Because of the cost in the United States of the medical care I need, and the medicines, I have discovered that I simply cannot come back to the country of my birth. Fortunately, Brazil has a lot to offer, including free medical care and medicines.
Every two months I need to be seen by a doctor and get a new prescription for the medication that I need to survive. Sometimes, I need weekly visits to health care professionals depending upon my condition.
In Brazil, these bi-monthly or even weekly visits are free. In Brazil, even if I wait until the last day of medicine (which I sometimes do, unfortunately), I can still get an appointment at a free and public neighborhood medical clinic within a week, or I can go to a free emergency room and try beg a doctor to write a prescription on the spot. At least in Brazil, I have a constitutional right to free medical care and free medicine.
Once I have a prescription from a doctor, I can receive my medications for free at the hospital or clinic where I have seen the doctor, or for a maximum of five dollars, for a two-month supply, at a government-owned pharmacy, if the hospital or clinic's supply is low.
However, if I returned to the United States today, I know what I would find. I would have to apply for Medicaid. The last time I did this, in 2004, they told me I was "over-income" and ineligible. I could have appealed the decision, but that might have taken months. Even if I were successful, at any time the legislature and governor of the state I might live in could decide to change the eligibility requirements and refuse me medical care. That's a risk I cannot take.
When I left the United States for Brazil in 2004, I tried to get the vaccinations that are required for travel to Brazil. I discovered that the least expensive alternative in my area was to pay $850.00 dollars for those vaccinations. Instead, I decided to come to Brazil without the vaccinations (foregoing obviously necessary medical care, as so many US citizens and residents do everyday.)
Fortunately, I discovered that the same vaccinations that would have cost me $850.00 in the United States are available for free at any neighborhood health clinic in Brazil.
Brazil does not have single-payer health care system; it has a national public option, but also has private insurance companies competing to insure those who want or need to see private doctors at private clinics and hospitals. Sometimes private clinics are a better option and I have spent about eight hundred dollars at private clinics and hospitals over the last five years, for a surgical procedure and two-day hospital stay for my wife and eye and ear exams for myself.
I have also spent about seven hundred dollars or so on dental crowns, fillings and canals here that would have cost me five to ten thousand thousand dollars or more in the United State. When my daughter fell and chipped her tooth, a dentist fixed it impeccably for twenty dollars in one visit.
Because all medical care, public and private, is exponentially less expensive in Brazil, even from private practitioners, my wife and I so far have been able to self-insure, paying out of pocket when we need to see private practitioners for us or our three children. A friend who is a physician here tells me that, like in the United States, private insurance companies here often refuse to pay for expensive medical care when the patient needs it most.
So, my physician friend was not able to recommend any private insurance I could buy here that would be worth the premiums I would pay. Better to rely on the national public system of neighborhood health clinics, hospitals and pharmacies, where care isn't always perfect but it's always free.
Needless to say, I am glad that I have become a permanent resident of Brazil. If Brazil is a "third world" country, I'll take "door number three," thank you.