They’re all medical hotspots for Americans seeking procedures they can’t afford in the US, according to travel website Boots ‘n All.

International Living adds Mexico, South Korea and Turkey to the list.

If you’re considering living in a country known for medical tourism, you can be pretty confident that the quality of care is top notch.

But what about health care as a resident?

That’s a question more expats and future expats — especially from the US — will be asking.

US Healthcare is a Mess

The United States has a high level of medical technology. We also spend more on health care than any other developed country. The Council on Foreign Relations states that we spend 17% of our GDP on healthcare, and estimates that number will increase to 25% by the year 2025.

These high levels of spending don’t translate into improvements in life expectancy or infant mortality, however. For life expectancy the US (78.3 years) lags behind Japan (82.6) , Hong Kong, Iceland, Switzerland, Australia and 31 other countries, including Cuba.

Infant mortality is no better. Singapore sees only 2.31 infant deaths/1,000 live births, followed by Bermuda, Sweden, Japan and Hong Kong. The US shows up at #46 on the CIA Fact Book list, with 6.26/1,000, just behind Guam (6.05) and Cuba (5.82).

We’re facing epidemics of diabetes, obesity, heart disease and cancer.

Now the GOP wants to eliminate Medicare and exchange it for vouchers that seniors would need to use with private health insurance. Preliminary estimates indicate this switch would cost seniors $7 for every $1 spent by the new system.

If seniors were barely surviving financially with Medicare, you can be sure they won’t manage without it.

Looking Abroad for Health Care

As the cost of healthcare increases in the US, and as more uncertainty surrounds it, more and more baby boomers and seniors will look at living overseas. And they’ll be looking at countries and cities where they can find good quality care at affordable prices.

Many countries — and most European countries — have taxpayer supported insurance that covers nearly everything. However, if you’re not a legal resident worker paying into their social security system, that’s not an option as an expat.

Mexico’s government-backed healthcare is available to legal residents, including retirees at a very reasonable cost.

Panama’s system relies on private insurance.

Costa Rica has universal health care for legal residents, as well as private insurance plans available.

Ecuador has a hybrid public/private system.

In some countries, you can’t buy into private insurance once you’re past age 60 or 65.

At this time, if health care is driving your overseas retirement plans, you’ll need to do your homework. It’s complicated, and every country is different.

Here are some materials to start you on your quest:

Understanding Expatriate / Travel Insurance: A Primer. This is a very basic article on understanding different insurance terms and options.

How to Arrange Health Insurance Overseas for $100 a Month or Less . . . Even Free new, expanded Third Edition

Lots of information has been published about going abroad for healthcare as a tourist. I’m finding less about choosing healthcare as an overseas resident, but as I find more, I’ll post it for you.

Have you found good resources for finding out about healthcare and insurance in a different country? Please share them with us.

There was a silence at the other end of the phone line. “Oh,” she said, “you’re about the fourth or fifth person who’s told me that in the last couple of months.”

Then today, I watched various news and comments on the health care debate in Congress. It is a sad fact that the US is the only Western democracy which does not provide health care for all its people. Alan Grayson summarized the Republicans’ health care reform plan – “Don’t get sick, and if you do get sick, die fast.”

Michael Moore, traveling the country speaking and giving interviews as his new documentary launches, refers to our health care system as “cruel.” Statistics indicate the biggest reason for personal bankruptcies and home foreclosures in this country is the cost of health care. All of which made me start wondering … is our broken health care system and its cost driving US citizens to leave the US and move overseas?

Medical Tourism

Google the phrase “medical tourism,” and you’ll get over 28 million hits. According to an article in the Wall Street Journal, September 30, 2009,

“Insured Americans are starting to see some unusual options in their health-provider networks: doctors and hospitals in Singapore, Costa Rica and other foreign destinations.”

M.P. McQueen writes that a “small but growing number” of insurers and employers are offering Americans the option to seek medical treatment abroad. According to the article, open-heart surgery, costing at least $100,000 here, can cost as little as $8,500 in India.

Some 15 or so years ago, billionaire Richard M. DeVos, cofounder of Amway Corp., made headlines in the British press for his personal medical tourism. After being turned down for a heart replacement here because of his age, he traveled to Europe. According to news reports at the time, he “donated” about $50,000 to a hospital in England, where he then received a heart transplant at no charge, thanks to the British National Health system. DeVos is listed at #117 in Forbes list of world billionaires. Known for his extreme right-wing conservatism which would deny universal coverage to average Americans, DeVos apparently has no compunction about taking advantage of taxpayer subsidies for his health care when it suits him, just as he has no compunction about having taxpayers foot the bill for the new arena for his Orlando Magic basketball team.

Americans Abroad

Estimates place about 6.6 million Americans living abroad, with that number growing rapidly. Richard C. Morais, writing for Forbes.com, reports on a “new lobbying effort” by US retirees living in Mexico to expand Medicare to cover Americans in Mexico. According to Morais, Paul Crist, a former aide to Sen. Sarbanes now living in Puerto Vallarta, has formed an organization to lobby to get Medicare accepted there.

According to the AMMAC (Americans for Medicare in Mexico) website, the choice for many to move to Mexico is

“almost an economic necessity. In a survey conducted by a team led by Dr. David Warner, Professor of Public Health Policy at the University of Texas, Lyndon B. Johnson School of Public Policy, it was found that the lower cost of living is the primary reason seniors choose to move to Mexico. The median income for a retired couple living full time in Mexico is $35,000 per year. There are few places in the U.S. where $35,000 is sufficient for a comfortable lifestyle, while in Mexico that sum is quite adequate.”

(As a side note, I would like to point out that to some of us planning to retire abroad, $35,000 annually is a large budget. An average Social Security check for a worker retiring in 2009 is about $1,500, resulting in an annual income of only $18,000.)

The same survey found that 63% of Americans retired in Mexico had paid into the Medicare system for 31 years or more.

A December, 2008 article in International Living, a well-known purveyor of information for those seeking an overseas life, states:

“We can’t afford to live in the States anymore.”

We’d just finished dinner with a couple of International Living readers. They’ve decided to buy a house in Merida, where we live, and move here permanently.

“Health care and insurance costs alone are killing us. Add property tax, and it’s too much…especially when you consider that the value of our house in the States is falling fast.”

Suzan and I have heard this a lot lately, from Americans wondering where they can go to retire in style.”

(Read the entire article at http://www.internationalliving.com/Publications/Featured/where-to-retire.)

In fact, the organization regularly assesses the cost and quality of health care in all of its discussions of any given country. So do major living abroad resources, like Transitions Abroad, Escape Artist, and others.

The AARO (Association of Americans Resident Overseas) has requested its members to submit their perspectives on health care in the countries they live in. You can see a few of them.

Obviously, health care is a concern for Americans who live abroad. Nowhere, however, could I find any information about how many Americans are driven to move overseas primarily because of the cost and quality of of health care.

So – if you have moved overseas, or are planning to, and your major motivator is health care, please join the dialog! Just click the comment link below, or send an email to info at futureexpats.com.