Latin America's Top Health Care Haven - U.S. News & World Report (blog)

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Health care, both the quality and the cost, is a prime concern for anyone approaching retirement. Some retirees are moving abroad in order to get access to top-notch health care at affordable prices.

Here’s the good news: You have an excellent option for arranging access to world class medical care that is as good or better than services you could get from the best facilities in the U.S. And most health care facilities overseas charge just a fraction of the cost of similar care in the U.S.

Doctors in the U.S. struggle with high overheads and insurance costs, while trying to keep the drug companies happy and fend off personal injury lawyers. The patient often takes a back seat to all these conflicting agendas. The improvement in the quality of care can be dramatic when only the doctor and the patient are involved in the doctor-patient relationship.

Cuenca, Ecuador, for example, is one of the world’s top places to consider retiring overseas for many reasons, most notably this city’s excellent health care system. The cost of care in this city is so low that it’s a place where you could go without health insurance, if you chose, and pay for care as you need it. I know several retired Americans in Cuenca who have taken this approach and been very happy with their decision.

Cuenca is becoming a popular city for medical tourism, and has begun offering city-sponsored programs. Cuenca’s five top hospitals have joined together to offer a package deal. The medical tourist (or retiree) is provided with an ID card that entitles you to a package of exams at standard prices at the facility of your choice. You sign up for the bundle of medical services that best suits your needs. Prices range from $66 to $401 for the entire suite. Here are some examples:

Mammogram: $40Chest X-ray: $25PSA test: $15Cholesterol workup (Cholesterol, HDL, LDL, and triglycerides): $8EKG: $25EEG: $60

One important advantage of medical care in Ecuador is that the results and records belong to the patient. The doctor delivers them to you, along with any recommendation, and you can do as you please, easily going somewhere else for follow-up or treatment if you like. Your medical tourist card also entitles you to hotel and travel discounts throughout the city, including things like hot springs and massages. You can see the city, while getting a great check-up at a low price.

Even if you’re not part of this program, your costs for health care services can be very low. A hospital stay in a semi-private room at Santa Ana Hospital is just $30. A private room with an extra bed for family members is $50, while a private suite is $75, including meals, but not doctor fees or medications.

A friend recently had a minor surgery performed at this facility. The total cost was $90, including the outpatient surgery, office visit, local anesthesia, and supplies. In addition, he paid $20 for associated lab work, bringing the total to $110. My friend had the exact same procedure performed in Arizona in 2011. The total cost there was $5,190. After insurance, his portion of the bill came to $347. It cost 300 percent more to have the same procedure performed with insurance in the U.S. than it cost to undergo the procedure without insurance in Ecuador.

Going without health insurance can be frightening and certainly isn’t for everyone. If you would prefer to carry insurance, coverage can be extremely inexpensive in Cuenca. For example, premiums cost less than $60 per month for complete coverage for a 60-year-old male.

Retirees considering a move overseas should also make sure each place provides nursing home care in case it is eventually needed. Many countries simply don’t provide assisted living facilities to a standard the typical North American retiree is probably looking for. Cuenca is an exception. In this city you will find good nursing home care at an affordable price. The total cost for a clean, professionally staffed facility where the residents are well cared for can be $450 per month, including 24-hour doctor and nurse attendance, food, laundry, personal care, and occupational or rehabilitative therapy.

Kathleen Peddicord is the founder of the Live and Invest Overseas publishing group. With more than 25 years experience covering this beat, Kathleen reports daily on current opportunities for living, retiring, and investing overseas in her free e-letter. Her book, How To Retire Overseas—Everything You Need To Know To Live Well Abroad For Less, was recently released by Penguin Books.

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In Health Care Case, Lawyers Train for 3-Day Marathon - New York Times

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Last week, there were so many of the mock arguments that lawyers call moot courts that they threatened to exhaust something that had never been thought in short supply: Washington lawyers willing to pretend to be Supreme Court justices.

The problem, said Paul D. Clement, who represents the 26 states challenging the law, was not just the length of the arguments the court will hear, but the variety of topics to be addressed.

The law itself is a sprawling revision of the health care system meant to provide coverage to tens of millions of previously uninsured Americans by imposing new requirements on states, employers and insurance companies and, through what has been called the individual mandate, by requiring most Americans to obtain insurance or pay a penalty.

