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US Health Care Ranks Below Costa Rica?

Posted on Monday Aug 24, 2009

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(Warning:  Eric rants!)

 

I don’t normally pay much attention to the latest in US news.  But for us who know 3rd world health care very personally I can’t stand not saying something.  So I thought I would post it here where no one really reads it.

 

The WHO ranked Costa Rica’s health care above that of the US and many people in the US were shocked and upset.  Well, I can tell you the health care here is better, faster and cheaper.  In the capital, San Jose, they have all of the latest high tech equipment from MRI and 3d TAC to bone scan machines.  You can walk in without an appointment get a scan, pay $20-$150 and walk out with your results usually inside 2-3 hours.

 

So I was a bit offended by the people who were offended that even Costa Rica ranked higher.  Well, I would definitely rank Mexico higher than the US too and I found Mexico was way down on the list at #61 (http://www.photius.com/rankings/healthranks.html).  But I looked closer at the requirements and I think if you look at the health performance rankings by country it provides a better picture (http://www.photius.com/rankings/world_health_performance_ranks.html) with Costa Rica #25, Mexico #63 and US #72. 

 

My real problem is with all these people on TV screaming about health care.  (Keep in mind I can only see Internet news and for TV it’s Fox News and CNN International and CNN International isn’t at all interested in the subject).  Please, the system is broken and the insurance companies, pharmaceutical companies and lawyers broke it.  Let’s not try to defend the current system.  I see it has gotten to the point where some people show up with guns to the political rallies.  What the hell?!  People are not getting proper medical treatment or going bankrupt trying (about 50% of bankruptcies are as a result of medical expenses) should be the focus of anger.

 

It is crazy.  Medicare and Medicaid are social programs.  So are the police and fire services, big deal.  The bulk of the non-war related deficit is in Medicare/Medicaid so there is a lot of room for “social” improvement.  Why are so many people afraid of trying to fix some that is broken for most Americans?  And I say “most” Americans because after experiencing health care of other countries I didn’t realize how bad I had it.

 

I can empathize with people who have steady jobs, employer covered insurance with reasonable co-pays not being interested in change.  However having had major health care issues in Mexico and Nicaragua and smaller but non-trivial check-up type exams in Costa Rica, Panama and Ecuador, even that insured service isn’t great in the US.  (Sherrell would be denied insurance coverage in the US because of pre-existing conditions, making coverage unattainable in the US for us).

 

As an uninsured foreigner, for example, I can walk into a clinic, see a doctor ($4.18 in Ecuador to $50 in Mexico), discuss my problems (no time limit), and get recommendations for tests.  I can then walk into a testing facility, either independent or associated with a hospital and get my testing done that day (assuming I don’t need to fast or something unique for that specific test).  I pay less than $200 (even for complex tests) and walk out with my results in my hands.  I can then choose to go back to the previous doctor (the follow up is often free), or take my results to other doctors and shop around for opinions.

 

If I need hospitalization the costs run between $15 (Ecuador) and $200 /night (Mexico), with $100 (Nicaragua) being more common.  These prices are all inclusive of care and medication at high-end modern facilities designed to US standards and there are cheaper options of course.  They are fully staffed and are often certified by American Quality Assurance companies for safety, cleanliness and training.  The same goes for the medical labs with certifications for both equipment and training from international organizations (usually US).

 

I don’t claim to know all the ins and outs of the finances behind each country’s system.  However looking at the WHO rankings I see these countries are no where near the high US costs and yet doctors are still paid well which I think is very important.  For people who need special high cost operations and have to go through the fully covered insurance of a socialized program, progress can be frustrating and slow, but at least they can get help.

 

While I don’t trust politicians, I do think a new approach is needed to health care and trying just about anything is worth the risk.  The worst that could happen is we could increase the deficit and the same people don’t get health care.  It’s not like we are going to war where people will die and trillions of dollars will be lost.  I really don’t think the hostility shown against the new plan is warranted at all.

