The words Medicare savings are a red flag to some and a carrot to others; depending on where you stand on the issue of health-care reform, the label is code for cuts or a promise to root out fraud and save billions. But far away from the debates in Washington, a group of expatriate baby boomers point to one place they believe real Medicare savings could be realized: Mexico.
Paul Crist, the owner of a Puerto Vallarta resort who once worked as an aide to former U.S. Senator Paul Sarbanes, says that paying for medical treatment in Mexico could save Medicare almost a quarter of the average cost for most procedures. "My research, as well as the research of others, shows that health care in Mexico costs less than a third of that in the U.S.," Crist says.
A doctor's office visit or house call (still a common practice in Mexico) costs only $25 to $40, according to a 2007 study by the University of Texas LBJ School of Public Affairs. The same study presented information on comparative costs for common procedures: a hip replacement costs between $43,000 and $63,000 in the U.S., compared to $12,000 in Mexico, according to Texas-based hospital chain Christus Muguerza, which also operates in Mexico; a coronary bypass in Mexico costs an average of $21,000 compared to $149,000 in the U.S. Citing statistics from the U.S. census and State Department, Crist estimates approximately 200,000 of the 1 million U.S. citizens living south of the border are Medicare-eligible.
However, Crist says many Medicare-eligible expats living south of the border are forced to fly back to the U.S. for medical treatment because Medicare will not pay for most coverage outside the U.S., even though they have paid into the system during their working lives. Medicare will cover only emergency care if it occurs within 60 days of leaving the country. To utilize their benefits, Medicare-eligible American citizens in Mexico have to opt for periodic flights home or else choose to pay out-of-pocket medical expenses. And because expatriates have diverse geographic origins in the U.S., there are no specific congressional districts they can pressure to legislate change in the Medicare rules on their behalf.
Crist took matters into his own hands. Touting the potential savings to Medicare, he founded Americans for Medicare in Mexico and began campaigning for reform. He travelled to Washington earlier this year to lobby Congress for expansion of Medicare to expats in Mexico. He visited about 85 congressional offices and says many members were open to the idea. Other expat groups like the Association of American Residents Overseas (AARO) joined in a letter-writing campaign. But as the health-care-reform battle grew larger and the bills more complex, Crist says supportive members of Congress told him 2009 was not going to be the year the change could be made.
Resistance to the expansion of Medicare to Mexico is coming from some health-care industry groups like the American Medical Association and the American Hospital Association, according to David C. Warner, who teaches public affairs at the University of Texas LBJ School. Warner says these groups see it as the beginning of a slippery slope that will lead to expansion of Medicare coverage to places like China and Eastern Europe where health-care costs are rock bottom.
Warner adds that the issue also has been raised at the highest levels by Mexican President Felipe Calderón in a meeting earlier this year with President Barack Obama. But any pressure from Mexican interests could be politically tricky, Crist says: "It would not necessarily be helpful to have Mexican firms pressuring Congress on an issue that will benefit this industry and the Mexican economy generally. This could create a backlash among some [U.S.] political groups."
However, there are several forces set to join the battle that could change the power balance. Not only are more expats finding Mexico's climate and low costs welcoming, but investors are flocking to Mexico as a growth market for health care and senior living. "Many in the baby-boomer generation have seen their retirement savings disappear and it is not likely those funds will be built back up quickly," Crist says, explaining why Mexico, with its low costs, has become attractive. Seeing potential profits, he adds, "the developers and operators of senior housing, which runs the spectrum from independent-living communities through nursing-care facilities, are certainly betting on a substantial influx in the coming years." Developments aimed at attracting seniors have been built near Puerto Vallarta and in the northern Baja peninsula, and independent-living projects are planned for San Miguel de Allende, already a popular expat center north of Mexico City, Warner notes.
"Some of the developers in Mexico are affiliated with firms in the U.S., so there will certainly be support in Washington from those firms," Crist says. "Both the senior-housing industry and the health-care industry are internationalizing, and the U.S. players in these industries will be big winners. They have the capital, and the experience to dominate this industry in Mexico and elsewhere, because the senior-housing industry, in particular, is so new in many countries."
Crist plans to hold town-hall meetings in 15 Mexican cities beginning January to pull the expat community together and launch a massive letter-writing campaign. He and other proponents are also hoping to engage another key group in the fight, the so-called returnees Mexican dual citizens, or Mexican-born citizens with legal status in the U.S. who are Medicare-eligible after a lifetime of payroll contributions. In the U.S., proponents will focus on gaining the support of a key member of Congress to carry the banner. Warner says two from Texas are likely targets: Democratic U.S. Representative Eddie Bernice Johnson and Republican U.S. Representative Pete Sessions, whose districts include concentrated returnee populations, multigenerational families with roots in the state of Guanajuato, Mexico, the cradle of Mexican independence and a favorite spot for expat retirees.
"The opportunity to provide services to Americans at much lower cost outside the U.S. border is enormous," Crist says. "This is pushing even private insurers to explore coverage options outside of the U.S., and Medicare will certainly be a part of this globalization, sooner or later. My preference is for sooner."