2010 Convention of NASSCOM, India's IT and Outsourcing Trade Association

The headline on the April 17 article read:

“For India, US health care a sea of opportunity

Outsourcing firms in India brace themselves for onslaught of work following US health care reform.”

According to the article, India’s huge outsourcing industry will get a 7-year boost.

“India’s outsourcers — the call centers, the medical record transcribers, the software developers — are quietly gearing up for the increase in administrative work and technology development the health care legislation promises.”

Call centers, telecommunications, banking and finance comprise the bulk of the work that US companies presently sent to India. Healthcare currently makes up only about 5% of the total, but is expected to grow swiftly.

Last year’s stimulus bill included an initiative to get everyone’s personal medical records digitized, and much of this is expected to go to India. New health insurance enrollments and routine maintenance of records by the insurance companies may also be outsourced to India.

Currently there are no state or federal regulations which prohibit personal medical data from being sent overseas, although some insurers don’t allow it for their policy holders.

In an interesting twist, three of India’s biggest outsource firms are setting up operations in the US in order to take on that business.

You can read the entire article here.

A quick Google search turns up several Indian sites that offer outsourcing solutions specifically for healthcare, including Outsource2India and Genpact.

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A couple of days ago, Limbaugh, self-proclaimed leader of the far right, told an on-air caller he will leave the country if health reform passes. Read the article

Limbaugh said he would go to Costa Rica. The only problem with that plan? Costa Rica has universal health care.

According to International Living:

“Costa Rica has universal health care, one of the best health systems in Latin America.

“Statistics from the World Health Organization frequently place Costa Rica in the top country rankings in the world for long life expectancy, often even ahead of Great Britain and the United States, even though the per-capita income of Costa Ricans is about one-tenth that of the U.S. and the U.K.”

Never known for his consistency, Limbaugh is now denying he would move there. Instead, according to the Huffington Post:

“I said, ‘Look, there are insurance companies who don’t want to be put out of business.’ … They are establishing health care clinics with quality doctors in places like Costa Rica. They’re going to continue to sell policies to people who have the ability to fly down there and get treatment. If I have to get thrown into this massive government health care insurance business and end up going to the driver’s license office every day when I need to go to the doctor, yeah, I’ll go to Costa Rica for treatment, not move there.”

I guess Limbaugh has totally missed the point that the only so-called reform bills in play right now would provide a massive giveaway to the insurance companies and make the Wall Street bailout look like a kid’s birthday party by comparison.

In any case, it made me wonder where Limbaugh might go if he really did decide to leave.

Socialist Europe? Not a chance. Let’s take a look at what Rush might find in English-speaking countries outside the US, since I’m sure the guy who bleeds red-white-and-blue wouldn’t want to live among those who wouldn’t understand his harangues.

1. Canada. With their single-payer, government sponsored health care, that would be a “no”.

2. Great Britain. National Health Service. No go.
3. South Africa has a combination system, which includes both public and private plans.
   

   “South Africa’s health system consists of a large public sector and a smaller but fast-growing private sector. Health care varies from the most basic primary health care, offered free by the state, to highly specialised hi-tech health services available in the private sector for those who can afford it.”

4. Australia. According to a government website:
   

   “The Australian Government funds universal medical services and pharmaceuticals and gives financial assistance to public hospitals, residential aged care facilities and home and community care for the aged. It is also the major source of funds for health research and provides support for training health professionals and financial assistance to tertiary students.

   State and territory governments provide a variety of direct health services, including most acute and psychiatric hospital services. State and territory governments also provide community and public health services, including school health, dental health, maternal and child health, occupational health, disease control activities and a variety of health inspection functions.”

5. New Zealand’s medical care is also public.
   

   “New Zealand’s healthcare system is funded mainly through general taxation. Treatments are usually free or subsidised. Medical treatment is generally very good. Private healthcare is also available.”

6. India might be a possibility. Their system is mostly private, and medical tourism is big business there. On the other hand, to live there Limbaugh would have to put up with an enormous non-white population.
7. African countries where English is the official language – Kenya, Gambia, Ghana, Liberia, Nigeria, Rwanda, Uganda, Zambia and Zimbabwe to name just a few. No way would our boy Rush live amongst Africans. Unless he could be king, maybe.
8. Island Caribbean nations. There are a few Caribbean islands where English is spoken. But in Saint Lucia, for example, the public expenditure for health care is twice the private expenditure. In Jamaica, health care is free to all citizens and legal residents. Oops. Barbados has government-run clinics, in addition to the public hospital.

Face it, Rush, the civilized world provides health care for its citizens. You want to help your buddies in the insurance business? Support the current bills and they’ll love you forever. This Congress doesn’t have the spine to provide health care.

