Pajamas Media

38 Comments

1. TennesseeVolunteer:

I am self employed and found it cheaper to buy insurance than to be covered under my wifes plan. At age 57 with no health problems I pay $441/mo.
In order to have a great quality of life for as long as possible, I work out one hour a day but I could do a better job of not eating so much. I totally agree with the author that if we were responsible for our own health and expenses, we’d all be more responsible for how we live our every day life.
So much of our medical overhead has nothing to do with care but compliance, malpractice coverage etc. When I was a kid, people walked to the store, tended gardens, sat outside under the tree and had to get up and go to the kitchen to answer the phone! Our poor and middle class were healthier then. Our health care should concentrate on large problems (cancer, car wrecks) and our everyday health should be our responsibility. We’d be a lot better off.

Sep 9, 2009 - 6:02 am 2. jharp:

Interesting piece.

Sounds like the Panamanians are much smarter than the fools we have here in the U.S.

And I cannot for the life of understand the support we have for our current health care system. It is common knowledge that we have the most expensive system by far, about double. People can lose everything over an untimely illness. And the care is no better than the countries who spend half of what we spend.

Sep 9, 2009 - 6:29 am 3. Free Quark:

I have read that some hospitals in Britain send patients to India for routine bypass surgery because it is so much cheaper.

Maybe we could do the same with Panama.

Sep 9, 2009 - 7:08 am 4. paul_unalaska:

Mr. Miller, thank you for the article. I’ve only a few questions.

How much money does Panama’s health care system invest in medical research, technology?

Does it constantly improve its staff members response, surgical practices?

Is Panama subjected to a large number of non-Panama citizens/ illegal aliens abusing its system?

If you’ve had to stay overnight in a Panama hospital, what’s the quality of food, cleanliness, availability of medicine, doctor, nurses, check-ups, post-op follow-up, etc.,? You’d spoken of a cultural component that supplies food, linen etc., What if I hadn’t any of those amenities?

I see for more significant surgeries, care you have to go elsewhere. Whereas most U.S. hospitals have an ‘all-in-one’ facilities. Hmmm.

What is Panama’s per capita average? Would you assume the service, cost would be as efficient if the population were, oh I don’t know, 10,000% higher?

jharp, the ‘fools’ in the U.S. medical profession in myriad of facets are a key component to why individuals are able to live longer, more healthier lives worldwide. Your personal crusade to decry the American medical field is just that – personal. Your clouded emotions on the subject are moot..

Sep 9, 2009 - 7:17 am 5. jharp:

“I have read that some hospitals in Britain send patients to India for routine bypass surgery because it is so much cheaper.”

Wellpoint is sending patients(Americans)to India for knee and hip replacements because it is a fraction of the cost here.

Sep 9, 2009 - 8:01 am 6. jharp:

paul_unalaska:

“jharp, the ‘fools’ in the U.S. medical profession”

You misunderstand. The “fools” I refer to are the ignorant American’s who support our current system and shout down any meaningful dialogue. “Death panels” “Socialized medicine” “rationing” “government takeover” “power grab” among other total nonsensical claims. (Teabaggers and the like)

Those in the medical profession are quite smart and are using the system to profit immensely.

Sep 9, 2009 - 8:08 am 7. paul_unalaska:

My mother had both her knees replaced, 12 months apart from one another, voluntarily. Her private insurance allowed an in-out affair, 4 days apoece for each knee in Aspen, Colorado.

jharp, medicare would’ve covered the procedures as well. Quit selling garbage of it being ‘a fraction of the cost..’

There is ONE city I’d trust in India for ANY medical care. Bangalore. Anywhere else in India I’d be frightened..

jharp, did you know a majority of India’s med students go to Russia for med school? For it’s cheaper there than even India. These folks are learning Russian when attending school.

Afterward, many of the graduates flock to the U.S. Weird, huh? (sarc off)

Sep 9, 2009 - 8:18 am 8. Fantom:

I would have no problem with 25% of a workers wages being placed into a private account from which private medical insurance, as well as a true retirement can be purchased.

Sep 9, 2009 - 8:22 am 9. jharp:

paul_unalaska:

“jharp, medicare would’ve covered the procedures as well. Quit selling garbage of it being ‘a fraction of the cost..’”

Obviously medicare covers joint replacements. As for the rest of your post.

