April 13, 2008 – Stop!

Why is it that coming back to the states is so stressful? It used to be that coming home from a vacation engendered a deep sigh of contentment – we had a lovely trip, but home is where you can relax. I suppose part of it is that we are disassociating from our home in California, and embracing more aspects of Costa Rica. Part of it has to be that when we left for Costa Rica, we also left behind some responsibilities – and they were still here when we got back. But I think the biggest factor is that when we are in Costa Rica, we don’t have the same sense of urgency. When we are in California, we put so much pressure on ourselves to get things done, *and* we have to do it on a schedule.

After just 3 weeks back, we were climbing the walls – stressed out, but oddly bored. So we said “stop!” – took a deep breath, and chucked the schedule. After all, our time really *is* our own…

Just to complete our de-stress, we went *dancing!* We met 17 years ago during a ballroom dancing lesson. We finally went back :~?. Not only was it great, I think it may actually have been more fun than the first time.

As for my schedule – it will be a while before I post our review of living in Alajuela. We like to take a bit of time to let our thoughts and impressions settle, anyway.

April 13, 2008 – Alterations, Anyone?

A while ago, I “ungrew” a lot of the clothes I brought to Costa Rica :). So I set out to find a way to get them taken in. I asked my neighbor if she knew of a seamstress nearby – she knew one, but not close. Then another neighbor walked by, and we had a short discussion about what I needed. Both neighbors said I could use their sewing machines, but I explained that even though I could sew, I couldn’t measure the clothes on myself. They suggested going to a dry cleaners (even Más por Menos has one inside the large store near Alajuela’s International Mall). Apparently, many dry cleaners and Laundromats have people who can fix clothes.

I asked another friend where to look, and he said that the bridal shops and tuxedo rental stores all had tailors on site. There was one just 100 meters South and 25 meters West of the post office – right around the corner! When I went in, there were 3 gentlemen working at sewing machines.

When they found out that I wanted some pants taken in, things got a little awkward – I didn’t see any other women customers, but there were dresses for weddings and festivals around. The tailors seemed reluctant to mark my clothes for alterations. They asked how much I wanted taken in, and where (I said that I needed to put them on, so they could see for themselves). When I did that, I pointed out where they were loose – then I asked them if they needed to mark them. They said yes, but they wanted me to pull them in. They were very careful not to touch me. Rick thinks that they feel they have to be very careful of their reputation, since they do a lot of business with families (and I was alone when I went there). I have to admit it, I would be careful too – especially since I needed the sides *and* the crotch taken in :D.

All went well though – I picked up my altered pants 2 days later, and paid the huge sum of c2500 ($5).

Just like shoes, Costa Ricans get clothes fixed or altered. There are plenty of places that do these things – we just have to think about doing so. Quite a change – but very welcome…

April 10, 2008 – Calling Long Distance

Even the simple things can be confusing. We know all about the different options in the states for making long-distance phone calls, but what about in Costa Rica? Doesn’t ICE have *the* monopoly on this?

ICE certainly is the only provider of telephone (and internet) service, and calls within Costa Rica are all local. So the only long-distance calls are international. So it sounds like the only way to make an international call is via ICE.

Well, not exactly. You see advertisements for international calls on fliers, and in internet cafes. Usually, the fliers have *bad* deals ($36/minute), and the internet cafes have good deals.

Then you find out about Skype - *everybody* talks about it! Skype allows users to make telephone calls over the Internet to other Skype users free of charge and to landlines and cell phones for a fee. (http://en.wikipedia.org/wiki/Skype) Calls from Costa Rica to the states are a *lot* more reasonable. The drawback is that if you have a slow connection, or there is too much traffic on the internet, you get a lot of echo and delay during your phone conversation. Also, if you want to *receive* calls via Skype, you need an internet connection in your house, and your computer has to be on all the time (or at least whenever you want to get a call)…

Enlinea is not as well-known. It is a voice-over-IP-protocol call-back system. When you sign up, you get a USA phone number to call. When you want to make a call to any USA phone, first you call the number given to you (your Costa Rican phone has to have international calling enabled). It is always busy – just hang up. The system recognizes that you called, and in a few seconds, it calls you on the phone number you registered. You enter the phone number you want to call, and the system puts you through. Because the phone number that you called was busy, ICE doesn’t charge you for the call. And since you were called (the call-back part), ICE doesn’t charge you for the received call either. Your account at enlinea covers the time you talk. The drawbacks are:

• When the internet is overloaded, sometimes the call-back misses you – you need to try again (and you get a strange message on your voice mail)
• When the internet is overloaded, you get a lot of echo and delay during your phone conversations.
• If the people you are calling screen using caller ID, they may ignore your call – it looks like you are calling from some place like Nebraska (not Costa Rica!).
• ICE may block the call-back phone number.

Sometimes people in the states are a bit shy about calling you in Costa Rica (after all, someone might answer in *Spanish* - gasp! OK, seriously, this can be a real deterrent for people. What some people have done is set up an 800 number in the states – friends and family call the 800 number, and the call is forwarded to the Costa Rican number, and the caller never even knows. The nice part is that you can change the forward-to number – nice if you are going back and forth between Costa Rica and the states (or anywhere else). The drawback is that you own the 800 number, so you pay for the call – not so nice if telemarketers or campaigners get the number…

Are any of the alternatives legal? Usually a monopoly makes sure that their option is the only one. And the ICE monopoly is state-owned…

Rate Comparisons:
ICE direct – 100 cents/min
Skype – 2 cents/min (UPDATED per comment - thanks!)
Enlinea – 10 cents/min
BBG – $36/min

April 4, 2008 - Public Health Insurance (Caja)

We finally decided to sign up for Caja – the Costa Rican public health insurance. This covers you for any pre-existing condition, prescriptions, and emergencies. Everything we’ve heard (though I don’t have personal experience here) says it doesn’t do so well for regular health maintenance – long lines (everyone gets a 10:00 appointment), not-so-full workup (e.g., usually cholesterol is measured, but not HDL/LDL breakdown), and slow timelines for some time-critical procedures (e.g., cancer treatments can be scheduled months too late – I know, yikes!). Many people use a two-tiered method, where they have Caja *and* either private insurance or no insurance but use a private doctor. Since many doctors provide treatment under both Caja and private, you can often use the same doctor for your health – he will be able to tell you when to get something done under Caja.