 

In Costa Rica employers pay 9.25% and workers pay 5.5% to the health care system.  The overall amount is much less than is spent in the US and yet not everyone is even close to being covered in the US.  People like Sherrell are SOL for coverage in the US and the costs are so high forget paying it out of pocket.

 

Health Care is like dealing with cancer, there is no good solution.  No one is going to be jumping for joy but I think the US can do a lot better if they suck it up and try something new rather than complaining.

 

The history of Costa Rica’s system which is 68 years old and has both public and private option for full coverage.  The system is very interesting and mirrors the US debate, only in 1941 when it started, not 2009.  Looking at the history shows me why there are a lot of dollars being spent to lobby congress as the public option helped keep the private sector from reaping billions in profits.  http://www.ticotimes.net/topstoryarchive/2009_08/082109.htm  However it is a system similar to Canada, which the US is not going to adopt, but many of the arguments in 1940’s were the same as today in the US and were proven to be invalid.

 

Unfortunately I feel the US health care plan will probably be whittled down by big money and be too little too late.  And people like Sherrell will still be un-insurable.

Engine Breathes Easier

Posted on Friday Aug 14, 2009

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Words (342)

About 2 years ago in Nicaragua I had the wet exhaust side blow out (there are two sides: a wet and a dry side) and leak hot salt water everywhere. Let me tell you nothing corrodes metal faster than boiling hot salt water. Thinking, I was prepared because I had noticed the decay and searched out some parts back in Mexico, I assumed a couple days of work and I'll have it fixed. No go. I had purchased the wrong size parts! As usual I went to the internet to look for other parts and found that the type of steel I was using wasn't a good choice anyway. After many failed searches in Central America it took someone flying into Nicaragua from the US to bring some nice new 314 stainless parts.

After searching out all the leaks, everything was good. So I decided to pull off the insulation on the exhaust riser just to see how good that side was. It's the dry side of the exhaust before the salt water is injected for cooling. Stupidly I thought, I'm sure its fine and didn't pull of the itchy insulation earlier when I was buying parts for the wet side. Yikes, about 1/2 the thickness had rusted away underneath the insulation! I did a quick estimate and figured that would give me about 500 hours before it would fail. Based on my previous searching, I didn't stand much of a chance getting the parts again without someone flying them in. So I put it off until I could get parts again.

Flash forward to the present and now the time has come. I couldn't easily find the parts in Ecuador or Panama, but the problem is only getting worse. I pulled out the exhaust assembly and took it down to a great machine shop here in Golfito. In about a day and $55 they removed the rusty mess and machined some new stainless for it. The exhaust looks so good I took a picture of it before wraping it back up with insulation. Isn't it sparkly?

A three year long habit...broken.

Posted on Thursday Jul 30, 2009

Photos (7)

Words (630)

A great way to save money is not to use a dock or a mooring ball and just anchor. Well, we started slowly breaking the habit. We did some work for trade of a buoy here in Golfito for a few months. That was nice and I didn't have to scrub the anchor chain every couple of weeks or so. But now we've really moved up -- to a dock! We are required to bond our "vehicle" to avoid paying a customs tax on the value of the "vehicle". This law is meant for cars and trucks. But not knowing what to do with boats, they decided it should apply too.

The trouble is the only places that can bond in Golfito are marinas. Very expensive marinas. We did negotiate a rate, and we only have to do it for 3 months before we can get a new cruising permit. So we've been saving money to average out the stupidly high marina costs. We should still be able to average under our budget for the year...we hope!

Here's a picture of us at the dock, breaking a 3 year long habit of anchoring. I waited until some rain was coming to take the photo. Notice our full on gypsy appearance? We even have a clothes line on blocks rigged on the foredeck because having your laundry done is super expensive too!