“By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad, according to the Deloitte Center for Health Solutions, a consultancy. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi said. Similar savings could be achieved for such common procedures as hip replacements and spine surgery.”

http://www.nytimes.com/2008/11/21/health/21abroad.html

And… …About 750,000 Americans headed abroad last year for major health care, and an estimated 1.5 million are expected to this year, according to a study released last summer by the Deloitte Center for Health Solutions. The largest U.S. health insurers are starting to take notice.

Aetna Inc. launched a medical tourism pilot program earlier this year. Cigna Corp. and UnitedHealth Group Inc. representatives say they’re studying the idea.

Sep 9, 2009 - 8:32 am 10. Fantom:

Hmnn, I can get my kid insurance for about these same rates.

http://www.panama-guide.com/article.php/20040922145544306

“n Panama, insurance is normally sold by “brokers” who act as the middleman between the customer and the insurer. The brokers are not usually loyal to one insurance company or another, and can quote you a variety of options and different rates of coverage.

The variables in healthcare coverage are usually the age and health of the person to be covered, the type and quality of the coverage, your (as a patients) flexibility to choose hospitals and doctors (or do you have to use the ones prescribed by the insurance company), and the amounts of deductibles. If you are young (20’s to 30’s) in good health, you can get basic coverage for as little as $60 per month and excellent coverage for up to $130 per month. The older you are, the more you’ll pay. “

Sep 9, 2009 - 8:39 am 11. Fantom:

9. jharp:

I would imagine everything is cheaper in India or most second world counties.

Could be wages, maybe you should work for what they pay in India. Opps f’ergot.. you don’t work, my bad.

Course there IS a downside to medical tourism.

http://medicaltourismguide.org/risks/

Sep 9, 2009 - 8:45 am 12. rjallen:

I think the author of this article hit one problem dead on. That is the malpractice lawyers and the cost of the unnecessary tests to prevent the suits. 15 years ago a neurosurgeon here in the states had to pay $120,000.00 per year for malpractice insurance. This is not a typo and no he did not have malpractice payouts by the insurance company. One of the biggest reforms would be to cap the malpractice suits. The other major problem was also mentioned. Obamacare advocates and the media like to quote the number of uninsured at 46 to 50 million people in the United States. However, 24 to 26 million are illegal aliens that drain the local hospitals and pay nothing for their care. Those two things would make the current health care system more affordable for everyone. (jharp) If you have read any of the current bill which I realize is constantly changing you would realize that it is socialized medicine there would be rationing as in other countries programs who have the government healthcare, and it is taken over by government to oversee it. I don’t believe that there is a country with any population size that doesn’t have all the above. We are founding out more and more of the shortcomings of nationalized medicine. This doesn’t even bring into play the most obvious of problems we currently have and that was also mentioned above. The 9 trillion dollar deficit we currently have without adding the healthcare.

Sep 9, 2009 - 8:56 am 13. Dan Miller:

Re comment #4, Health care in Panamá is not perfect, as I tried to point out in the article. With a relatively small population (3.3 million), I doubt that much significant medical research occurs here. The social security hospital reliance on family members to provide much of the non professional care provided at U.S. hospitals by paid staff probably would not work in the U.S. As to illegal aliens, there are very few and those who come get bounced to a far greater extent and more quickly than in the U.S.

The Panamanian physicians I have encountered do maintain proficiency. You might Google “neurosurgeon “Eimir Perez,” and “surgeon “Paul Alegria” who practice here. Dr. Perez performed the back surgery referenced in the article, and Dr. Alegria removed a lesion on my forehead which turned out to be cancerous; the biopsy indicated that the margins were clean, meaning that he probably got all of the bad stuff.

As to “more significant surgeries,” some are available in Panamá and some are not. Hospital Punta Pacifica, in Panamá City, is affiliated with Johns Hopkins and probably has the capacity to perform most significant surgeries. Its web site provides details. I have heard many favorable, and no unfavorable, comments from others. I have no personal experience with it, and hence can’t comment from personal knowledge.

The relative population size and density here contribute to both the good and the bad insofar as medical care is concerned. Were the population 10,000% greater, there would doubtless be inefficiencies and many things would be very different.

The principal attributes of the medical system here which I suggest might well be implemented in the United States include a substantial reduction in medical malpractice litigation, establishment of rudimentary and easily accessible clinics to take many burdens off hospital emergency rooms, and a recognition that everybody dies sometime. Another factor is that physicians here, at least those whom I have encountered, are not pressed to take more patients than they can handle and are not burdened with the high volume of paperwork required of many physicians in the U.S. This results in having more time to spend with individual patients. I alluded to most of these factors in the article.