The decision in the case will have enormous practical consequences for how health care is delivered in the United States. It is likely to land in June, with large repercussions for both Mr. Obama and his Republican challenger just before the two parties hold their nominating conventions.

The justices have broken the case into four discrete issues, scheduling a separate session for each, for a total of six hours, the most in one case in more than 40 years. Mr. Clement, like his principal adversary, Solicitor General Donald B. Verrilli Jr., will be arguing three times.

Walter Dellinger, who was acting solicitor general in the Clinton administration, said he was worried about “the enormous endurance challenge this will be for Verrilli and Clement.” Mr. Dellinger, who has argued more than 20 cases in the Supreme Court, said making even a single 30-minute presentation is draining.

“The day or two after a Supreme Court argument, I just basically collapse,” Mr. Dellinger said.

The central issue in the case, to be argued for two hours on Tuesday, is whether the individual mandate is constitutional.

But first, on Monday, the justices will hear 90 minutes of arguments from three lawyers about whether they should be hearing the case at all.

An 1867 federal law, the Anti-Injunction Act, bars suits “for the purpose of restraining the assessment or collection of any tax.” The federal appeals court in Richmond, Va., and a prominent federal appeals court judge in Washington have issued opinions saying that the 1867 law means a decision in the health care case must be deferred until 2015, when Americans will first be penalized if they do not have health insurance.

But neither the Obama administration nor the parties challenging the law agree with that ruling. So the court appointed a Washington lawyer, Robert A. Long, to speak on behalf of that argument. The court makes such appointments every year or so, and the practice has been the subject of some skeptical academic commentary.

Mr. Long will be followed on Monday by Mr. Verrilli and a lawyer for the private challengers, Gregory G. Katsas.

The Obama administration initially agreed that the court could not rule on challenges to the law for a few more years, but it reversed course in the appeals courts. It has since relinquished other opportunities to slow down the case and insists it wants a prompt decision.

Mr. Long was one of three lawyers who presented mock arguments in the grand ceremonial courtroom at the Supreme Court Institute at the Georgetown University Law Center. On other days, the moot court program there helped prepare Mr. Clement, twice, as well as Michael A. Carvin, who represents private challengers to the law.

Mr. Clement and Mr. Carvin will face Mr. Verrilli on Tuesday for the main event, the argument over whether the requirement to obtain insurance was authorized by the Constitution as a regulation of interstate commerce or by the power to levy taxes. The administration says the health care law is well within the powers granted by the Constitution, while the challengers say it plainly exceeds what the federal government may do.

For Wednesday, the court has scheduled a double feature.

In the morning, the justices will hear 90 minutes of arguments about what should happen if they strike down the mandate. The federal appeals court in Atlanta, whose decision is under review, ruled that it was possible to remove just the mandate and leave the balance of the law intact.

As with the 1867 law, neither side agrees with that ruling. So here, too, the court has appointed an outside lawyer, H. Bartow Farr III, to argue the point.

Mr. Clement will contend that the entire law must fall. A colleague of Mr. Verrilli’s in the solicitor general’s office, Edwin S. Kneedler, will argue for a middle ground, saying that most of the law should stand but that two other provisions — one forbidding insurers to turn away applicants, the other barring them from taking account of pre-existing conditions — are intertwined with the mandate and would have to fall along with it.

On Wednesday afternoon, the two main lawyers, Mr. Verrilli and Mr. Clement, will return for a one-hour encore, this time to argue over whether Congress exceeded its constitutional authority in expanding the eligibility and coverage thresholds that states must adopt to remain eligible for Medicaid, the federal-state program that provides health care to poor and disabled people.

There is room for only about 400 people in the courtroom, and prominent lawyers and politicians have been scrambling for tickets. The court has set aside about 60 seats for members of the public, and the line started forming on Friday morning.

Emmarie Huetteman contributed reporting.

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A Lawyer Who Can Simplify the Complex Draws a Big One: Obama's Health Overhaul - New York Times

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Less than a year after becoming solicitor general, Mr. Verrilli will go before the Supreme Court for three days next week to defend the Obama administration’s health care overhaul law, one of the president’s signature and most controversial accomplishments.

