Marta Nystrom spent her career advising other people about retirement. When she decided to retire, before 65, decided to leave America. One factor- rising healthcare costs.
Alan Pitt: Good day. This is Alan Pitt with Healthcare PittStop, and I have an unusual interview today. As many of you know, we have a bit of a healthcare crisis in America, with many Americans really struggling to pay for healthcare. Some people are looking for novel solutions. I came across someone who actually left the country—they moved to Colombia—because they wanted to retire early, but to retire before the time that they could get Medicare. I thought it would be interesting to talk to Marta Neestrom about her journey to Colombia and to find out how healthcare factored into that choice. Thank you very much for a giving me an interview, Marta.
Marta Nystrom: You bet. I’m happy to be with you today.
AP: So really, the first question I have is: Why did you choose Colombia as opposed to some other more common choices that people hear about? Costa Rica is a place that many people talk about. Why Colombia?
MN: Some of the factors that played into our decision making, and we checked various countries and visited Panama before visiting Colombia, were that we wanted to find a climate that appealed to us; we wanted to find a locale that had plenty to offer in terms of culture, things to do, and things to explore; and we wanted, of course, good healthcare. But we also needed good infrastructure because without good infrastructure, you’re not going to connect well with friends and family back home.
MN: Costa Rica is kind of lacking in infrastructure and it’s become a lot more expensive as more expats have been finding it and moving there. So it was kind of ticked off our list; we decided it was not suitable for us fairly early on.
AP: Yeah, most people think of Colombia, I guess, how they see it on TV, on shows like Narcos and Drug Lords. Is that still an issue in Colombia, or has that changed a bit?
MN: It has changed a lot. I think Pablo Escobar’s been dead… What? Twenty-five years now? A lot can happen in 25 years. Following his death, the city of Medellín went through a fairly stressful time when cartels were vying for power, and that lasted about 10 years. And then, through some really good leadership in Medellín and in Colombia, the country kind of reinvented itself. I will say that it’s going through a little bit of a struggle now. I think in the American news you read that President Trump has been sort of hammering the Colombian president, Duque Márquez, on the fact that cocaine production has reached an all-time high here. And you do see some evidence of that; there are places within the city of Medellín that normal people don’t go.
AP: Sure. That’s true of lots of American cities too though, right?
MN: Exactly. From the first time we were here, which was five years ago, there’s a lot more graffiti. We know through friends and news that there is a little bit more crime, that there’s more gang activity. But again, this is something you could expect in American cities.
AP: Yes, that’s true. When you were working here in the US, what did you do? What was your career?
MN: I was a financial advisor and portfolio manager, and my area of expertise was working with the 50-and-over age group to help them prepare for retirement, and to help them understand when they could reasonably expect to retire—or, in some cases, not retire. Sometimes that involves working to help them find alternative plans that might work well for them, including becoming an expat to another country.
AP: So this is a topic you seem to know well. How did healthcare factor into your move, your choice to move out of the US?
MN: It was one of the top reasons. Both my husband and I are under Social Security and Medicare age. We have a reasonable stream of investments. But had we decided to stay in the US, a large amount of income would have had to be allocated to healthcare premiums through ObamaCare, with extremely high deductibles. That just didn’t seem appropriate for us. It didn’t work for us.
AP: Yeah, they talk about the donut hole once you’re enrolled in Medicare, but I guess there’s another donut hole—the one between when you might want to retire and the age of 65. COBRA is what people fall back on, and it’s just so expensive.
AP: I have to think that people here in the US think that healthcare in Colombia is second-rate. We tend to think of our country as the best. Can you tell me a little bit about Colombian healthcare?
MN: Sure. A lot of Colombian doctors have trained either in the US or in Europe; they are very competent in their knowledge and abilities. A percentage of them speak fluent English. I will say that one notable difference is that when you go through the state system, it’s obvious you’re going through a state system. We went to a dentist to have our teeth cleaned, for example. You can set up the appointment online, you’re supposed to show up 20 minutes early. You’re sitting in a large room with a group of people. You take a number, you go to the window and you pay your very small copay and then you’re sent up to a room where there must be 20 other patients with curtains around them receiving whatever dental treatment they’re there for. As a patient in that scenario, you’re very aware that you’re just a number in a system. For some services, there are fairly lengthy delays. I have a friend who is trying to get a knee replacement and is still waiting after a month, even after a doctor said that it needs to be done urgently. She is still waiting to get in to see the doctor who will evaluate her condition.
AP: Is there a private healthcare option in Colombia?
MN: There is a private option, and generally, it’s less than a third of what we would pay in the United States. That same friend of mine is considering going private for her knee replacement. Her primary care doctor said, “Think about that very carefully, because if you have any secondary problems, for example, an infection or something that doesn’t go right, you cannot come back into the government system to have that treated. You’ll have to continue to go through private care.”
AP: Oh, that’s interesting. Complications are addressed only in the private system if the primary treatment is private. Now, when you say it’s less than a third of the expense, you mean less than a third of the total cost of a knee replacement in the US? Do you have any sense of what those costs would be in a private option?