Sep 9, 2009 - 8:58 am 14. Tata:

SR. Miller: SU VISION SOBRE EL SISTEMA DE SALUD DE PANAMA, ESTA MUY LEJOS DE LA REALIDAD DE LA QUE USTED DESCRIBE. eL SEGURO SOCIAL EN MIA PIAS ESTA FINANCIERAMENTE QUEBRADO. POR LOS BILLONES DE DOLARES QUE LOS POLITICOS DE TURNO HAN ROBADO. USTED NECESITA ENTRAR A UNA SALA DE HEMERGENCIA PUBLICA, Y SE DARA CUENTA QUE SU HISTORIA NO COINCIDE CON LA REALIDAD Y QUE SU FILETE FUE UN SUENO. CADA DIA MUEREN EN MI PAIS UN NUMERO IMPORTANTES DE PACIENTES POR MALA PRACTICA, POR FALTA DE MEDICAMENTOS Y POR NO CONTAR CON EL DINERO DEL QUE USTED DISPONE PARA TRATARSE EN UN SANATORIO PRIVADO. EN LOS HOSPITALES PODRA USTED ENCONTRAR DOS PACIENTES EN UNA MISMA CAMA, SIN MEDICAMENTOS Y SIN AUXILIO DE NADA. LO QUE SI ES CIERTO Y COINCIDO CON USTED, ES QUE LOS SEGUROS PRIVADOS SON MAS BARATO Y PUEDE OBTENER UNA ATENCION BUENA…PERO ESO SOLO SI TIENE DINERO…RECUERDE QUE MAS DEL 80% DE LOS PANAMENOS SON POBRES……EL PRESIDENTE SALIENTE DE PANAMA MARTIN TORRIJOS JUNTO CON LA CANDIDATA COMUNISTA BALBINA HERRERA, HICIERON MILLONES DE DOLARES VENDIENDO MEDICAMENTOS AL SEGURO SOCIAL Y DE MALA CALIDAD QUE ACTUALMENTE HAY UNA DEMANDA ANTE LOS TRIBUNALES PORQUE UN JARABA PARA RESFRIADO VENDIDO CON VENENO MATO A MAS DE 100 PANAMENOS. ESA ES LA VERDADERA HISTORIA.

Sep 9, 2009 - 9:20 am 15. George S.:

14. TATA

no se que lado de discurso estas, pero tu dijo que el estado roban bilones de dolares …no se es un buen argumento para dar control a estado.

estoy en aquerdo contigo en que hay muchas pobres que no pueden pagar por seguro y no tiene seguro con trabajo disponible sus circumstancia. por un gringo en panama la cuenta es mas o menos como el autor escribe.

al fin de dia el mercado privado dan los mas oportunidades y servicios. sin embargo hay pocos exemplos de un mercado libre en este mundo. el estado siempre mezcal/batir en el mercado con resultos malos. por eso nunca va a mejorar nada si el estado gana mas control.PUNTO.

Sep 9, 2009 - 11:39 am 16. Dan Miller:

Tata, I agree that the social security system in Panamá is “bankrupt,” that much was stolen by former administration officials, and that the situation would have become far worse had Balbina Herrera — a chavista and supporter of former dictator Noriega — won the presidential election. She was soundly defeated, her party, the PRD, is in turmoil, and I think that President Martinelli has, since he took office on 1 July, done a far better job than did any prior administration in rooting out corruption. He needs to muck out an Augean stable, and it will be a difficult task. I am also well aware of the cough syrup imported from China containing ethylene glycol instead of glycerine and of the consequent deaths. At least significant steps were taken, rather promptly, to deal with the situation.

True, I can afford better health care here than can many Panamanians. I can also afford to live better in many other respects. On modest social security retirement benefits, I could live far less well in the United States, and could afford only far worse medical care than I can here in Panamá. Money goes much further here. As to 80% of Panamanians being “poor,” a lot depends on one’s definition of “poor.” There seems, at least in our rural area, to be a substantial work ethic and the percentage of people who consider themselves “poor” is very likely far lower than that figure. The entitlement culture noted in the article does not appear to have taken root here. In Colon and Panamá City, the gulf between the affluent and the poor is doubtless greater than here; in some of the extremely remote comarcas, life is pretty rough, and not only in its medical aspects.

