Thailand is that place in the world where my oldest daughter Emily chose for her college semester abroad. The semester abroad is a requirement for her major in international development at Calvin College. Southeast Asia had found a special place in her heart in travels she experienced in her teens and early twenties aboard Faith.

Chiang Mai.

My wife Lorrie and I both dwell on the heavenly side of that magic fiftieth birthday, the birthday that showers each of us with tests for gender-specific and non-gender-specific blessings deemed important by the medical community. By nature, I am a medical procrastinator, and by a different nature, Lorrie is frugal. Neither of these tendencies lend themselves to rushing into the fifty-plus medical testing clinics, or in my case, rushing toward procedures to correct known medical issues.

My New Year’s Resolutions for many years have included the correction of these known medical issues, one being a basal-cell carcinoma that was removed from my nose several years ago, but that for no apparent reason, was bleeding every now and then for no apparent reason with increasing frequency, and the second, a tumor of some sort on my right jaw, about an inch from my ear.

This year, I even scheduled an appointment with my doctor for the first week in January to demonstrate some effort on my part on actually adhering to my New Year’s resolution. I do make it a priority to get a physical every three or four years, and since my last physical was four years ago in Phuket, Thailand, the timing worked well.

As a result of this latest physical, my doctor recommended again that I address the basal-cell and the tumor in addition to having a colonoscopy performed, a chest x-ray, a treadmill stress test, and some blood work and urinalysis performed. So, I promptly followed-up with his last recommendation—I peed in a cup—and fell comfortably back into my old routine of ignoring my New Year’s resolution on or about January 7, three full days later than last year.

Emily boarded a flight for her semester abroad a week after I gave up on keeping my New Year’s resolution.

Lorrie’s age has probably been discussed more here than is prudent because she’s a woman and because she’s the woman that I share a marriage with. But she has reached a point in her life that certain tests are recommended and plans were soon laid for Lorrie to visit Emily and to procure those tests in Chiang Mai, Thailand.

Before Lorrie departed, and during her time away, she continued to encourage me to follow through on my own pursuit of health, but with time and distance from the first inclination to break that resolution, the excitement of the whole ‘get healthy, or at least learn that I’m not dying’ thing diminished in importance.

With Lorrie away, I took my seventh grade son Gregg II to Florida for his Spring Break, think this might alleviate our pain and suffering in the absence of his mother and my wife. One morning she called. Between sobs and gasps she related the story of how she had been on the treadmill for a stress test and how they determined something wasn’t quite right and how she was now in a hospital room waiting for a cardiac catheter test to figure out what was going on and how the doctors wanted her to do this before going ahead with the colonoscopy that was scheduled for tomorrow and that she didn’t feel comfortable with the notion of dying.

We spent the day at mom and dad’s condo in prayer before breakfast, and concerned most of the day with what might be happening. The next call found her to be more chipper, with the report that some of her capillaries had shrunk, as often happens when people age. No big deal.

During Lorrie’s last week of her three-week visit, in which every phone call except the one found her marveling at the treatment she was receiving, Emily called me.

Now, I’m married to Lorrie, and as every man who has ever been married knows, being married has a tendency to affect one’s hearing of certain sounds from a certain source. A whole industry abounds in literature and counseling around this phenomenon, so no further discussion is provided here. But when your kid calls and tells you the same thing, “Dad, I love you, and think you should come to Thailand to receive medical care, just like mom is now here for.” Wow! I then knew I must go.

Soon after Lorrie returned home, I made plans to follow in her tracks. I asked Emily to reserve for me a room in the same guesthouse, The Suan Doi House, and I forged ahead with a job I find nearly as distasteful as receiving medical services—that of procuring airline tickets. The difference between these two unpleasant industries, is that after jumping through all the hoops to buy the necessary product, the person delivering the medical service genuinely cares about you as a person.

