Kirby R. Cundiff – June 11, 2019
Long-term care costs in the United States are staggering. The national average cost for an assisted living facility or home health care is $4,000/month, and the average cost for nursing home care is $8,000/month. These costs do not include skilled medical care or prescription drugs. Over half of retirees will need some form of long-term care during their lifetime. Currently, around 1.4 million Americans are in nursing homes. The average stay in a nursing home is over two years, and the majority of nursing home residents are female.
Since the median net worth of a retiree’s household in the United States is around $200,000, most Americans entering a nursing home will lose all of their assets during their nursing home stay. This is considered standard and is referred to in the industry as the spend-down period. After the spend-down period, nursing home residents will spend the rest of their lives living off of Medicaid in a double occupancy room, and their children will inherit nothing. If the children want their parents to have a little privacy in the nursing home, they will have to come up with another $500/month or more beyond Medicaid for a private room after their parents go bankrupt.
Like most health care costs in the United States, there is no reason for nursing home-related personal bankruptcy, and it is an American problem, not a worldwide one. The vast majority of labor performed to assist an elderly person in a nursing home is unskilled physical labor such as helping an elderly person on and off of the toilet or giving them a bath. Home health care aids may cost $4,000/month in the US, but largely, the same service can be performed by a live-in Filipino maid in Dubai, UAE, for $500/month. Full nursing home services much nicer than most in the US are available in Estonia for around $1,000/month.
Domestic Worker Visas
In the United Arab Emirates (UAE), individuals can easily process visas for domestic workers in a few days, and the costs are minimal. All guest workers in the UAE are required to undergo a physical examination for contagious diseases and receive some vaccinations. The cost of the physical exam and processing fees totals a few hundred dollars, and the process takes about a week.
The annual cost of sponsoring a domestic worker in the UAE is under $100. In the United States, a similar work visa, or even a marriage visa, will cost thousands of dollars and take many years to process. Only large companies can afford to sponsor foreign workers in the United States; a family bringing in cheap domestic labor is largely unheard of in the US.
Other forms of health care are also cheaper in the UAE and outside the US in general. Medical care is relatively plentiful in the UAE. A patient can get a doctor’s appointment within a few hours. Such an appointment, including blood tests, x-rays, and a consultation, might cost around $100 cash. While employers provide medical insurance in the UAE, it is not necessary in many cases. Allowing foreign doctors to practice in the US with an easy work visa would be a way to greatly reduce health care costs and improve health care availability.
Most (non-narcotic) drugs are available over the counter in the UAE for a fraction of the US cost. For example, Nasonex, a nasal spray for sinus infections, is $350/bottle in the US with a prescription. Nasonex costs about $20/bottle in Dubai over the counter and $5/bottle over the counter in Turkey. Legalizing the importation of cheap foreign pharmaceuticals and moving most drugs to over-the-counter status in the US would significantly help reduce US health care costs.
Infrastructure and Migrant Workers
If the US were to emulate a UAE guest visa system, it could lower both skilled and unskilled labor costs in health care, as well as other industries. The UAE has excellent airports, a new metro system, and superb highways built largely by cheap Indian labor; the US transportation system is in shambles. Highly paid union labor is likely to resist cheap overseas labor, but if the system is structured so that current domestic employees were foremen over the vast number of migrant workers necessary to repair America’s crumbling infrastructure, that might change.
In the US today, there is significant resistance to mass immigration due to its perceived effect on crime, the social welfare system, and voting trends. In the UAE, around 90 percent of residents are migrant workers, but there are no refugees. There is no social welfare or government-funded education system for migrants and no path to citizenship. There are no concerns about who the new arrivals will eventually vote for. The system does seem to benefit both the native-born Emirati citizens and the migrants. While there are stories of abuse, guest workers earn more than they would in their home countries, and many guest workers have started businesses and become wealthy.
The average income of an Emirati citizen is over $120,000/year (the average income of a US citizen is $60,000/year), and there is no shortage of people wanting to work in the UAE. The Emirati system has helped make its citizens some of the richest people in the world while providing a land of opportunity for people from poor countries. It also has no income tax, benefiting those fleeing high taxes in the US and Europe. The US should consider the advantages of such a guest worker system over the mess of an immigration system it has today.
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