(This article is in response to an opinion about health insurance for Cruisers on the sailingcalypso website.)
Health Insurance for Cruisers Contra Calypso
Subtitle: You don’t need Health Insurance if you’re Lucky!
Let me disclose right from the start that I am a Canadian cruiser and have been in the international health insurance business for expats for decades, and I do get a little charge and do a little dance when I make a sale! I also make half a million dollars a year from other businesses, but I had my first business success in international health insurance and still have great affection for the business. If I don’t make a sale, I don’t care! It’s not life or death for me! The only people that don’t buy health insurance are those that can’t afford it, or those that are so confused about it, that they think they can’t afford it. Everybody is interested in the subject because they want it! Almost all cruisers are without health insurance!
Summary of Message from Calypso Article: Sailing is a healthy lifestyle so you will rarely get sick, and if you do and aren’t in the USA, it won’t cost you much!
Retort: Well Calypso, only if you’re lucky is that true!
Calypso, you are lucky that in all the examples you mentioned you didn’t have really serious trauma. Trauma caused mostly by motor vehicle accidents is most likely to get you in hospital and if it’s serious, it often requires air evacuation in order to save your life if you are in a remote place. Cruisers will most often be in remote places and they will be in countries where the standard of driving and the mechanical state of vehicles is poor and the accident rate high and you’ve got no legal recourse! Also, if you are unlucky you might be robbed, assaulted and badly injured; there are many lawless poor remote places that we get to.
Personal Anecdote: My Chinese Mother-in-law had an unlucky day on her very last day in the prime of her life. She was riding a bicycle and run over by a 16 year old idiot child of nouveau riche parents that bought him a flash car. Her skull was completely crushed. She was living in Chengdu City China in Sichuan province but the young driver had a bona fide driver’s license from China’s Tibet province. Strangely, he had never actually been there! My wife had no recourse even though the driver’s license was obviously fraudulent because the rich parents bribed the police to fix things. There are many lawless places where life is cheap and the authorities don’t care where you are either lucky or dead.
Calypso, you were lucky that you didn’t get cancer, a tricky disease that requires the latest 1st world technology and science to treat in order to identify the type of cancer you have, even the type of mutation your cancer cells have, and a current therapy plan with multiple concurrent targeted very specific (sometimes mutation dependent) treatment methodologies! Try finding a decent up to date Oncologist in the 3rd world!
Calypso, you are lucky you didn’t have something as simple as a hernia, the most common complaint that is best treated with laparoscopic (keyhole) surgery, something that is not available in the 3rd world. During the Napoleonic wars, the Royal Navy issued 40,000 trusses to sailors with hernias! I could go on and on about how lucky you were! I would never have hernia surgery the old way!
Personal Anecdote: When I was in Nassau for the first time I rented a small motorcycle/ scooter and toured around the New Providence Island. I found that the front drum brakes were so far out of adjustment they almost weren’t working at all, and the front wheel is supposed to provide 70% of braking! I had a previous experience with this in Seoul where I borrowed the small motorcycle from a friend. This motorcycle belonged to a Canadian English teacher woman who returned home because of bad trauma after she had an accident. No wonder! The front brakes were barely working! Borrowing a 10mm wrench fixed the problem immediately. When I returned the motorcycle in Nassau, I checked all the other front brakes of the motorcycles for rent, they all had the same problem. The rental operator didn’t give a shit, and the police officer I brought over to bring this to his attention didn’t care much either. This is the attitude you find in many places! Verdict: Have some mechanical knowledge or just be lucky!
American cruisers always ask me the same question: “Is that the monthly premium?” My answer is no, that’s the annual premium. So right away it is 12 times cheaper than they initially thought, but they still don’t buy it! America is a special case because the domestic health insurance business there is so screwed up and health care is so expensive. Part of the reason is the US Constitution that says the Federal government can only regulate interstate business. Insurance is deemed to be state regulated which creates effectively 50 different countries creating barriers to portability for individuals moving to other states, and what you end up with is 50 nightmare costly regulatory bureaucracies. Then you have the legal system which imposes no penalty to plaintiffs for litigation without merit as in every other normal country. That’s why America with 5% of the world’s population, has 25% of the lawyers and why obstetricians / gynecologists pay professional annual indemnity insurance premiums of $400,000! That’s why medical professionals instead of doing what’s right for the patient, practice litigation shy defensive medicine driving up costs! So I agree with Calypso, it is expensive in the USA. So many US cruisers have been without insurance for so long living in the USA because they legitimately couldn’t afford it, that they continue to be uninsured for the following reasons. They are psychologically used to being naked (uncovered), are justifiably jaded about the domestic industry weaseling out of claims (US policy wording contracts are necessarily written defensively and are very legalistic), and reject the whole idea of insurance as a rigged game they can’t win by not playing the game because they have done it for so long and have been lucky!
Message to American Cruisers:
- Buy a British policy some of which have won plain English language awards for their wordings, and from a country that has a normal litigation system.
- Comes with a free government insurance ombudsman that in the event of a rare dispute decides in 56% of cases to the policy holder and orders the insurer to pay.
- British policies (unlike some American ones) can’t deny claims for pre-existing conditions you couldn’t have known about.
- British policies unlike all American ones have creative methods of underwriting that can cover pre-existing conditions for a 10% premium surcharge
- They are cheap options! $2.5 million worldwide hospital cover age 55-59 is US$956 annually (!) with evacuation benefit not subject to the annual deductible of $2500. For $100 extra you can mitigate the deductible somewhat.
- If you’re younger, it can be much cheaper!
Other Nationalities with Home Country National Healthcare systems:
Firstly there is the question of travel insurance versus medical insurance. If you are still “tax resident” in your home country even though you are cruising, travel insurance is what you want to buy because you have medical insurance back home. Americans are one of the few nationalities that pay income tax to their home country even though they are non-resident expats so this doesn’t apply to them. There are snags for cruisers because of peculiarities of travel insurers which assume you are getting on an airplane! Cruisers often don’t know their departure date or return date! Many times Cruisers can’t buy the policy before they depart, a stipulation of many travel policies rendering them void. So be careful, buy one without these restrictions! Buy a policy that you can purchase on-line for the time you think you need it, and extend it close to expiry once you have made your return home travel plans. If you are an expat or not tax resident back home, then you need international health/medical insurance. With Americans that can’t get out of the Affordable Care Act, travel insurance might be the answer for you now.
The mentality of nationalities from countries other than America seems to be that they can always get back on an airplane and be back on their home country medical system and get free care. That’s why many don’t buy it! That is true for some countries. I don’t know all the details for every country, but I know it isn’t true for Canada and the UK that have residency requirements. I sincerely hope you’re lucky because if you don’t have cover you may not be able to cut the IV lines beside your ICU bed so you can get on the airplane to take you home!
There is always cruiser discussion about health insurance because people are interested and want it. There are inexpensive options available that Cruisers are certainly unaware of. Most don’t buy it because they are living very cheaply and either can’t afford it or have other priorities. Most people think they are lucky until it runs out!