Mr. Verrilli, a veteran of 17 cases before the Supreme Court, five of them since taking over as solicitor general, has been an advocate for the rights of death row inmates and has successfully argued fine points of telecommunications law. He has also had at least 30 cases before federal appeals courts and state supreme courts.

But this will be the first time he has argued the health care law in public.

Former colleagues and court opponents say he is ready. “He will be able to make the best case for the legislation,” said Theodore B. Olson, a Washington lawyer who has argued 58 cases before the justices and served as solicitor general under President George W. Bush.

Mr. Verrilli’s strength, Mr. Olson said, is that he “marshals his positions in clear and understandable terms” rooted in law and common sense.

Neal K. Katyal, a professor at Georgetown University Law Center who defended the health care overhaul as one of Mr. Verrilli’s predecessors, recalled watching Mr. Verrilli argue a case before the Supreme Court in 2006. He called him “poised, confident, concise and brilliant.”

“I came out of the courtroom thinking, ‘There’s no way in heck I can ever do this,’?” Mr. Katyal said.

A tall man with a baritone voice and a salt-and-pepper mustache, Mr. Verrilli, 54, is described by friends as exceedingly polite and disarmingly self-effacing. During trials, he makes a habit of graciously acknowledging opponents when he thinks they make a fair point.

For all his gentility, Mr. Verrilli is also known for being passionate.

“Don can get a little intense right before a major Supreme Court argument,” Paul Smith, a longtime friend who worked with Mr. Verrilli for about two decades in private practice in Washington, said as he described Mr. Verrilli’s salmon-eating ritual.

Before the bench, Mr. Verrilli is serious and methodical, his voice getting deeper the more impassioned he becomes.

His demeanor strikes a stark contrast with that of Paul D. Clement, a solicitor general under Mr. Bush, who will also appear before the justices next week — to argue against the health care law.

Mr. Clement, who was a clerk for Justice Antonin Scalia and has argued more Supreme Court cases than any other lawyer since 2002, comes across as more relaxed in court appearances. Mr. Clement argues without notes, citing, from memory, the specific page numbers of legal documents. He has also been known to crack jokes.

Both men are known for distilling complex issues into straightforward arguments.

Even when Mr. Verrilli was not the highest-ranking official at a meeting, his thoughtfulness, preparation and civility gave him a gravitas that commanded the respect of others, said Joseph Guerra, a Washington lawyer who has known him for more than 20 years and served with him in the Justice Department.

“His openness to other points of view ultimately makes him a better lawyer,” Mr. Guerra said.

Mr. Verrilli has at times broken ground by raising new legal theories. In the 2005 case MGM v. Grokster, his best-known Supreme Court victory, he successfully argued that companies could be liable for inducing piracy if their business plans encouraged illegal downloading.

In 2009, while working in the Justice Department, he developed limits on the state secrets privilege, intended to make sure that it is invoked only when there are legitimate national security concerns.

In 2003, Mr. Verrilli successfully argued before the Supreme Court that if defense lawyers failed to investigate their clients’ background and inform a jury of mitigating evidence during a capital sentencing hearing, they denied their client effective assistance of counsel. This argument helped overturn the death penalty for a pro bono client of Mr. Verrilli’s, Kevin Wiggins.

Kitty Bennett contributed research.

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A Lawyer Who Can Simplify the Complex Draws a Big One: Obama's Health Overhaul - New York Times

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Less than a year after becoming solicitor general, Mr. Verrilli will go before the Supreme Court for three days next week to defend the Obama administration’s health care overhaul law, one of the president’s signature and most controversial accomplishments.

Mr. Verrilli, a veteran of 17 cases before the Supreme Court, five of them since taking over as solicitor general, has been an advocate for the rights of death row inmates and has successfully argued fine points of telecommunications law. He has also had at least 30 cases before federal appeals courts and state supreme courts.

But this will be the first time he has argued the health care law in public.

Former colleagues and court opponents say he is ready. “He will be able to make the best case for the legislation,” said Theodore B. Olson, a Washington lawyer who has argued 58 cases before the justices and served as solicitor general under President George W. Bush.

Mr. Verrilli’s strength, Mr. Olson said, is that he “marshals his positions in clear and understandable terms” rooted in law and common sense.