For the rest of us? There are lots of great places in the world to live where health care is available and affordable. And where we don’t have to put up with Limbaugh’s shenanigans.

As someone who plans to move to another country so I can afford health care, Limbaugh’s “support the poor insurance companies” position nauseates me. How about you? Let us know what you think by clicking the comment button below.

EM Forster’s classic novel of India under the British Raj examines the dark side of the expatriate experience. Although not absolutely necessary, it helps to understand a little of the history of England’s presence in India, because, central to the novel’s core, is the oppressor’s fascination with and repugnance of the oppressed – and vice versa.

Cast of Characters

Forster introduces his characters in order of importance, beginning with the Marabar Hills, 20 miles away from the city of Chandrapore. And, make no mistake, Marabar becomes the central character, acting on the human characters in dramatic and unexpected ways!

Next we meet Dr. Aziz, a young Muslim physician who works for the British in their hospital, and a group of his friends. They are discussing whether it is possible to be friends with an Englishman. Hamidullah, a lawyer who was trained in England, takes the position that it is possible – but only in England, not in India. He tells Aziz:

“It is impossible here, Aziz! The red-nosed boy has again insulted me in Court. I do not blame him. He was told that he ought to insult me. Until lately he was quite a nice boy, but the others have got hold of him.”

“Yes, they have no chance here, that is my point. They come out intending to be gentlemen, and are told it will not do. Look at Lesley, look at Blakiston, now it is your red-nosed boy, and Fielding will go next. Why, I remember when Turton came out first. It was in another part of the Province. You fellows will not believe me, but I have driven with Turton in his carriage – Turton! Oh yes, we were once quite intimate. He has shown me his stamp collection.”

“He would expect you to steal it now. Turton! But red-nosed boy will be far worse than Turton!”

“I do not think so. They all become exactly the same, not worse, not better. I give any Englishman two years. … And I give any Englishwoman six months. All are exactly alike.”

After some further discussion, Hamidullah states, “The English take and do nothing. I admire them.”

“We all admire them” is the response.

Aziz receives an urgent message from Major Callender, his superior at the hospital, ordering Aziz to report to him immediately. When Aziz arrives at the bungalow he finds Callender has gone out, leaving no message, and Callender’s wife and another English woman snub Aziz.

He stops on his way home at his favorite mosque, and suddenly an Englishwoman steps out into the moonlight. He shouts at her:

“Madam, this is a mosque, you have no right here at all; you should have taken off your shoes; this is a holy place for Moslems.”

“I have taken them off.”

“You have?’

“I left them at the entrance.”

“Then I ask your pardon. … I am truly sorry for speaking.”

“Yes, I was right, was I not? If I remove my shoes, I am allowed?”

“Of course, but so few ladies take the trouble, especially if thinking no one is there to see.”

“That makes no difference. God is here.”

They converse, and Aziz learns that she is the mother of City Magistrate Ronald Heaslop, the red-nosed boy. She has walked over from the Club, where the English are watching a performance of a play she had seen in London several years before.

Adela Quested has traveled from England with Mrs. Moore to decide whether she wants to marry Ronny Heaslop. After her adventure at the Mosque, Mrs. Moore returns to the Club, where Adela greets her with the statement: “I want to see the real India.” She repeats it to Ronny later.

“The request struck him as comic, and he called out to another passer-by: ‘Fielding! How’s one to see the real India?’ ‘Try seeing Indians,’ the man answered, and vanished.

“ ‘As if one could avoid seeing them,’ sighed Mrs. Lesley

“ ‘I’ve avoided,’ said Miss Quested. ‘Excepting my own servant, I’ve scarecely spoken to an Indian since landing.’

“ ‘Oh, lucky you.’

“ ‘But I want to see them.’

“She became the centre of an amused group of ladies. One said, ‘Wanting to see Indians! How new that sounds!’ Another, ‘Natives! Why, fancy!’ A third, more serious, said, ‘Let me explain. Natives don’t respect one any the more after meeting one, you see.’

“ ‘That occurs after so many meetings.’

“But the lady … continued: … ‘I was a nurse in a Native State. One’s only hope was to hold sternly aloof.

“ ‘ Even from one’s patients?’

“ ‘Why, the kindest thing one can do to a native is to let him die,’ said Mrs. Callender.”

Mr. Turton, the Collector offers Adela a Bridge Party.

“He explained to her what that was – not the game, but a party to bridge the gulf between East and West; the expression was his own invention, and amused all who heard it.

“ ‘I only want those Indians whom you come across socially – as your friends’ Adela told him.

” ‘Well, we don’t come across them socially,’ he said, laughing.”

