.  Poor kids, it sucks having a dad who thinks about how much education they can get out of going to the mall.

Moving abroad totally changed my response, mainly because the activities they were involved in required:

1. learning (Spanish)
2. cultural immersion
3. very little money (if anything)
4. physical activity  (walking, dancing, swimming)
5. no transportation assistance on my part

Dad, my friends want to walk over to the beach after school, can I go with them?  “Sure!”

Dad, my classmate wants to know if I can stay the week with her family to help her with her English and me with my Spanish.  Is that OK?  “Absolutely”!

Dad, my friends and I want to go to the under-age club and dance until dawn.  It is 10 pesos cover (US$1).  “Sure, come home when it is light and take a taxi with a friend.”

Generally, the requests the kids made so they could be with their friends were safe—especially considering that NO ONE was driving.  Buses or taxis were inexpensive and frequent.  Mexican parents love their kids as much as American parents do—they just have not been as inundated with fear-inducing 24/7 media.

The girls going out dancing one night a week until dawn became the norm.  In fact, I grew to believe it was exactly what teenagers needed more than just about anything else.  Having a night of dancing to look forward to at the end of the week and then exhausting themselves doing something they loved made the perfect weekend for them and us.

I learned to love to say “yes” and looked forward to hearing about what they learned.

Plus, for less than $10 my kids could each have what they unfailingly referred to as “the best night EVER” complete with dancing, food and transportation.  Big grins all around.

A very cool benefit of learning to say “yes” was that the kids became good judges of how far they could push me.  They learned what I thought was a positive, safe and worthwhile experience (Spanish, physical activity, no cars, group of friends, low cost) and what was not.  Because virtually everything was free or inexpensive, one of my biggest barriers was no longer a factor.  And, they have continued this same sort of value-assessment now that they are older and no longer have to ask for my permission.

Over time, it became quite clear to me that the parent-teenager rift that is standard in the US is not as prevalent in Mexico or Argentina.  If teenage requests are safe and low cost, then parents can more often say “yes”. Once parents say “yes” more often than “no”, then teenage rebellion becomes a moot point.

Switching from “No Dad” to “Yes Dad” was one of the most surprising and pleasant results of moving abroad as a family.  And because of this, I am sure I have a much better relationship with my kids than I would if we had not moved abroad.