Neal K. Katyal, a professor at Georgetown University Law Center who defended the health care overhaul as one of Mr. Verrilli’s predecessors, recalled watching Mr. Verrilli argue a case before the Supreme Court in 2006. He called him “poised, confident, concise and brilliant.”

“I came out of the courtroom thinking, ‘There’s no way in heck I can ever do this,’?” Mr. Katyal said.

A tall man with a baritone voice and a salt-and-pepper mustache, Mr. Verrilli, 54, is described by friends as exceedingly polite and disarmingly self-effacing. During trials, he makes a habit of graciously acknowledging opponents when he thinks they make a fair point.

For all his gentility, Mr. Verrilli is also known for being passionate.

“Don can get a little intense right before a major Supreme Court argument,” Paul Smith, a longtime friend who worked with Mr. Verrilli for about two decades in private practice in Washington, said as he described Mr. Verrilli’s salmon-eating ritual.

Before the bench, Mr. Verrilli is serious and methodical, his voice getting deeper the more impassioned he becomes.

His demeanor strikes a stark contrast with that of Paul D. Clement, a solicitor general under Mr. Bush, who will also appear before the justices next week — to argue against the health care law.

Mr. Clement, who was a clerk for Justice Antonin Scalia and has argued more Supreme Court cases than any other lawyer since 2002, comes across as more relaxed in court appearances. Mr. Clement argues without notes, citing, from memory, the specific page numbers of legal documents. He has also been known to crack jokes.

Both men are known for distilling complex issues into straightforward arguments.

Even when Mr. Verrilli was not the highest-ranking official at a meeting, his thoughtfulness, preparation and civility gave him a gravitas that commanded the respect of others, said Joseph Guerra, a Washington lawyer who has known him for more than 20 years and served with him in the Justice Department.

“His openness to other points of view ultimately makes him a better lawyer,” Mr. Guerra said.

Mr. Verrilli has at times broken ground by raising new legal theories. In the 2005 case MGM v. Grokster, his best-known Supreme Court victory, he successfully argued that companies could be liable for inducing piracy if their business plans encouraged illegal downloading.

In 2009, while working in the Justice Department, he developed limits on the state secrets privilege, intended to make sure that it is invoked only when there are legitimate national security concerns.

In 2003, Mr. Verrilli successfully argued before the Supreme Court that if defense lawyers failed to investigate their clients’ background and inform a jury of mitigating evidence during a capital sentencing hearing, they denied their client effective assistance of counsel. This argument helped overturn the death penalty for a pro bono client of Mr. Verrilli’s, Kevin Wiggins.

Kitty Bennett contributed research.

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Health care lawyer Clement as high court regular

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WASHINGTON (AP) — Paul Clement used to argue for the federal government's power until he started arguing against it.

But he's no flip-flopping political candidate; he's a lawyer. Changes like this are part of his job.

Clement is playing a key role in three politically charged Supreme Court cases in which Republican-led states object to Obama administration policies or federal laws on health care, immigration and redrawing political boundaries.

In the biggest of those, the 45-year-old law school acquaintance of President Barack Obama will be trying to sink Obama's health care overhaul.

Not that long ago, Clement would regularly stand before the justices and defend even the most aggressive uses of federal power, making his case without written notes and parrying questions with an easy banter.

He argued for the Bush administration's policy on detaining suspected terrorists, a federal law outlawing a medical procedure called "partial-birth abortion" by opponents, the McCain-Feingold law aimed at limiting the influence of money in politics and a federal ban on the use of marijuana for medical purposes.

Clement was President George W. Bush's top Supreme Court lawyer, the solicitor general, the last government job on his impeccable conservative resume. He was a law clerk for Justice Antonin Scalia, then worked for John Ashcroft, both when Ashcroft was a senator and attorney general.

If a Republican wins the White House, expect to find Clement among the top potential Supreme Court nominees, said Curt Levey, who heads the conservative Committee for Justice. "It's unimaginable that any Republican president wouldn't have him on their short list."

His recent run of cases hasn't hurt his chances.

"There's no doubt that Paul has become the leading advocate for the most deeply conservative causes in the law. That is a reputation he has worked hard to earn," said David Frederick, a Supreme Court lawyer who often represents consumers.