Friendship and Betrayal

The Bridge Party is duly held, and it is an utter failure. The British, with the exception of Adela and Mrs. Moore and the Turtons, whose duty it is to be hospitable, hold themselves aloof in one area, and the Indians stay in another area. The few conversations are stilted.

Ronny explains to his mother, “We’re not pleasant in India, and we don’t intend to be pleasant. We’ve something more important to do.” His mother thinks he talks

“like an intelligent and embittered boy. … One touch of regret – not the canny substitute but the true regret from the heart – would have made him a different man, and the British Empire a different institution.”

Mrs. Moore and Aziz meet again at a party given by Mr. Fielding, the Principal of Government College, at his school. Adela Quested is there, as well as a Hindu friend of Fielding’s, Narayan Godbole.

In an expansive moment, Aziz invites them all to come see him, then turns the invitation into an expedition to the Marabar Hills because he is ashamed of his shabby bungalow and doesn’t want to expose it to the English ladies.

The Marabar Hills, which look beautiful from the distance of Chandrapore, are known for their numerous caves. The caves are absolutely round and featureless, and have the distinction of turning every sound made within to a resonating “boum.”

The expedition starts cheerfully at the train station, but disaster ensues. Before the end of the day, Adela Quested is in the hospital, Aziz is in jail and Fielding has been cast out by the English. Levels of mutual distrust among the British and Indian communities for one another become elevated to new highs.

Forster skillfully weaves together threads of misunderstanding, isolation, mistrust, cultural and gender differences, betrayal and vengeance. The story moves slowly and introspectively.

In the end, Forster shows that at least one Indian and one Englishman can be friends, despite their lack of cultural understanding.

A Passage to India is not an easy book to read. The subject matter is disturbing, and the writing style is densely analytical without a lot of action. However, anyone interested in the cultural aspects of living in another country can learn a lot about the pitfalls of doing so by reading this novel.

Are they any expat-themed books you would like to see reviewed here? Let me know by sending an email or leave a comment.

In the Expat Web group on LinkedIn, a member asked recently, “As an Expat, which countries do you think have the best and worst healthcare systems?”

Belgium, Spain, Switzerland, Canada, Malta and France all received positive comments. One poster said Japan’s was “the worst I ever experienced.” The US was mentioned favorably, but “only if you have good insurance. Prices are about 5 to 10 times the costs of France or Belgium.” This kind of anecdotal information is interesting, but not all that useful.

Of course to most expats and would-be expats, especially those of us who are approaching retirement age, health care is an important consideration in where we choose to live. What is its quality? Is it at least as good as what I’m used to? How expensive is it? How accessible is it? Will I have to be in a major city to have quality care available?

So what’s a concerned health care consumer to do?

There’s an interesting bubble chart on the Columbia University website, showing the average life expectancy and health care spending by country.

The US is way off by itself as the biggest spender. But our life expectancy (77 years) lags behind Japan (85), Switzerland, Australia, France, Canada, Norway, Spain, New Zealand, Austria, Korea, Portugal, UK, Luxembourg and Denmark, all of whom spend considerably less (around half!) than we do per capita.

The WHO (World Health Organization) has published a listing of medical care by country. Compiled in the year 2000, it’s a bit outdated, but might provide a good starting point. You can see it here.

A Few Considerations

First, I think it’s safe to assume that the care you’ll receive in rural areas will not be as up-to-date or comprehensive as the care you can receive in major cities. That’s true in the US just as much as anywhere else.

If living in a bustling metro area is not your taste, how fast and easy is transportation to those areas you’re considering? Use your common sense – if your dream retirement is on a remote beach or mountain-top retreat that’s an 8-hour drive over mostly dirt roads to get to the nearest city, that will be an issue in accessing quality health care. If it’s an hour or two over good roads, you’ll have significantly better access.

Are there hot spots of medical tourism in the country you’re considering? If so, you can be pretty well assured those doctors will speak English, have up-to-date training and use modern equipment. According to Business Week:

“The low cost and high quality of medical service is a big selling point for Singapore and Thailand, which have heavily promoted medical tourism in recent years. Hospital costs are as much as one-half what they would cost in the U.S.” Read the entire article here

Other popular medical tourism destinations include Panama, Mexico, Argentina, Brazil, Malaysia, South Korea, India and Israel. There are plenty of websites which discuss medical tourism, as any Google search will show.

Once you’ve narrowed down some possible destinations with health care facilities that will meet your needs, conduct your own research. When you visit the area, ask a lot of questions, find out what other expats do for health care, visit the hospitals and clinics if you can.

Ultimately, as with any other aspect of your move, you need to just do it.