Thailand is an easy destination, as a thirty-day visa is granted to Americans on arrival. From what Lorrie and Emily have been telling me, Chiang Mai is an easy part of Thailand to be. I had never been to Chiang Mai, but have experienced the laid-back tourist destination of Phuket and the urban throb and hustles that Bangkok can thrust on the unsuspecting traveler.

To pack, the idea is to take the bare necessities in a huge, empty suitcase, because everything, with the exception of a few consumer electronics type things, is cheaper in Thailand. Count on buying the clothes you will wear during your visit there, as well as a great number of other items to take home with you.

An important tidbit I had to force myself to keep in mind was to not go online to schedule medical work in Thailand ahead of time. Unfortunately, as Americans, we have trained ourselves to take control of the situation so we know exactly what will happen from the moment we disembark the last flight until we make the return stroll through the airport to board our departure. I needed to land in Thailand with a ‘wish-list’ of things I desired tended to, a ride to the guest house, and a blank slate of agenda.

I flew from Grand Rapids, Michigan to Chicago’s O’hare to Tokyo to Bangkok where I cleared Customs and immigration, then slept the overnight layover on my bags at the airport before making the early morning flight to Chiang Mai.

I arrived in Chiang Mai at 9:00 AM. It was Friday.

Fictions held with conviction blossom into the sweetest fruits. We stay on this diet for years until our beliefs are cast into facts of granite. To be effective, these fictions must be cleverly tucked into the cleavage of rich reality; only there in the void, between abundant mounds of truth, can such lies be accepted. We nurse a love affair with these fictions—fictions of greatness and perseverance and ingenuity that serve to define us as ones set apart.

To construct a truly great fiction, not unlike a truly great movie script or novel, an element of the darker side, the evil, must be introduced. Love and happiness and pleasure and joy grow all the stronger when shadows of fear and foreboding and pain and hate provide contrast. For years, the Russians served to reinforce our goodness. Now, as Russians have again groomed a humanness not seen since Tolstoy, Muslims fill the void. We can’t say ‘Muslims,’ of course, so we’ve developed a codeword for that purpose: terrorists. The human mind has an amazing capacity to grasp the most absurd of convictions. Think how we assure ourselves of our own goodness in the knowledge that weapons of mass destruction in hands bent on human destruction must be avoided—a statement we make with the perverse superiority of possessing the only hands having so used them.

The flaw in fictions held as fact, like buildings constructed of rigid materials, granite and concrete without the benefit of a flexible reinforcing component, is that minor shocks to their foundations rapidly cause them to collapse on themselves, crumbling to dust and gravel. All we then have left is a gaping hole in the ground of our being. We lash out in anger at those that provided the materials, forgetting our own involvement in building such a grandiose structure of belief.

We dwell in a world of firm truths cupped in reality. One such truth is that health care in the United States of America is the finest in the world. American health care is sought after by kings and princes and captains of industry from all corners of the world. Another voluptuous truth is that the delivery of goods and services is most efficient when the means of production are held privately. (The validity of this awaits confirmation, as capitalism has lived in name only ever since society granted huge tracts of land upon which the great lumber and railroad empires built this nation.)

Falling between these mounds of truth are roughly sixty million citizens of the United States who find the cost of health care beyond their reach. How can this be? Also between these mounds of truth is the void where fictions are manipulated into existence. The claim that we have the best health care in the world is massaged to be understood that health care outside of America is sub-standard. The fact that those kings and princes and captains of industry choose to come to America for the most complicated of procedures is coined to suggest that quality health care exists only in America. To believe otherwise is somehow another belief in an abstraction no less horrifying than terrorism.

During a romantic four and a half year voyage aboard a fifty-six foot sailing boat named Faith, my family witnessed the shattering of a great number of these fictions. My wife Lorrie and I took our three children to visit thirty eight countries—more if we count the countries we neglected to clear through immigration and obtain stamps in our passports from. In so doing, we experienced the horrors of medical care in some of those countries. I suggest, as a result of these experiences, that the most effective health and dental insurance available to a great number of American citizens is a Passport issued by the United States of America.

