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Shortly after I turned 50 I had a medical checkup in Key West. I remember only one specific piece of information the doctor gave me during that exam. He said, “There is no reason anyone should ever die of colon cancer.” An annual preventive colonoscopy would detect most potentially dangerous tumors before they became serious. The doctor planned to have an endoscopic exam himself every year.

His remark impressed me because genetically I’m in a group whose members too often draw the short straw for cancer. My father’s uncle died of colon cancer at age 43. Two more of my grandmother’s siblings also died of cancer in their 50’s. My sister, at 41, is an eight-year cancer survivor, and happily, enjoying a remission. My father developed lung cancer at 56, my age now. He survived 13 more years on one lung, stubbornness, and an ironic sense of humor.

The chances of my having a winning ticket in the cancer lottery should have put me on the colonoscopy bandwagon long ago. But it didn’t. Apart from the obvious reasons to put it off, there is another. Whether it’s also a genetic flaw I do not know, but I’m an insufferable tightwad. When I discovered the procedure in Key West cost something north of $5,000 I kept finding excuses to wait.

Five thousand bucks! The insurance policy I was paying $8,000 a year for wouldn’t cover any part of it — unless I already had cancer. The company promised up to a million dollars for treatment, but not a cent for prevention. Go figure.

In the five years since my 50 year exam I’ve saved $25,000 and avoided seeing my GI tract on TV, but at the risk of wishing I’d spent the money.

Now I’m living in Costa Rica. Medical care here is first-class. Private and public systems run side by side. A private doctor’s visit cost me $40. I waited less than a week for it. That doctor, not surprisingly, recommended an annual preventive colonoscopy.

I scheduled one. I called for an appointment around noon on a Thursday. I was stunned when the doctor asked me if I had eaten breakfast that morning. If I hadn’t, he was going to do the exam the next day. When I reported my huevos and tortillias he scheduled me for the following Monday. He told me how to get ready.

“How much will it cost?” I asked.  “₡110,000,” he said.  That little C gizmo means Colones — rhymes with baloneys in Spanglish. That’s about $220.

It would take about an hour from arrival to departure. I would have to buy my own laxative. Another $10 down the tubes, so to speak. Which brings me to an other advantage of having a colonoscopy in a second language. If your Spanish is bad enough, as mine surely is, embarrassment vanishes in the fog of linguistic confusion. Asking a pretty woman for a few doses of a laxative powerful enough to purge a water buffalo caused me not the slightest unease. I was too busy trying to understand her answer.

The procedure took place in the doctor’s office on the 7th floor of a modern clinic. I was 10 minutes late. We began immediately. The small consulting room was clean and new, lined with modern electronic gear and staffed by two typically friendly and perfectly lovely Costa Rican nurses. They spoke enough English to get me checked in with a minimum of embarrassment and confusion. When my Spanish collapsed, the doctor spoke fluent English. Even at less than a 20th of the cost of the same procedure in Key West, I didn’t notice any scrimping or cut corners.

They knocked me out without any fuss. I awoke less than an hour later with some cramps and no memory of the procedure. My wife was thrilled she got to watch the whole thing.

The aftereffects were limited to a few spectacular farts. In 15 minutes I was on my way home with a dozen hi-res color photos taken inside my never-before-seen, looks-as-good-as-new large intestine.

So why do you pay 10 to 20 times more for the same hour’s work in the U.S.? I can think of a few reasons.

Separate public and private health care systems in CR means very few third party payers and even fewer costly regulations in the private system.

Without insurance, private patients do not suddenly become rich as Croesus when their bill reaches the magic “deductible” number. Demand is limited by common sense rather than the limits of gold-plated insurance policies. Preventive medicine is cost effective. People spending their own money are always more careful with it. It keeps prices reasonable.

And then there’s the legal system. Contingency lawsuits are unknown here. You can’t just sue a doctor and expect a settlement because it’s cheaper to pay than fight. Sue and lose you pay for everything. In the States we have a lawyer for every 275 people.  If we just include working adults, there are only about 125 to support each attorney. By comparison, they are thin on the ground here. The money Costa Ricans save on lawyers alone buys a lot of medical care.

It’s no wonder Ticos live so long. They can afford to.

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