MN: Yeah. I don’t know the specific cost of the knee replacement, but an acquaintance of mine had to undergo open-heart surgery, and just was very badly off. Actually, I think they implanted a pacemaker. I don’t want to say it was over the top… But he had no health insurance here in Colombia. He was a visitor from United States, passing from Ecuador into Colombia, and had an emergency. I think everything totaled was about $18,000.
AP: And that was in the private side?
MN: That was in the private side.
AP: Now, you are not a Colombian citizen, is that correct?
MN: No, I’m not.
AP: But Colombia allows you to have access to their public healthcare anyway?
MN: Right. I pay premiums to do that.
AP: So you elect to be a part of the public system, and you pay a premium, even though you’re not a citizen of Colombia?
MN: That’s right.
AP: That’s interesting. Those premiums, do you have a sense of what those are?
MN: I don’t yet, because they’re supposed be to be based on your income, and I have not yet paid income tax to Colombia because I’m still a fairly new resident. So, true, the premiums will probably double or triple in a year. But currently, it’s about $35 a month.
AP: Oh my gosh. You could have a couple of lattes that you miss and you’d be covered.
MN: Yeah. Exactly.
AP: That’s crazy. Are you personally worried about more advanced care? If you had to get more advanced care there in Colombia, if you had cancer, for example… I think people here might be thinking, “Oh my gosh, it’s great if I have primary care, or even a pacemaker.” What about real advanced care? Have you had any experience with that, other than your friend with the pacemaker?
MN: Well, this is second-hand again. Another expat has a Colombian friend who was diagnosed with some form of cancer. I think it was going to take him around four months to get in to see the oncologist through the system. Difficult decisions may have to be made in terms of choosing to stay within the government healthcare system or going private. Privately, you can get in to see doctors much more quickly, and they also are much more accessible after treatments. I had a gum transplant done and the doctor said, “Just call me if anything comes up.”
AP: It’s interesting—most Americans think that there’s what we have versus single-payer, but most countries, like you’re describing, have a public option—sort of a single-payer option and a private option. I think that’s true of just about every country in the world. You have a private option if you want to do that. Are there other Americans you know who have gone through a similar decision-making process? You must have, in your previous career, talked to other people who left the country or thought about leaving the country to avoid healthcare as their major expense.
MN: Absolutely. When we were scoping out Panama as a possible early retirement destination, we travelled the whole country and met lots of expats who had opted for Panama for the same reasons: healthcare, the lower cost of living. There are many expatriates in Colombia, too, and Ecuador has been a popular choice. I’m talking just about Central and South America. Others who have considered this type of solution opt for places in Europe that are attracting a lot of expats. There are places in Asia: Vietnam, Thailand. Those are popular choices. Parts of Malaysia. There are expats who are picking up and moving all over the globe now for healthcare, higher quality of lifestyle, and lower cost of living.
AP: What I’m hearing from you is that you have no intention of coming back to the States for any of your care, really, at this juncture.
MN: At this point, no. We do have sort of an idea in the back of our heads that once we are both on Medicare and Social Security and have some other income streams, maybe we’ll come back to do RV travel for a couple of years. But it’s not necessarily a commitment to come back to the United States permanently. We’ve looked into continuing care in Colombia, and Medellín has some fantastic senior living facilities for assisted living and nursing homes.
MN: For people who have dementia, the one place that we visited, they actually assigned a full-time person to be with that patient all the time.
AP: Wow. Yeah. I think that supersedes what one would get here in memory care. This is kind of a loaded question, but do you have any opinions about the fact that America, this country, has created this situation where people are being kind of driven out?
MN: I think it’s sad. Unfortunately, and other people here tend to agree with me, given the convoluted nature of the problems surrounding our healthcare system, it doesn’t seem to be something that can be easily unraveled. We’re dealing with everything from the high cost of malpractice insurance for physicians, to the intrusive role of insurance companies in how they manage claims, to the American Medical Association making a solid portion of its income from creating medical codes, to the high cost of obtaining a degree to become a doctor and paying off those debts. It just goes on and on.
AP: You must be pretty informed to know that the American Medical Association is actually vested in the coding… Essentially, the insurance industry, which is kind of absurd. That’s trademarked, and they make a cut of every charge you get on your bill. I find your situation something that’s very sad, personally. That people have to look outside the US for care if they wish to retire before the age of 65, and I agree with many of your comments. We have to figure out how to provide disruptive change, rather than change around the edges. I really appreciate your time. Any final thoughts for folks younger than 65? What should they be thinking about?
MN: Well, I think for people who maybe feel okay with their healthcare except for certain aspects of it—say, dental care—places like Costa Rica, Panama, and Colombia provide excellent tourist healthcare.
AP: Oh, interesting.
MN: If people need to have major medical stuff done on teeth or even facelifts are a big deal down here. And it’s good care.
AP: How interesting! Marta, I really want to thank you again and I hope that this interview has been informative to people. I think your experience points out a major gap where we are; it’s 2019 and American citizens are leaving to get healthcare. Thank you so much for your time today.
MN: You’re welcome. Have a good one.