I did not suggest that Panamá offers a perfect model for health care in the United States; it would be silly as well as pernicious to try to impose it without modification. Panamá lacks the resources necessary to provide perfect health care for everybody, and so does the United States. The social security system in the United States is also “bankrupt” or approaching bankruptcy, and the economy is doing rather badly. In the United States, as in Panamá, there are limits on what can be done. With her substantially more limited resources, I think that Panamá does a better job with medical care than does the United States with her far greater per capita resources.

As noted in Comment # 13, there are aspects which the United States should at least consider. Were some of the funds now spent in the United States on medical care directed toward rudimentary local clinics, were there a substantial reduction in medical malpractice problems, and were there drastic reductions of the bureaucratic necessity for physicians to deal with excessive busywork instead of with patients, I think that medical care could well be better at lower cost.

Sep 9, 2009 - 12:05 pm 17. Abu Infidel:

and a recognition that everybody dies sometime

Exactly.

Currently we are performing one hugely expensive treatment after another to save a life that’s hanging by a shoestring.

We’re mortal. Let’s accept it.

Sep 9, 2009 - 12:37 pm 18. Abu Infidel:

An example of trying to save lives hanging bu shoestring, written by a nurse

Very thought provoking

http://well.blogs.nytimes.com/2009/09/09/prolonging-death-at-the-end-of-life/

Sep 9, 2009 - 12:46 pm 19. myth buster:

I would note that Panamanians have to pay 21.7% of their income for health insurance and Social Security. It may work, but it is very expensive, and that’s after implementing Tort Reform. That needs to be considered.

Sep 9, 2009 - 12:51 pm 20. Dan Miller:

George S., I agree that the free market works best in most circumstances. Venezuela should have made that obvious to anyone familiar with the situation there under Chávez. A decade or so ago, pre-Chávez, Venezuelan medical care was quite good for those with the resources to afford it, and better than it currently is for those lacking such resources. I strongly suspect that medical care in Panamá is presently far superior to that in Venezuela for those lacking such resources as well as for those with those resources.

There are some things the government is in a position to do which the private sector is not. Roads are one example. National defense is another, and other examples could easily be provided. Even in the private sector, some governmental oversight is needed. The existing antitrust laws should be enforced, and criminals need to be punished. There are criminals in every society, and unfortunately there are too many in government. Also unfortunately, far too much attention is being given to radical change and to meeting unrealistic expectations, and far too little is being given to enforcement of existing laws.

I don’t think that “Obamacare,” whatever it turns out to be, would fix the current problems with medical care in the United States, and feel strongly that it would make the situation far worse, for all. The “entitlement” mentality so common in the United States should not be perpetuated.

It will be very interesting to hear tonight exactly what President Obama says must be done; based on his prior statements, I don’t expect to hear much with which I shall agree.

Sep 9, 2009 - 12:53 pm 21. Poor Citizen:

I run into alot of Americans over here and one of the things they often tell me is how surprised they are that some of the European countries, like the people in Sweden are so much better off than America in health care etc. and how that makes them feel disappointed. I remember thinking like that when I first left America with the military many years ago. We assume that we are naturally, better off than everyone else and its a bit of a shock when we learn, some of those foreign countries do some things better. However, I have faith that America will get this health care issued sorted. Good article, thanks.

Sep 9, 2009 - 12:58 pm 22. Dan Miller:

Myth Buster, I think your 21.7% figure is off, and would be interested in knowing your source. As noted in the article, our one full time employee pays 9.2% of his salary and we pay 15.96%. That covers medical care for his entire immediate family during his working years as well as medical care and other post-retirement benefits. In the United States, the FICA contribution is 7.65% for employees, and I am not aware of any routine medical care it covers during an employee’s working years, either for the employee or for members of his immediate family.

Sep 9, 2009 - 1:13 pm 23. George S.:

Dan Millar

I have no interest in listening to obama. he has lied about most everything. would I read a book if I knew the author was a serial lier ??? most definitely not, so it is a surprise to me that anyone would care to listen to the pre-book lies.

as for government having it’s place. sure ..military and oversight should be the total. Roads etc (and much of the military is civilian run and serviced) are still handled by the private sector. the government says where they want them and to what standard they are to be built.

That is how they should be handling health care …set the standards and let the private sector do the rest. let fair competition work. don’t make it an unworkable monster and then say “see we need to nationalise the system. the democratic party is a criminal enterprise. CHICAGO STYLE

and to the idiot who thinks that people on a shoe string should be cut loose …no one is presently doing proceedures on cases where there is no hope, so why bring up something like this …in the name of “liberal dishonesty!!!”. they are cut loose …I would never want that decision in the hands of the goverment or YOU.

