On a return flight from India to New York City, I had a layover in Frankfurt. I struck up a conversation with an older gentleman at a restaurant. We connected over our shared soup order and swapped travel stories. He explained that he had been to Costa Rica for dental work. His insurance didn’t cover the procedures he needed. It was less expensive for him to travel abroad for care. His story resonated deeply with me.

The High Price of Growing Old in America

My parents, both originally from India, chose to retire there because healthcare costs in the U.S. became unsustainable as they grew older. It was a practical decision. However, it came with heartbreaking consequences. We lost precious time together as we were separated by thousands of miles. We kept in touch, but it was never quite the same. Having spent over 20 years in healthcare myself, I understood their decision, even though it hurt. Their story is just one example of the difficult trade-offs many face in today’s U.S. healthcare system.

A Firsthand Look at Indian Healthcare

I visited India to see my father, whose health was deteriorating. Watching his care firsthand was eye-opening. The efficiency and affordability were remarkable. His primary care provider had direct access to specialists, instant lab results, and medications on hand. A cardiologist even rode a bicycle to the clinic just for his consultation! Within two hours, my father had his lab results, a thorough cardiology exam, appointments with specialists, and medication—all for about $300 total, including prescriptions. It was astounding.

The Harsh Reality of U.S. Healthcare

This stands in stark contrast to my experiences in the U.S. I’ve often paid $500–$700 per month for health insurance. Sometimes it’s for my family. Other times, it’s just for myself. This is on top of co-pays, deductibles, and a $90 monthly fee for a concierge emergency clinic to avoid long waits. Even then, getting a primary care appointment might take a month, a specialist two months, and lab tests weeks. At the doctor’s office, I fill out endless forms (including payment agreements), then wait 30 minutes or more for a rushed 15-minute consult. Billing is a separate headache, with surprise charges for services insurance refuses to cover.

The Insurance Labyrinth

From my experience in practice management, I know that insurance companies depend on unpaid labor from healthcare providers. They rely on this unpaid labor to navigate their convoluted systems. Their ever-changing billing protocols—often a result of constant mergers and acquisitions—are a nightmare. Contrary to what many believe, insurance reimbursements to doctors are far from generous. Wellness visits are reimbursed at shockingly low rates. Doctors must see more patients to cover their overhead and staff costs. The system is built to maximize profits, not patient care.

Who Really Profits?

Pharmacy Benefit Managers (PBMs), like CVS, are the real winners in this system due to powerful lobbying. To some extent, the federal government also benefits. These organizations—sometimes called “drug dealers”—wield immense influence over drug prices and access. Meanwhile, the public is distracted by less critical debates, and the fundamental problems of healthcare access and affordability persist.

Rethinking Health Insurance

Over my lifetime, I’ve paid more than $250,000 to health insurance companies and concierge clinics. My family has used only a fraction of those benefits. Each year, I renew my policy, fully aware that most of that money is gone for good. It’s a tough pill to swallow. It made me reconsider my approach—maybe my parents were onto something after all.

Is Self-Pay a Better Option?

What if I ditched health insurance, paid the Obamacare fine (for now), and continued paying into Medicare/Medicaid? Doctors often offer payment plans, and hospital foundations can help with large medical bills. With discipline, I could save at least $6,000 annually – money I could use for self-pay or medical tourism. The food in those countries is probably better as well.

Fear and Financial Decisions

Fear has shaped most of my healthcare decisions. Insurance companies thrive on our fear of the unknown. I regretted letting fear guide me. Otherwise, I might have donated a large chunk of that quarter-million dollars to research. I could have also contributed to charitable foundations. I could have paid for more time with practitioners, or invested in things that truly matter to me—like healthy food, fitness, and travel.

Hope for the Future

It may be too late for my generation to overhaul the system, but I have hope for the next one. They’re more informed and better equipped to speak out. I’m trying to peel away the bandage of fear, because now I know better—and I can do better.

*Pharmacy Benefit Managers and Their Role in Drug Spending, Commonwealth Fund, April 2019. https://doi.org/10.26099/njmh-en20