Within months of leaving on our journey, Gregg II, my five-year-old son provided us the opportunity to purchase for him eleven sutures above his left eyebrow in Panama City. Excellent service, excellent talent, no scar remains, and the cost to Lorrie and I was two dollars for the registration paperwork and one dollar for the sutures—about 9¢ per suture.

A month or so later, far into the evening on the Galapagos Island of Isabela, a rebellious cotter pin inflicted a nasty gash on the whiter part of my right forearm, and required the purchase of more sutures. We arrived at the clinic, banged on the door, and the live-in receptionist instructed us to make ourselves comfortable while she roused the doctor. On arrival, the doctor promptly set to work on my five sutures, wrote a prescription for an antibiotic, and charged me the equivalent of $5.00. The antibiotic I was to take for a week cost $3.50, again following the fetching of a groggy pharmacist.

In French Polynesia, certain young members of our expedition experienced a rash from becoming salt-water-logged—exactly what one expects from kids in the Pacific Islands. When the pharmacist handed us a bottle of topical medicine, we asked, “How much?”

To our delight, he replied, “You are in France, you owe me nothing.”

To obtain visa extensions in Australia, chest x-rays to check for tuberculosis were required of the three of us over sixteen—Lorrie, my daughter Emily, and me. This proved an expensive ordeal, but was still less than half of the nearly $600 these x-rays would cost at home.

In an exercise of bravado or stupidity on a motor-scooter in Malaysia, I broke five ribs and the scapula on my right side. I received a chest x-ray for $25, then, for another $30, a consultation in which the doctor informed me that I must wait for healing to happen—the medical profession didn’t have much to offer in healing either my bones or my stupidity.

Also in Malaysia, we learned that pharmacists are allowed to use their training and their judgment to dispense medications—narcotics excepted—and are not simply the gatekeepers of doctor’s wishes they appear to be at home.

We have been taught to believe the fiftieth is a birthday of medical milestone proportions. As life played out, my fiftieth birthday was celebrated in Langkawi, Malaysia. As a birthday present, Lorrie procured for me a physical to be performed by the wonderful staff at Bangkok International Hospital in Phuket, Thailand. The most expensive parts of the $250 we were charged happened to be the stress-treadmill test and the chest x-ray.

As a snack during our sail from Phuket to Sri Lanka, I found a frozen Snickers candy bar in the freezer. During my first bite, this bar managed to extract a porcelain crown from my top front left tooth. Once in Sri Lanka, a post was installed and a new crown fitted. It cost fifty dollars, an exorbitant sum of money for which the dentist was truly apologetic. As I left his office after the work had been completed, he said, “Don’t bite anything hard; it’s plastic.”

Somewhere between Southeast Asia and the Arabian Peninsula lived a mosquito that for her own procreative instincts inflicted on me a horrible disease. I believe we can rule out the Arab countries, as I don’t recall combating mosquitoes in their arid climes. Other than that, all I know is that malaria can lay dormant for up to a year in one’s system before symptoms occur. Symptoms occurred for me in the country of Eritrea.

A cruise ship happened to be in the same port, Massawa, at the same time as we were there; all of the guests were healthy and away on an excursion. The ship’s medical officer, believing I did not have malaria, made a first-rate project of me nonetheless, and filled me with fluids and shot me with the super-drugs you’d expect as a guest on a round-the-world cruise aboard the good ship Topaz.

Because Eritrea is, well, Eritrea, high expectations of a basic food supply, let alone medical services, are not fostered. My wife took me to the capital city of Asmarra, where a U. N. Hospital was situated. The Jordanian medical officers staffing this U. N. Hospital diagnosed falciparum malaria on my first day there. They then proceeded to tolerate my declining health for three days before confessing there were no medications available to treat my condition in Eritrea, and suggested I evacuate to Cairo, Egypt, on this night’s flight. Cairo was chosen as a destination because the twice weekly flight to and from Cairo is the extent of commercial air traffic at the Asmarra International Airport.