Sep 9, 2009 - 1:19 pm 24. Dan Miller:

George S.,

I agree that if a decision has to be made as to whether I shall receive the very best and latest medical care available to postpone my death briefly, I want to make that decision, based on multiple factors. A very good friend in the United States, age 83, was recently diagnosed with terminal and severely spread cancer. His life could perhaps have been extended for a few weeks of agony at very high cost, which had he so chosen he could have afforded. He made the decision not to go that route, and lasted less than two weeks following the diagnosis. He received appropriate palliative care, at home, and died peacefully, at home, with a book in his hands. If and when I have a similar choice to make, that will be mine as well.

As to the government setting the standards, I am far from convinced that the notion won’t be carried to extremes. It’s a matter of degree, and which standards should be set and how they should be applied are big questions. Unfortunately, one size does not fit all, and the more individual choice, and the fewer government-set standards, the better.

I shall listen to, or more likely read the text of, President Obama’s speech tonight. I shall try to do so with an open mind, rather than an empty head. My expectations are low, and I shall most likely be disappointed nonetheless.

Sep 9, 2009 - 2:00 pm 25. George S.:

Dan

agreed the government setting standards can be worrysome.

but as long as they are not the provider the free market can make up the shortfall to those who wish to purchase more coverage.

for example in Canada they do not allow such competition with the government. there is insurance programs available to exceed the government paid for services but the whole system is still under their control. it is a failed system. not sustainable.

if the USA adopts single payer it will be similar. all the bad things that can happen will. painfully obvious to students of history.

that may be why the obama and marxist company are so eagar to get hold of the education system to re-write history ..well actually they have been at it for some time now.

Sep 9, 2009 - 2:09 pm 26. Ruvy:

Dan,

The Israeli system, operating in a richer country, is far better than what Panamá can provide. One big difference is that Israel does cutting edge research in many fields of medicine. And unlike Panamá, Israel’s system is true universal care. Each individual, upon reaching the age of 18, is required to pay premiums to the National Insurance Institute, which then remits these premiums to one of four health providers which the insured chooses. When one marries, the insurance is automatically converted to family coverage.

Example: my wife (in her fifties) made an appointment for a mammogram upon the invitation of her health provider. The test will cost 25 shekels (about $6.70), an amount that is equivalent to what most caregivers to children get per hour.

Now what I just decribed to you sounds like “socialized medicine”, but the blunt fact of the matter is that it works far better than anything one gets in the States. And when it comes to health, what works best is what counts, not what pleases some ideologue.

Dan, I hope this note finds you and yours well.

Sep 9, 2009 - 3:16 pm 27. David W. Lincoln:

Filet mignon as hospital food. Doctors making house calls. This is a display of where money ought to go, instead of where too much of it has gone, and is going.

Sep 9, 2009 - 3:36 pm 28. Maria G. Gutierrez:

Mr. Miller, I love Panama, I have family in Panama. Really very well to do family in Panama. Two years ago, during Christmas, my aunt was visiting her daughter and grandkids in Panama from Miami and got very sick. She spent two weeks in the hospital part of it in intensive care with a severe respiratory problem. The total bill was somewhere around $30,000.00. Her well to do family does not want her living in Panama because it is cheaper to keep her in the States since she is a medicare recipient, and by the way a real medicare user (interpret as you wish).

However, I think that the fact that Panama has 3,000,000 people alone should make comparisons with the US system impossible. It is comparing apples with pears.

Sep 9, 2009 - 5:04 pm 29. Fantom:

22. Dan Miller:
Myth Buster, I think your 21.7% figure is off, and would be interested in knowing your source. As noted in the article, our one full time employee pays 9.2% of his salary and we pay 15.96%.

And that adds up to a bit over 25% . What you pay is part of his salary too. The actual cost = both parts. If you were not paying that then he could reasonably get that 16% in wages from you.

Just because it is employer paid does not mean it is not a part of his total pay.

If I have employees and produce widgets in Pnama I have to pass those cost thru. So every person in Panama pays in cost of goods and services whatever mandates I have to cover as an employer.

Sep 9, 2009 - 5:29 pm 30. Fantom:

And I might add as well the cost of bookkeeping and records too.

Sep 9, 2009 - 5:32 pm 31. Calvin Ball:

Now what I just decribed [sic] to you sounds like “socialized medicine”, but the blunt fact of the matter is that it works far better than anything one gets in the States.

And you know this exactly how? Tell me about your unsatisfactory health care experience in the US, and I’ll tell you about mine in Israel.

