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Underwriting Our Health Care

Can Baja continue to subsidize a good portion of San Diegan's medical needs?

Numerous economic sectors in Baja are experiencing a paralysis of fear, especially in the medical sector, which has recently seen several kidnappings of high-profile specialists in Tijuana. Rumors persist the highly sophisticated drug cartels have recognized kidnapping as a high-yield activity. They are well financed, organized and act with brutal military precision.

Unlike many other successful professionals who move to San Diego and manage their Tijuana business from here, doctors must personally attend to their patients. The regularity in their schedules makes them vulnerable to kidnappers.

Doctors are well aware they are targets. But the press on both sides of the border have magnified the danger and fear has filtered into the ranks of active and potential patients, causing them to postpone treatment.

Unlike vacationers or pleasure visitors, most of those who cross the border for care — whether for a toothache or illness — have limited choices. Most are among the estimated 7 million Californians without medical insurance. They can, however, afford care in Baja.

The topic of medical care in Baja has been a hot one for The Baja Connection, a radio program I host each evening from 4 p.m. to 5 p.m. on KOOL 1040-AM and online at TheBajaConnection.com. Recent guests have included leading Tijuana doctors and health provider servers Blue Shield and SYMNSA. Both providers offer steeply discounted insurance plans for Californians to access medical care in Baja.

Blue Shield promotes Access Baja, a group HMO insurance plan offered in San Diego County for care received by licensed medical providers in Baja. SYMNSA also is an HMO. Blue Shield contracts with providers in Baja while SYMNSA runs its own health care centers there.

Savings can be considerable. For instance, the premium for a family of four having HMO medical insurance in California can reach $1,000 per month. SYMNSA, which has 20,000 insured members in California, charges about $400. (Blue Shield did not disclose membership numbers or premium rates for Access Baja.)

In group insurance, the employer typically pays 50 percent to 75 percent of the premium for the employee and varying percentages for the employee’s dependents. It would be common with a $1,000 premium for half to be paid by the company and the rest by the employee. That works out to $2.90 an hour for an employee who works the 172 hours in an average month and the same for the employer.

For many workers, the burden of this is simply too great and they choose to do without the insurance, using the $2.90 an hour for living expenses.

The Baja option, at half the cost and usually with lower or no co-pays, thus becomes more attractive. Dental care insurance savings are similar under Baja plans offered by Delta Dental, Aetna and others.

This amounts to a great medical subsidy to California taxpayers. How so? It is quite simple. Based on 2007 numbers, more than 300,000 people a year cross the border to access medical services in Baja. In many cases, the only other option would be showing up at an emergency room in California where care is mandatory and the hospitals (taxpayers) usually get stuck with the bill. That bill likely is much higher than it would have been had the patient earlier had access to affordable care.

The fear is this crucial health care relief system for California is being jeopardized by patients who no longer will visit their doctors in Tijuana, Rosarito, Ensenada and Tecate. The doctors and the patients need each other, and San Diego and California need that relationship to continue to grow.