Ronmel Rangel, 63, began to feel a familiar discomfort in his lower abdomen late last year. Twenty-five years earlier, while living in his native Venezuela, he had undergone surgery to repair a hernia on the right side of his groin. The pain had returned, this time on the left.
Now living in Portland, Maine, Rangel lacked health insurance. As a green-card holder, he qualified to purchase coverage through the Affordable Care Act marketplace, but the premiums for someone his age were beyond his budget. He decided to go without insurance, even though it had been a priority for him.
Instead, he relied on a concierge practice where patients pay a monthly fee for services. When his primary care physician, Ben Hagopian, diagnosed him with an inguinal hernia, surgery became unavoidable. Hagopian helped him compile a list of hospitals and surgical centers to consider.
A $23,000 Estimate
Rangel has a PhD in management. Armed with that knowledge and a naturally inquisitive mind, he began researching prices immediately.
His first stop was a nonprofit hospital close to home. He scheduled a consultation with MaineHealth, the state’s largest health system, and received an estimate showing it would cost approximately $23,000 to repair his hernia laparoscopically.
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“I wasn’t going to mortgage my life just to have surgery and spend the next 30 years paying off the debt,” Rangel said.
He kept shopping. He considered a surgical center in Oklahoma that was far cheaper, but he ultimately ruled it out because it was too far away. He also explored traveling to Universidad de los Andes in Santiago, Chile, where another of his daughters lives. There, his hernia repair would have cost about $7,000, but once he added thousands of dollars in travel expenses, that option no longer made financial sense.
This kind of aggressive price comparison is rare. While most Americans simply accept the first price provided by their local hospital, Rangel’s approach mirrors the small but growing trend of “medical tourism” where borders are treated merely as lines on a map rather than barriers to affordable care. It highlights a stark reality: in a system without price caps, geographic mobility is often the only leverage a consumer has.
Why Hospitals Cost More
A closer look at any hospital bill helps explain the price gap. Gerard Anderson, a professor who analyzes healthcare spending at the Johns Hopkins Bloomberg School of Public Health, noted that uninsured patients are often the ones hit hardest by wide price variations.