Sep 9, 2009 - 7:24 pm 32. Ruvy:

Calvin,

And you know this exactly how?

I learned all sorts of ways. I have a chronic condition, and it was only the neurologist here who was able to comprehend symptoms I described to him. Mind you this guy was from Latvia, not the States. And I’ve consulted some pretty good neurologists in the States.

My mother had a very severe stroke and was laying in a hospital in Brooklyn 22 years ago. I had just left her room where an intern explained to me that it was a race between the recovery from the stroke and the inevitable iatrogenic (he didn’t call them that) diseases that my mother would catch in the hospital – the longer she stayed, the more likely she would contract severe disease there.

I was walking away from the room when I saw a mouse running across the floor. I looked at the person who appeared to be responsible for cleaning. He just shrugged – it wasn’t his problem.

Finally, there was the gynecologist who told my wife, upon her losing a baby at 16 weeks – “Congratulations! You have a son!” That still pisses her off, even though it happened over 21
years ago.

These are not the nightmare tales you could hear – there are enough of them, but thank G-d I didn’t experience them. But I have not yet forgotten the $260,000 hospital bill my 20 year old racked up from his three month stay because he was a preemie. Fortunately, insurance covered all but $400 of it.

Sep 10, 2009 - 4:55 am 33. paul_unalaska:

jharp#6 – you just threw yourself to the wolves with those comments, jharp. ‘Teabaggers and the like.’

I don’t believe those who attend those protests appreciate the name calling. Much like people claiming you’re a liberal loon, libtard and the like.

As for ‘death panels’ – look at pages 425-430 of HR3200 version 3.0, tell me otherwise.

‘Rationing’ – page 494

‘Government takeover, and ‘powergrab’ – Health services is 1/6 of the U.S. economy. The Government is in charge of the health industry to perform presently, who will be supervise the Government if HR3200 is passed? Show me one instance when the Government hasn’t overstepped its bounds and been comfortable performing in limited capacity?

If the Government is getting involved now with health care to ‘keep the health care industry honest’, why can’t private companies do the same with regards to the DMV, FAA, competing with the unions for parks, roads contracts, etc.,?

The aforementioned are horrible institutions – what about ‘keeping them honest’? Private industry wouldn’t ‘take over’, only ‘keep ‘em honest.’

Again, I have private insurance. I’ve experienced Cobra insurance which is Government ‘health care light’ – its abysmal.

Ignorance is a 2 way street, jharp.

TATA, thank you for your comment as well.

Sep 10, 2009 - 5:59 am 34. Dan Miller:

In thinking about the transplantation of the health care system of Panama to the United States, without modification, as I did not suggest in the article, it is necessary to keep in mind that Panama is a very different place, particularly in the rural areas.

This account of a “city boy’s” venture into one of the rural areas is well done and well worth looking at — even if only for the nostalgia the photos produce.

Many sugar cane refining facilities similar to the ones shown in the blog’s photos remain operational in our still quite rural area; there was one on the land we bought several years ago to become our home; we recycled much of the structure into a small stable to accommodate no more than two of our horses should they become ill and unable to be kept at pasture for a while.

Within half an hour by horse, and not much less by car, many such refining facilities can be found, still in operation. They look primitive, and are much like those in use many years ago — primitive but very well suited to their purpose. (We still have the wooden sugar molds like those displayed in the photos.) The refined sugar they produce looks exactly like that shown in the photos, and is different from the “brown sugar” one finds in the U.S. It has a more molasses flavor. As the linked blog article indicates, nothing is wasted in the refinement process.

It’s a different world here, and one which I have come to love.

Sep 11, 2009 - 10:35 am 35. Max:

Wow – social security taxes of 25% – seems like expensive “free” cover. No thanks.

Sep 11, 2009 - 11:37 am 36. urbanleftbehind:

I’m surprised that VDH doesnt mention this, but the Greek health care system is funded by motor fuel taxes that result in $8.00 / gallon gas. I know they can be sh#&&y drivers but talk about taking sin taxes to the extreme.

Sep 11, 2009 - 1:22 pm 37. Jennifer in Marin County:

What can you tell me about the cost of living for a senior on only social security of $1200 per month – are there discounts on rent?

Sep 13, 2009 - 6:56 pm 38. egypt holidays:

In thinking about the transplantation of the health care system of Panama to the United States, without modification, as I did not suggest in the article, it is necessary to keep in mind that Panama is a very different place, particularly in the rural areas.

Oct 8, 2009 - 11:45 pm

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