The High Cost of Health

I went to Bumrungrad International Hospital in Bangkok yesterday morning to refill two prescriptions and get a dermatology checkup. When I left I was 17,761 baht ($555) poorer (at least I will be when I pay my Visa bill). One of the risks of living abroad is the cost of medical care, but I had always assumed that it was cheaper in Thailand, despite the lack of health insurance. Apparently I was wrong.

The big expense was for two skin biopsies: 11,983 baht (of which Dr. Suparnee got 7,000). My skin is a mess because of years spent on Southern California beaches trying to get a tan. I had biopsies last summer and was even treated for one spot on the side of my nose. So some kind of intervention was not unexpected. The two biopsies, on my shoulder and the back of one calf, took less than a half hour. Jerry said his angiogram last year at the same hospital was cheaper. I go back next week to find out the test results, but I doubt that I will continue to have six-month checkups.

I paid 1000 baht for my time with Dr. Watcharaphong Saechere. He gave me two-month prescriptions for Mevalotin, the Thai version of Pravachol, a statin drug to lower high cholesterol, and Seretide Accuhaler, the Thai substitute for Advair, the spay I have been taking daily to prevent asthma attacks. The hospital supplied two months of both for 4778 baht. Now I have been told that prices are lower outside the hospital pharmacy but that you take the chance of getting a counterfeit version of the medication.

Back in the states, I received excellent health insurance from the University of California upon retirement. I have no idea what Pacificare Secure Horizons gave Dr. Magid for my skin biopsies; I only paid for an office visit. Six-month prescriptions for each medication by mail from RX Solutions were under $100, certainly less than what I've paid here at the hospital. But UC dropped Pacificare last year and I switched to Blue Cross PPO which I hope will pay a portion of any extraordinary expenses here in Thailand. I am waiting to receive my new membership card from home.

Jerry had open-heart surgery at Bumrungrad a couple of years ago, and, although cheaper than it would have been in the U.S., it still set him back over $5,000. If my prostate cancer decides to speed and and try to kill me, I will undoubtedly encounter some high medical expenses which will eat away at my meager savings. This is reality and it must be faced.

Bumrungrad is a first-class medical facility and the ill and ailing come from all over the world to avail themselves of its relatively cheap services. I saw a number of women in full black burka, eyes hidden, their men in white robes and wearing turbans. I wonder if they only see women doctors? All of the patients in the skin care/laser surgery waiting room appeared to be western women. I went to the hospital without appointments and waiting time was minimal. It is the medical equivalent of a supermall with a food court, Starbucks and McDonald's on the mezzanine. If I were sick, Bumrungrad, a short walk from my apartment, would not be a bad place to heal, if I could afford it.

What of the average Thai, though? What I paid yesterday would be a month and a half of wages for Pim. Of course maybe Thais, with their dark skin, do not suffer from skin cancer as we palefaces do. There are hospitals cheaper than Bumrungrad and I may look into them if I want to continue having skin checkups. Jerry's brother-in-law in Surin was treated for a groin sprain of some kind and his bill for almost a week in the hospital was 8,000 baht. He probably makes less than that in a month. But Jerry paid the bill. Without a farang in the family, what do poor Thais do when they get sick?

As I write this, the results from Super Tuesday in the U.S. are coming in. McCain and Obama (oops, I mean Hillary) appear poised to capture their party's nominations. The Bangkok Post featured a story this morning about Americans casting ballots for the primaries at the Foreign Correspondents Club in Bangkok. Will it make any difference? Will anything change in America? I know, McCain has become an ugly rubber stamp of Bush. And Obama is certainly more a friend to the poor than Clinton, who, like her husband, is beholden to corporate interests. Every election, Americans get to choose the lesser of two evils, Tweedle Dum over Tweedle Dee (or vice versa). The Democrats presided over the debacle in Vietnam and now its the Republicans turn with Iraq to shame themselves before the world.

I'm reading the excellent A History of Thailand by Chris Baker and his wife, Pasuk Phongpaichit (Cambridge University Press, 2005), in which I learned that the U.S. dominated Thailand economically after World War Two. The authors write that "the U.S. need for a client-state and its support for Thai democracy were at cross-purposes." So American dollars went to the military, strengthening a sector of the government that was inordinantly large and continues to dominate the political process. During the Vietnam War, "three-quarters of the bomb tonnage dropped on North Vietnam and Laos in 1965-68 was flown out of seven US. bases in eastern Thailand." Military aid peaked in the 1960s and 1970s at $123 million. The U.S. apparently got its money's worth.

In "Charlie Wilson's War," film director Mike Nichols shows how U.S. military aid to the Mujahedin in Afghanistan (ironically ?) prepared the way for the Taliban and its support of Osama Bin Laden's Al-Qaeda terrorist organization. It is well known that the American right supported Iraq in its war against Iran, then turned against Saddam when he invaded Kuwait. Does the right hand of American politics know what it is doing? Can all of its support for the wrong side be accidental? Now I read that Bush is pushing a budget that will practically bankrupt America, giving his successor problems even more severe than the swamp of Iraq. Is this all an accident?

Perhaps living so far away from American shores is turning me into a conspiracy freak. The country of my birth is no longer the land of the free, the champion of democracy. It is the home of the distracted, drugged and indifferent, the headquarters of global corporate capitalism, in whose name it is attempting to control the world. I truly doubt that Obama will even attempt to turn this around. He can't get elected without accepting offers he cannot refuse from the powerful. I wish all of this were not true, and that I could regain the hopeful optimism I had when voting for Kennedy in 1960. But I fear the worst.

I say this while acknowledging that all is not perfect here in Thailand (or anywhere else, for that matter). The political situation, as the new elected government prepares to take over from the military, is confusing. Will the Army sit back quietly while the politicians it threw out of power last year come back into office? The King's age means that momentous changes will take place in the not too distant future. Despite the strong Thai baht (which means my dollars are declining), the economy is in trouble. There is a huge divide between the richest and the poorest citizens. But because of the strong Buddhist influence, I believe that compassion and generosity are core values of Thai culture. In America, I'm afraid, making a profit comes first.

Second Thoughts: I sound like a stuck record. Perhaps only those who participate in a system have the right to criticize it. Consider my rant the ravings of a foolish old expatriate.