Clement is scheduled to argue seven cases at the high court this term, roughly 10 percent of the total and a staggering figure for a lawyer in private practice. Supreme Court lawyer Thomas Goldstein jokingly introduced Clement at a recent event as having "the distinction of arguing every case in the Supreme Court this term, or nearly so."

The last of those will be a defense of Arizona's immigration law in the face of a challenge from the White House.

He already scored at least a partial victory when the court threw out interim Texas electoral maps that were drawn by federal judges and opposed by the Republicans Clement represented.

But the centerpiece of Clement's work, and of the high court term, is the election-year fight over the law that is intended to extend health care coverage to more than 30 million people. Clement will carry the bulk of the argument among several attorneys with clients opposing the law.

Representing Florida and 25 other states, Clement's central argument is that Congress went too far in requiring nearly every American to purchase insurance or pay a penalty.

"There have been a lot of crises in this country over the years, economic, other, where Congress might have thought that forcing individuals to purchase a particular good or a particular service might have been a useful means of government action. But the government never did," he said.

Born and reared in Cedarburg, Wis., Clement was a year behind Obama at Harvard Law School and worked under him on the Harvard Law Review. He was the youngest solicitor general, at 38, in 115 years.

Clement's unassuming, buttoned-down image provides little hint of his fondness for alternative rock bands he sometimes sees at Washington's 9:30 Club. He lives in suburban Virginia with his wife and three sons.

He has maintained a heavy workload despite an upheaval in his professional life that took him from the 800-lawyer King & Spalding firm to tiny Bancroft LLC. Atlanta-based King & Spalding spent a reported $5 million to lure Clement after he left government in 2008. Clement won't confirm the figure, but he does not dispute it.

Clement easily attracted deep-pocketed clients, including National Football League owners in their dispute with players.

But his representation of House Republicans in support of the Defense of Marriage Act prompted an internal struggle at the firm. The Obama administration is no longer defending the 1996 law that defines marriage as a union between a man and woman, and prohibits the government from granting benefits to same-sex couples.

King & Spalding eventually withdrew from the case, leaving Clement in the uncomfortable position of having to quit his clients or the firm. He chose the latter, which drew criticism from some gay rights groups but praise from lawyers across the political spectrum, including Justice Elena Kagan, an Obama nominee to the Supreme Court.

At Georgetown University last year, Kagan spoke of Clement's "integrity, professionalism and honor" and said Clement's critics "misunderstand the traditions and ethics of the legal profession."

Clement himself says the experience bolstered his view that he would not choose clients out of fear of taking on unpopular causes. "It seems like a formula for a really uninteresting legal practice," he said.

And despite his ties to Republicans, Clement insists that when he stands before any court, "you have to really buy into the notion that positions are taken on behalf of a client. They're not your positions."

He notes that he has been on the liberal side sometimes — arguing for California prison inmates seeking better medical and mental health care and seeking higher fees for lawyers who won changes in Georgia's foster care program.

Still, when he left King & Spalding, he, along with many of his clients, ended up at Bancroft, run by Harvard law classmate Viet Dinh. The 13-lawyer firm is heavy with former Bush administration officials, including Dinh, and law clerks to Chief Justice John Roberts.

EDITOR'S NOTE _ This is part of a weeklong package of stories previewing the Supreme Court's consideration of President Barack Obama's health care overhaul law

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Health care by the high court on a regular basis, Clement

WASHINGTON (AP) — Paul Clement used to represent the Federal Government in power until he started arguing against it.

But he does not flip-flopping a political candidate; He is a lawyer. In this way, the changes in his job.

Clement will play a major role in the politically charged the three with the highest cases of Republican Guard led the States object to the Obama administration policies or federal law, health care, immigration, and the display of political boundaries.

The majority of the 45-year-old law school, buddy, President Barack Obama is trying to sink Obama's health care overhaul.

Not long ago, on a regular basis, to stand before the justices, and Clement to defend even the most aggressive uses of federal power, in his case, without written notes and parrying questions about the easy banter.

He claimed the Bush administration policy, detaining suspected terrorists and the serious medical procedure opponents call "partial birth Abortion", the Federal law on the McCain-Feingold law designed to limit the money policy and the use of the medical purposes of Federal marijuana prohibition of influence.

