Gringo Gripes – Caja Health Care

Bless you, AM Costa Rica. Once again I have been inspired by my morning reading. Over the past couple of issues there has been a ‘dialog’ (if you want to be polite) between detractors and defenders of my adopted country of residence. Since I’m both a detractor AND a defender, I shall wade in where wise men never go.

The August 22 edition carried a letter to the editor in which the author complained about being ‘coerced’ into buying into the public health system. He was also irate that (according to something he read somewhere) there were doctors (at least one) earning $36,000 a week. Sadly, no source was cited. I decided to do a little web surfing myself, and I found an article in Tico Times stating that by working double shifts, a doctor can earn as much as $7,000 a month. A little math tells me that this is $84,000 a year. That’s a pretty nice amount in Costa Rica, but not quite the $1,872,000 a year the letter writer claims. Not to mention that the average salary is more in the range of $30,000 a year. Now, I think it would be very easy to find doctors who make two million a year in the US of A. And CEO’s of HMOs in the USA? Check out the list below of the best paid:

  • Stephen Wiggins, CEO, Oxford Health Plans, Inc. $29,061,599
  • Wilson Taylor, Chairman and CEO, CIGNA Corporation $11,568,410
  • David Snow, Executive Vice President, Oxford Health Plans, Inc. $10,403,451
  • Robert Smoler, Executive Vice President, Oxford Health Plans, Inc. $10,085,972
  • Of course these guys don’t have it easy like working physicians and surgeons. They are probably forced to fly all around the country first class and stay in 5 star hotels (put on expense accounts) and go to meetings and decide how much they can get away with raising rates. So we should have sympathy for these unfortunates.

    I pay $550 a year for my Caja membership. For that I get free doctor visits, free medicine, free hospitalization and no co-payments for anything. Strangely enough, the quality of care isn’t quite as slick as the private hospitals here that are still (relatively) cheap by US standards, but can easily run into the thousands of dollars for anything requiring surgery, extensive tests or a hospital stay.

    I did a little research on Medicare costs, and winding my way through the labyrinth was giving me a headache so I gave up after coming to the basic conclusion that unless you never get sick, Medicare costs more than the Caja. And private insurance for someone over 60? Don’t make me laugh.

    So yeah, the public health system here isn’t everything it could be. What exactly do you get for $550 a year elsewhere? And realize that gringos coming down here have not paid into the system all their working lives as the locals have. Too many gringos come down and want everything they had back home, only cheaper. They bemoan having to pay taxes here but want the same services and security they had back home. My advice is pretty basic. If you want to live in a place like the USA, you should live in the USA. San Diego has lovely weather all year round, top notch hospitals, efficient banks and (for the most part) low crime rates. You can live in a nice gated community and hang out with other people who are just like you. If you can’t afford to live there, do your homework and pick someplace else.

    I’m not one of those ‘love it or leave it’ types. There is lots of room for improvement and thoughtful critique. But half-baked talking points and dubious ‘facts’ don’t cut it. If you’re looking for a paradise that fits your ideology, you aren’t likely to find it in Costa Rica. You might try one of those newfangled artificial islands that PayPal billionaire is building. Costa Rica will survive without you, believe it or not.

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    1. We just signed up for Caja as a requirement of our cedula renewal. No complaining here. You get more than you pay for, $62.50 per month for a family of three! That is chicken feed compared to even a high deductible (read: pays nothing) policy in the States. The Caja is unlikely to be our primary provider. We are healthy (thanks in part to our lifestyle here in CR!), so usually we just use the free doctors in almost any pharmacy (you learn which ones are good quickly), then perhaps private, but Caja is an excellent backup.

      In general, since we've been here I find that the gringos that complain about life here are the ones who don't stay long (fortunately), but there are an inexhaustible supply of them (unfortunately). You are exactly right, they are trying to fit their European or USA-ian frame of reference into CR's culture, politics, economics, etc. Classic round peg meets square hole. We complain, too, of course, but it's more of a resigned-to-it complaining and all around I see CR improving in lots of ways and a lot of advantages that the U.S. doesn't have, such as the health care system. In the States, they think they are getting a great deal at these new "fast-food" clinics where it costs *only* $99 for a 15 minute consultation!

    2. Cy Bolinger says:

      Well, I haven't learned much from Casey or NoCalRefugee posts on the CAJA system. It most assuredly is overloaded and bound to get worse since all expats applying for residency after March 1, 2010 have to pay into a medical system which is in financial tatters. Many of us disrespectful folks who come to CR for cheap medical care will try to USE the CAJA. Yep, it will get worse in a culture where customer service is a joke. There are no "thank yous" or "be sure and come back to see us". Ticos do love our money though, and to prove how agreeable they are about inflated expat pecuniary matters, are glad to over charge us for most anything from Spanish lessons to veterinary bills. Most of us stay disillusioned since we don't like living in the states either so living in Pura Vida becomes the lesser of the two evils. We, to be sure, are malcontents with money!
      Cy Bolinger
      U.S. Journalist (retired)