I've taken to jogging up the jungle mountain nearby with Sherrell (who walks) and Reilly (a dog who runs). We do that about 2-3 times a week and we put our bicycles back together. Yes! The same crappy bikes from Ecuador which we rode in Panama too! They still work despite being wrapped in plastic on our deck and sailed about 700 miles.

Here's a view of Golfito from on top of the jungle mountain.



Here's some photos from a nearby anchorage to remind us of what waits once our 3 months are up and the rainy season has calmed down.





One REALLY BAD thing about being at the dock is keeping Jordan from going bonko on the dock and racing around other boats. We put a harness on her and tie her to a little cat run we made so she can hang out on deck, but not escape. You can see she's doing alright.



There are ships which bring boats in and drop them off. Imagine having the money to ship your boat around to wherever you want to be, then flying in all big shot like and using it after you've paid some guys to clean it up and sort it all out for you. Well it happens more than I thought. Got an extra $15,000-$30,000 you can be cool too. The first day we arrived we passed a Yacht Path ship loading up a sailboat. Look closely and you'll see the sailboat sticks out over both sides of the ship. If the owner only knew...haha.



We have had a great time here so far. There are TONS of animals around in the jungle and even in the water. One day a dolphin put on a show right by our boat!



Well not much more to write really. I'm trying to give some English lessons to a friend who wants to learn. Our radar is still broken, but we might have parts coming to Maryland. I'm (Eric) am going back to the East Coast to visit family in Sept. It will be my first time back in the US since 2004...yikes!

We are going to keep working on the boat and getting ourselves organized now that we can use the dock space which is an added bonus, along with power and water. But we both would prefer to be out on the anchor or even the mooring again.

A whole pile of pictures

Posted on Friday Apr 24, 2009

Words (67)

We've gone through our photos and have created slide shows of them to share with everyone. You can either go to our home page and see the list of new stories or you can follow each of the links here.

Photos from our time in Bahia de Caraquez, Ecuador

Photos from travel in Ecuador

Photos from travel in Peru

Photos from crusing Colombia

Photos from transiting the Panama Canal (on Moondancer)

Is that mast on jacks?

Posted on Tuesday Apr 21, 2009

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Words (220)

Sometimes we have to find creative solutions to solving problems. In this case our mast sits on our deck and inside there are wires that run through the deck to the inside of the boat. All fine and good until one day it started leaking and we had a waterfall inside our boat. So how do you lift a mast without a crane or two boats tied on each side to hoist it? Well, we decided to try to jack it up.

I built some supports and then tied the mast fore and aft at the base, just in case it tried to move. Then we took off the sails, boom, and anything that added weight to the mast. When we were ready, we loosened all the stays as much as possible, and we started jacking each jack (one on each side) slowly. After we raised it about 2-3 inches we could clean out the old sealant, then we blocked and moved each jack one at a time to clean each side and then reseal it with new sealant.



It seems to be keeping the water out so far. We're pretty excited that for about $25 bucks for the jacks we probably fixed the problem. Now we are cleaning up all the gear and repainting everything to protect it from oxidizing.

Golfito

We spent the night anchored off a peninsula called Bruica and it was nice because we actually got to use our own guidebook to navigate there!

However we're getting a bit anxious for civilization and our garbage and laundry is really piling up so we spent the night and bolted in the morning to Golfito where I'm now writing this message. It was a long trip full of very sloppy waves and my body aches from the loooong day. But Golfito itself is very calm and it is so nice just to anchor and enjoy a cold drink.


{GMST}08|04.630|N|82|50.950|W|Good spot

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weird to be back again

Posted on Saturday Apr 11, 2009

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This post contains a GPS location. Click here to see it on the map.

Almost a year ago to the day we departed this anchorage for that fateful 7 day passage to Ecuador. The one where we helped two another boat about 300 miles.

Anchoring here alone it seems like such a long time ago -- another age. Yet here we are again. I didn't think I'd be back, but sometimes you never know the path you're going to take.