Clement was President George w. Bush senior Supreme Court lawyer, solicitor general in the last Government, his fitness will be continued. He was a law clerk for Justice Antonin Scalia and John Ashcroft, British Columbia, and then when the Senator and attorney general Ashcroft had worked.

If the Republican Guard to win the White House, expect to find among the top the lists of candidates, the highest possible Clement, said Curt Levey, the conservative Council. "It is the will of the Republican President, is it not to him in their short list."

His recent Run of cases does not hurt his chances.

"There is no doubt that Paul has become the leader in the opinion of the Advocate General, the majority of the deeply conservative causes. David Frederick, the Supreme Court lawyer who represents the often consumers have reputation, he has worked very hard to earn, "said.

Clement is scheduled according to the claims of seven cases in the high court that the term around 10% of the total quantity, and a huge picture of a private practice lawyer. The Supreme Court lawyer Thomas Goldstein on the last event to jokingly Clement "is the difference between arguing always at the highest level in this period of time, or nearly so."

Of these, the last is the defense of the Arizona immigration law: the challenge from the White House.

He preparoitujen already, at least in part, the Court threw out the profit when the interim Texas election maps-that's the federal judges and the Republicans Clement represented.

But the centerpiece of the work, and the high court of Clement-the term is the election year legislative control, the purpose of which is to extend health care coverage to more than 30 million people. Clement to run more than one lawyer in the middle of the argument in the opposition to the law with the customers.

Florida and 25 other States representative Clement's central argument is that Congress went too far in requiring almost all American to buy insurance or pay a penalty.

"Has had a lot of crises in this country during the year, the economy, the other, which may have thought about the Congress that forcing individuals to buy a particular good or service has been the Government's actions in an effective way. But the Government has ever had, "he said.

Born and raised in Cedarburg Bryggare Clement was the year of Obama's Harvard Law School and worked in his Harvard law review. He is the youngest solicitor general, 38, at 115 years.

Clement's unassuming, buttoned-down picture contains his fondness alternative rock bands, he can see sometimes in Washington, a little tip for the 9: 30 Club. He lives in suburban Virginia with his wife and three sons.

He has maintained a heavy burden, despite the upheaval in the new dress, which took him to the 800-lawyer firm King & Spalding, a small Bancroft LLC. Atlanta-based King & Spalding spent a reported $ 5 million, maybe after he left Government to Clement in 2008. Clement did not confirm the figure, but he does not deny it.

Clement deep pocketed customers attracted easily, including the NFL owners in the event of a dispute over the players.

But his representation of the House Republicans in support of the Defense of Marriage Act prompt internal battle. The Obama administration no longer defends the 1996 law, defined as marriage between a man and a woman, and the Union shall be prohibited to grant same-sex couples the benefits to the Government.

King & Spalding will ultimately withdrew from the case, leaving Clement to stop his clients or the firm's uncomfortable position. He chose the latter, which drew some criticism in the case of a gay rights groups, but the lawyers praise political spectrum, including Elena Kagan, Obama's nominee for President to the highest level.

Georgetown University last year, Kagan spoke of Clement's "integrity, professionalism and honor" and understand the critics, "said Clement's abuse of the traditions and law ethics."

Clement, in fact, says, the experience of a visit to the degrees of his Show that he did not choose the fear of the customers, taking unpopular causes. "It feels really uninteresting legal practice, with the formula," he said.

And his ties to the Republicans, though Clement claims that when he stands before the Court, "you have to really buy into understanding that the activities carried out on behalf of the client. They have their own positions. "

He finds that he has been the liberal side, sometimes arguing, as the California prison facility inmates to seek better medical health care, mental health services, and for higher fees for lawyers, who won the Georgia changes contribute to the care program.

Still, when he left the King and Spalding, he, along with many of his customers have ended at the Bancroft, Harvard Law classmate Viet Dinh. 13-the former Bush administration lawyer, business is heavy, the officials, including the Dinh and the officers of the Supreme Court John Roberts law.

Editor's note _ is part of a weeklong package of stories, a preview of the Supreme Court for the President Barack Obama health care overhaul law

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