Lorrie and I asked how much we must pay for the U. N. Hospital’s treatment and were informed it was $125 per day, or $375. “Yes, but what about the medications, and x-rays, and all of the other stuff?” As Americans, we carried the American knowledge that we were to be charged for every little thing.

“Oh, no. That’s not how the U. N. Hospital works,” said the hospital director, “we charge $125 per day for whatever medical services and treatments we provide.”

The Arab Contractors Medical Center in Cairo, Egypt, did have access to the medications and managed to get the nasty parasites under control after three days. At the time I was discharged, I was required to pay for the services rendered—x-rays, ultrasounds, medications, hospital stay in a private room, doctors, nurses, food. This hospital was privately owned and for-profit and all services were itemized on the bill. The Egyptian government provided no help by way of subsidies for me because I am not Egyptian. They charged $475 and made money on me.

Of the above examples, both the French and Panamanian governments pitched-in to help fund our medical coverage. The remaining examples, with the exception of the U. N. Hospital, on which I have no knowledge of how their fees are based, demonstrate the cost of health care outside of the United States of America.

One of the greatest fictions surrounding the Health Care Industry in the United States is that this massive industry is engaged wholly in the provision of health care. In truth, a large portion of this industry exists solely for the purpose of extracting profits and paychecks on the backs of the relatively few talented individuals engaged in patient care.

The cost of health care in the United States of America includes many factors that bear no relation to the cost of medical services and medicines. Over 20% of the health care industry dollars shuffled around in this country is siphoned-off by financial services enterprises in the form of health insurance. But, health insurers do not engage in the provision of health care; they are simply the money changers.

Not long ago (I preface things that have occurred in my lifetime with this), a doctor’s practice consisted of the doctor, a nurse to fetch things for the doctor and to administer such services that nurses held qualifications to minister, and a person to serve as both the cashier and appointment coordinator. Quite often the job requirements of the cashier and appointment coordinator were filled by the nurse, or when the nurse was engaged in a particularly useful ministration, say for instance, a geriatric enema, the doctor would perform these functions. Two talented people could define a medical practice. Now in America, to get paid, that same doctor (not really, because that same doctor retired) requires not only the nurse, but also has three or four people engaged solely in that doctor’s business of getting paid by health insurance companies on behalf of the patient.

Generally, that entity from which our paycheck is generated is our ultimate boss, so the health insurance companies find themselves in a position of authority to dictate which procedure or medication or therapy is covered under their plan for the patient, and which procedure or medication or therapy is not covered. The doctor, who chose this profession to care for his or her patients, must now satisfy the judgment of an organization run by a business administrator, not a doctor, in order to get paid.

Once the doctor is paid by the health insurance companies, he must first pay the additional employees in his office that made this payment possible—the medical billing specialists. Of the remaining money, none yet spent on patient care, the doctor must pay the people in his office who are engaged in providing health care, must pay the rent and the cost of the practice, and then, before he or she gets paid, must pay for a service that organized crime calls ‘protection’, otherwise known as medical malpractice insurance.

In addition to these taxes by insurance companies and the support systems they spawn, a system is created by the legal profession forcing doctors to perform myriad tests and procedures outside of their professional judgment for the sake of averting a potential lawsuit.

Recently, the wizards in Washington whittled a new round of tweaking into American health care. During the debates, we were offered a glimpse into their reasoning when the Speaker of the House of Representatives said: “This bill is not only about the health security of America. It’s about jobs. In its life, it [the health bill] will create four million jobs—400,000 jobs almost immediately.”

Jobs are important when they add value to a thing, but the value of the health care industry, the only value of the health care industry comes from the professionals trained in the art of healing. They are the ‘talent in the room,’ so to speak, supporting the health insurance, the medical malpractice insurance, the medical billing, the attorneys engaged in suing health care providers, the attorneys engaged in defending health care providers, in addition to a whole slew of other industries. The addition of these 400,000 new jobs only places additional burden on that ‘talent in the room.’