This little island is pretty protected and there is a fresh water stream so we might do a little laundry. Other than that, we'll probably rest a day before starting the hops to Golfito.

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14 miles of dead fish

I'm no biologist, but it seems something is seriously wrong when you run into a bunch of baby fish (fry) that are dead. At first we thought, hmm...lots of dead little fish and they sure do stink but after about 3 miles of dead fish we began to wonder if this was going to hamper our snorkeling in Islas Secas. I jokingly said, "It can't be like this for another 11 miles." But it was a carpet of dead fish for 14 miles. There must have been 10 million of them. As we got closer the island they were floating belly up in big clouds swirling on the water.

It seemed to just be small fish of all the same type. I scooped some up as we sailed by and found they still had signs of the egg yoke so they were probably quite young. Something in the water? I don't know but swimming in dead fish stew didn't sound like fun, even if the water was ok. It's too bad to because everyone raves about the snorkeling at Las Secas.

Not to miss trying it, I jumped in, but the visiablity wasn't very good. There is a lot of coral and fish which was a surprise, but the spectre of dead fish stew kept me from staying in the water long.

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Ensenada de Rosario

Well, I tried my hand at working on 2 more generators and a second attempt at a third, but I had no luck. No one seemed to be to disappointed and they appreciated my work. I did get a VHF radio wired up and got some LED lights working, so I wasn't a total failure. Part of the problem is there are no parts around here. One generator needs a new field controller and another has some burnt out wires on the rotor and the third was quite a mystery why we couldn't get the engine running. It's too hot for lights anyway, right?

We said goodbye to Domingo and his family and a few of the others we met and took off to see some more of the coast. According to our charts we are anchored on top of a 450' hill. Stupid charts.

The coast here is beautiful and full of islands, jungles, beaches, and howler monkeys. We're both surprised at how nice this part of the coast is. The water is also very clear which adds to the effect. We are slowly working our way back to Costa Rica and with the water Domingo gave us we should be able to meander our way there at our standard pace without having to go to a city or somewhere with a reliable water supply.

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Fountain of Youth

Posted on Wednesday Apr 8, 2009

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Ever heard of someone loosing 20 years off their age in one day? We've been getting to know this family that lives here in Bahia Honda. I've been working on their generator, VHF radio, LED lights and Sherrell has been busy reversing time. She was talking with Domingos wife who insisted she was 90 years old. At some point in the discussion she disappears and brings out her ID card which shows her birthday on 1949. Sherrell then explained to her that she was only 60 years old, but rather than being pleased she seemed a bit distraught. She said Domingo told her she was 90. Since Domingo is a bit older looking than her we wondered if something more
complicated was going on. Sherrell is a trouble maker.

We haven't got much work done on the boat. Our radar is still not working right. I think it needs a new cable. That's going to be expensive to get shipped down. Domingo did offer to let us take water from his property which he has plumbed running water from a creek high up in the hills. It is very clean and we were able to replenish our water supply so now we have lots of water on the boat again!

This is a great bay to hang out in. The only draw back is it is removed from any supplies. There is a small hotel here which runs to Puerto Mutis once a week, but that's it. Too bad because I could spend a lot of time in this bay. The small store in the village just doesn't have enough supplies to keep us demanding gringos fed properly.

Domingo took us on a tour of a indigenous village where his wife comes from. You can only enter at high tide through a maze of mangroves. It is a stark contrast to go from the skyscrapers of Panama City to the mud huts in these towns. The village was fullof curious people who chatted with us and often offered us food. They have a proper school, a little Catholic Church, a store and
naturally a solar powered satellite pay phone. The trip was interesting and we got to meet some more of Domingos family and friends. But birth-control would do this places a world of good as 12 kids is really a bit much. Hey Pope are you listening?

On other news, the Tehuantapec is forecast to blow at hurricane force. I don't think it has ever developed a storm that strong this late in the season

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