As expats we get asked this question a lot, and the short answer – at least for now – is NO. We’ll say more about that, but first, here’s a little story.

home-dialysis Will we ever live in the U.S. again? The Expat Life
This thing costs about $1,000 to buy and $83K a month for the privilege to use it! I think I’m in the wrong business.

We heard yesterday from a good friend in the U.S. Our friend is now on in-home kidney dialysis and just received the bill for her first month of treatment. Are you sitting down? It’s $83,000 for ONE MONTH. That’s before Medicare, of course; their out-of-pocket cost is “only” $918. That’s almost $1,000 A MONTH, for treatment she needs to stay alive, plugged into a machine that by itself only costs $1,000! Such is the outrageously cruel state of medical care in our birth country, where an estimated 47,000 people DIE every year because they can’t afford the treatments they need to survive. That number’s from 2009; we doubt seriously it’s gone down much in the ensuing nine years, especially now that the Affordable Care Act has been gutted beyond recognition.

After three years living in Panama and traveling to other countries, and also hearing several stories from friends who have received treatment here and elsewhere, we’ve come to realize that we have choices. We don’t have to live in a place where we might lie awake at night wondering how we’d pay for it if one of us had a serious medical crisis. Most of the rest of the world “gets” that medical care is a right, not a privilege, and even developing countries like Panama provide at least basic care for all of their citizens.

Our choice to live outside the U.S. isn’t just about medical care, although that’s a huge driver for us as we get older. And it’s not really about the current dismal political climate in the U.S. (don’t get me started). We’ve come to realize that our country, the one that gave us birth and opportunity, and the right and ability to travel, doesn’t look like our home anymore. When you stay in a bubble and believe all the propaganda, it’s easy to think that your home country is number one. But travel gives you a different perspective.

Our friend and fellow blogger Kris Cunningham posted an article today that reflects our feelings on this topic, and we wanted to share it here. We don’t completely agree with the author; we didn’t decide to become expats to “escape the rat race” — we did it because it’s a springboard to travel, adventure, and new experiences. In fact, we touched on some of these themes in this post. But the rest of the author’s points are well-taken.

Thanks, Kris and Joel! Here’s their post:

Joel alerted me to this really interesting and well written article by a woman who has lived outside the USA for 20 years. She talks about a much better work – life balance, lack of fears of gun violence, availability of health care, education, affordable child care, retirement pension, and a government that cares for its citizens (she lived in the Caribbean and is now in southern France) . . . read the rest



  1. Sadly, America’s healthcare is indeed very expensive. I feel it as a major challenge to continue living in the U.S. compared to two countries where I had lived before – Indonesia and the Netherlands. Sometimes I wonder if there is regulation on the healthcare service prices. I am guessing every healthcare provider can set up their own prices. I have never considered to live in the U.S. permanently either. I feel you and I wish there is a change in the healthcare system that fair and affordable for everyone regardless their economic status.

  2. Aha, there you are! Great article that echoes our feelings. The example of the dialysis machine demonstrates just how broken the U.S. health care system is. If and when the U.S. mentality changes from Darwinian to an understanding that everyone deserves dignity and respect, lives will improve, and the level of dissatisfaction & disenfranchisement will drop. It’s no wonder there’s so much violence and anxiety in the U.S.

  3. I so hear you on many levels. We’ve had our fair share of medical expenses underway but relatively speaking, they are far less expensive for the same quality of care. Our current plan is to sail back to the US (Hawaii) in December 2020, but I feel like the ‘country’ I left doesn’t exist anymore. I miss my friends and family, but I don’t like the current political climate. And right now, I am having too much fun to go home.

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