Healthcare Refugees: The Next American Exodus

Healthcare Refugees: The Next American Exodus
Affordable, quality care is drawing Americans overseas.|©iStock/MartinPrescott

I have this recurring conversation that usually starts with a friend or reader confiding: “My health insurance premiums are insane.” Or: “My deductible is $7,000—what’s the point?” Or worse: “I got a surprise bill for $42,000 after a routine hospital visit.”

What comes next is a familiar cocktail of anxiety, disbelief, and anger.

Particularly the anger.

Americans in my circle, and the Americans I see posting videos on various social media platforms, are absolutely livid that the U.S. healthcare system is such a sh**show. It is clearly not designed to provide healthcare, but to pull money from consumer wallets to fund corporate lifestyles, and only grudgingly to pay for as little insured medical cost as a company can get away with.

But the people I talk to often have just approached the pivot: “What if I just moved somewhere cheaper? I see people going to Turkey or Costa Rica for really good healthcare, and I’ve heard about this ‘medical tourism’ stuff. I just wonder if it really makes sense.”

Spoiler alert: Yes—it makes a lot of sense.

Healthcare without the threat of bankruptcy?

Like I said… makes a lot of sense!

The open secret is that America doesn’t have a healthcare system. It has a healthcare industry. Systems are for making things work. Industries are for making profits.

So, Americans are increasingly opting out and going abroad for healthcare needs that are more affordable. And don’t think “affordable” means substandard. Truth is, the US has middling scores in terms of healthcare outcomes.

The independent research group The Commonwealth Fund highlighted in a 2024 report that “Americans are sicker, die younger and struggle to afford essential health care.” Compared to nine other high-income nations in that report, America ranked dead last, with a lower life expectancy and higher rates of death and disease despite spending far more than any other country on healthcare.

I feel confident you’ve heard the term “medical tourism.” The phrase conjures up (quite accurately, I’ll say) images of someone flying to Bangkok, Thailand or Algodones, Mexico for dental implants or knee surgery, holing up in swank hotel for a few days or a couple weeks, then flying home… and the entire cost is less than it could be to stay in the U.S. and pay for co-pays and deductibles and whatever charges the insurer won’t cover (and there are always charges US insurers won’t cover.)

But what we’re seeing now is something different.

Something deeper.

A migration.

Not for a procedure… but for a life.

These are the New American Healthcare Refugees—Americans who are making a permanent—or at least long-term—decision to move abroad for access to affordable, high-quality care they simply can’t afford back home.

For many, it’s the rational decision for a very base reason: They want to live.

They want to preserve quality of life in their 50s, 60s, 70s, and beyond, and without the stress of wondering whether they can afford their meds… or wondering if a minor fall will lead to medical bankruptcy.

The Numbers Don’t Lie

When quality care costs less, going abroad just makes sense.
When quality care costs less, going abroad just makes sense.|©iStock/courtneyk

In the U.S., the average premium for private health insurance in 2025 is about $8,435 per year per person. A family of two or more easily runs $15,000 to more than $20,000. By comparison: Here in Portugal where I live (and where I am about to turn 60) the Cadillac plan I have that covers me, my wife, and a 12-year-old, is $3,480 per year.

Per. Year.

Less than $300 per month.

And that’s a private plan. If I stuck with the state plan, Portugal operates a very highly rated healthcare system, my costs would basically be nothing, and everything would be covered.

In France, a country ranked #1 in the world by the WHO for healthcare quality, you pay around $35 to $70 a month for private supplemental insurance if you’re not part of the public system. Visits to the doctor cost around $25–$30, and you get most of that reimbursed.

In Malaysia, where hospitals in Kuala Lumpur and Penang rank among the top globally for expat care, a specialist consultation might cost $20–$30, and you can lock in top-tier surgery at private hospitals for a fraction of what it costs in the U.S.

Costa Rica offers universal healthcare (Caja), and private insurance options are also available for a few hundred dollars a year. You can see a specialist the same week, often at clinics where many doctors are trained in the U.S. or Europe.

To be absolutely clear, these aren’t third-world clinics with flickering lights and hand-cranked exam tables.

I’ve been inside numerous medical facilities in Portugal, Spain, the Czech Republic, even southern China, and all were modern, Western-style hospitals serving locals and expats alike with the kind of personalized care that disappeared from America bedsides decades ago.

And while the financial savings are massive, the real dividend I’ve discovered is peace of mind.

In most of these countries, healthcare isn’t a profit center. It’s a public good. A human right. Something people expect as part of civilization.

As such, the whole tone changes.

There’s no arm-wrestling with insurance. No “we don’t cover that.” No networks. No hidden codes that get you slammed with a $17,000 charge for sitting in a hospital bed.

Instead, there’s a focus on care.

You walk in. You’re seen. You’re treated.

It’s almost… civilized.

I came down with a nasty bout of pneumonia in the fall of 2024 while living in Lisbon. I visited the ER three times over the course of two weeks. I had several doctor’s appointments… and it was fantastic care. Like, I sensed that they really gave a damn.

So, where to go for this level of affordable care?

Let’s break this down into three global regions:

Europe

Portugal: Europe’s rising star for healthcare expats. Great care, low costs, easy visa options, and a culture that supports slow living.

France: The Cadillac of care. If you qualify for the public system or pay for private top-ups, you’ll get access to the best.

Spain: Affordable, efficient, and home to some of the healthiest people in Europe. Mediterranean diet included.

Latin America

Costa Rica: Popular with retirees. The public Caja system plus strong private options make it a favorite.

Mexico: The most accessible option for Americans. Great private hospitals in places like Mérida, Guadalajara, and San Miguel de Allende.

Colombia: Frequently ranked among the best healthcare systems in Latin America. Modern hospitals and English-speaking doctors in Medellín and Bogotá.

Asia

Malaysia: Long known as a medical hub. Penang and Kuala Lumpur hospitals offer top-tier care at bottom-tier prices.

Thailand: World-class dental, cosmetic, and general medical care. Bangkok and Chiang Mai are expat favorites.

Vietnam: Rapidly improving. Ho Chi Minh City now has internationally staffed hospitals serving a growing foreign community.

Who’s Making the Move?

Why pay more for less? The global search for better, cheaper care is on.
Why pay more for less? The global search for better, cheaper care is on.|©iStock/rfranca

It’s not just ultra-wealthy snowbirds or digital nomads who are alighting abroad for better healthcare options.

These days, middle-class Americans are choosing that option as well.

Teachers. Truck drivers. Veterans. Nurses. Single moms.

People who got sick and tired of being one diagnosis away from destitution.

People who did the math and realized: “I can’t afford to stay here because healthcare costs are killing me.”

People who realized that the so-called “best healthcare system in the world” doesn’t exist in America, and that the very best healthcare in the US only works if you’re rich or lucky.

You see the same stories I see. People rationing insulin. Skipping scans. Avoiding treatment because they’re afraid of the bill.

This is not what a civilized country does to its retirees. Or anyone, for that matter.

But the antidote isn’t complaining. It’s getting smart, and understanding that you don’t have to play by America’s broken rules.

You can opt out.

You can choose a different model.

You can build what I call a “medical lifestyle”—one rooted not in fear and compromise, but in autonomy and access.

Because in the end, healthcare isn’t just about living longer.

It’s about living better by way of a truly affordable healthcare system, rather than living as a profit center in a medical industry.

And if that means packing a bag and planting roots somewhere new, so be it.

Because freedom is not just a slogan.

It’s the ability to protect your health… and your wealth… on your terms.

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