A bloated system exists within the structural framework to make and keep it so—that explains part of why health care in the United States is the most expensive health care in the world. An unfortunate aspect of the high cost of health care in the United States is the pressure it places on her citizens to seek those services elsewhere or to forego those services altogether. I am one such citizen and these are the perceptions that prompted me to seek out health services in a country twelve time zones away from my home and my family.

This is my story. (This is the end of the introduction, brought in three parts, to my upcoming book on Medical Tourism in Thailand. Please visit Sailing Faith’s homepage to purchase my previous book, Sailing Faith: The Long 

One of the greatest fictions surrounding the Health Care Industry in the United States is that this massive industry is engaged wholly in the provision of health care. In truth, a large portion of this industry exists solely for the purpose of extracting profits and paychecks on the backs of the relatively few talented individuals engaged in patient care.

The cost of health care in the United States of America includes many factors that bear no relation to the cost of medical services and medicines. Over 20% of the health care industry dollars shuffled around in this country is siphoned-off by financial services enterprises in the form of health insurance. But, health insurers do not engage in the provision of health care; they are simply the money changers.

Not long ago (I preface things that have occurred in my lifetime with this), a doctor’s practice consisted of the doctor, a nurse to fetch things for the doctor and to administer such services that nurses held qualifications to minister, and a person to serve as both the cashier and appointment coordinator. Quite often the job requirements of the cashier and appointment coordinator were filled by the nurse, or when the nurse was engaged in a particularly useful ministration, say for instance, a geriatric enema, the doctor would perform these functions. Two talented people could define a medical practice. Now in America, to get paid, that same doctor (not really, because that same doctor retired) requires not only the nurse, but also has three or four people engaged solely in that doctor’s business of getting paid by health insurance companies on behalf of the patient.

Generally, that entity from which our paycheck is generated is our ultimate boss, so the health insurance companies find themselves in a position of authority to dictate which procedure or medication or therapy is covered under their plan for the patient, and which procedure or medication or therapy is not covered. The doctor, who chose this profession to care for his or her patients, must now satisfy the judgment of an organization run by a business administrator, not a doctor, in order to get paid.

Once the doctor is paid by the health insurance companies, he must first pay the additional employees in his office that made this payment possible—the medical billing specialists. Of the remaining money, none yet spent on patient care, the doctor must pay the people in his office who are engaged in providing health care, must pay the rent and the cost of the practice, and then, before he or she gets paid, must pay for a service that organized crime calls ‘protection’, otherwise known as medical malpractice insurance.

In addition to these taxes by insurance companies and the support systems they spawn, a system is created by the legal profession forcing doctors to perform myriad tests and procedures outside of their professional judgment for the sake of averting a potential lawsuit.

Recently, the wizards in Washington whittled a new round of tweaking into American health care. During the debates, we were offered a glimpse into their reasoning when the Speaker of the House of Representatives said: “This bill is not only about the health security of America. It’s about jobs. In its life, it [the health bill] will create four million jobs—400,000 jobs almost immediately.”

Jobs are important when they add value to a thing, but the value of the health care industry, the only value of the health care industry comes from the professionals trained in the art of healing. They are the ‘talent in the room,’ so to speak, supporting the health insurance, the medical malpractice insurance, the medical billing, the attorneys engaged in suing health care providers, the attorneys engaged in defending health care providers, in addition to a whole slew of other industries. The addition of these 400,000 new jobs only places additional burden on that ‘talent in the room.’

A bloated system exists within the structural framework to make and keep it so—that explains part of why health care in the United States is the most expensive health care in the world. An unfortunate aspect of the high cost of health care in the United States is the pressure it places on her citizens to seek those services elsewhere or to forego those services altogether. I am one such citizen and these are the perceptions that prompted me to seek out health services in a country twelve time zones away from my home and my family.

This is my story. (This is the end of the introduction, brought in three parts, to my upcoming book on Medical Tourism in Thailand. Please visit Sailing Faith’s homepage to purchase my previous book, Sailing Faith: The Long Way Home. )