So, one afternoon we went to ARCR (Association of Residents of Costa Rica) to get signed up. We are already members; this is an additional benefit provided. Normally, premiums for Caja are 13% of your income. But, since we are rentistas, we are not allowed to work. Our residency deposit isn’t really income in the same sense. But ARCR has an arrangement with the government that allows them to cover members under a corporation. So, our paperwork consisted of “getting on the payroll.” I know, this sounds suspicious, but it is legal, and has been for at least a decade. We filled out information, paid three months of premiums, and $5 to activate. Then we got a “payroll” certificate for Rick to take to the Caja office in San José. By this time, it was a bit too late to go there, so we came back to SJ the next day.

We got the Alajuela bus to San José, then caught the cementerio (yellow/orange with purple) bus to Caja (cattycorner from the National Theater). We asked the guard at the entrance where to find the “area administración de planillar,” and stood in a short line. Then we showed the payroll certificate and got a Caja number for Rick. We called ARCR and gave them the number for their records. As of now, we are both covered if we have an emergency. But there is one (only one?) more step.

Since we live in Alajuela, we need to register at the clinic in Alajuela before we can get regular treatment. This is also where we get the insurance cards. The next day, we take a taxi to the new hospital, ask the guard where to go, and he says (arg!) we need to go to the clinic, not the hospital. We take another taxi to Clínica Marcial Rodríguez (which happens to be pretty darned close to our apartment), go to the area marked “afiliación,” show copies of our electric bill and wedding certificate, and Rick gets his insurance card. However, I have a problem. I am supposed to be covered under Rick’s Caja, but the copy of our wedding certificate is not good enough – it is too old (it probably also needs more stamps and translations). Who knew? We have no other proof that we are married – our cedulas don’t indicate this. So we leave with Rick’s coverage secure, and mine a bit iffy – ARCR assures me that if I get in an accident, I will get treatment. We can provide the coverage proof afterwards if needed.

It took three days and a few headaches, but we have coverage! Since we are under 55, our cost is $61 per month. Once we (that is, Rick) reach 55, our cost drops to $43 – nice to look forward to a *drop* in cost!

I’ve since heard of someone who went in to *renew* her Caja insurance, and had a problem with her wedding certificate. Their solution was to get re-married in Costa Rica – it took a couple of hours, 2 witnesses, a lawyer, and $150. We’ve been married over 15 years, and it looks like this might be the answer for us as well. Why not? We already “got married” again in Hawaii – all that was required there was kissing in the wedding grotto…

April 2, 2008 – USA Health Insurance (Rant)

Once in a while, I gotta rant. This time, it’s about how fouled up the health insurance situation is in the states.

Most places that I have worked touted themselves as being on the cutting edge of health insurance reform (I’d say health insurance gimmicks). Most of these changes resulted in the employee paying part of the premium.

When we first heard about this, it was called “Flexible benefits” because you got to choose your health plan, and balance that choice against how much more you would pay each month. This soon became the norm.

Another place I worked pushed even more. At first, they provided you a way to measure your health via a questionnaire. You could do this or not – it was supposedly anonymous (but we suspicious types never really believe that). The next year, you got a discount on your premium if you completed the health questionnaire. The next step was this – if your health measurement indicated you had a problem or a health risk, you got a discount if you did something about it. For example, if you smoked, you got a discount if you joined a stop-smoking program – the discount applied even if the program didn’t work, and you still smoked. Likewise for a weight-loss program. The final step (although there is probably still something that can be squeezed out), was that you only got the discount if the problem got better – you stopped smoking, lost weight, etc. Written this way, you could argue that your health is important to them, and that they are providing incentives for you to get healthier. Cynics would say something a bit different.

If you tie in the insurance changes with the cultural effects of professional life in the Silicon Valley, you get a potent mixture. Life revolves around work. Stress builds up. Health suffers. The attitude is “Oh you’re sick? Did you get that report done?” You see co-workers coming to work with fevers, still working outrageous hours, because they have deadlines and expectations. You get a culture clash when you find out that people in other parts of the company go to their child’s soccer game in the middle of the afternoon (Don’t these people have any sense of priorities!?!?). THEN you find out that you’re expected to join programs to reduce the health problems largely caused by spending so much time at work. And just when are you supposed to go to these programs? So you end up resenting the system and paying more for your health insurance. And you aren’t any healthier…

So, this was just a low-level irritation for me for decades until I asked my health insurer about gastric bypass surgery. Then the irony hit full force. You have health insurance, which you pay more for because of a weight problem. Certainly, you do things like diet and exercise to help it. But there is no way you are going to go to a doctor multiple times per month for three (3) years for a medically supervised program – how can you do this when you don’t even have enough time in the day to get a full night’s sleep? Since retiring, I now had the time and the insurance (18 months of COBRA) to really do something about it. But the insurance won’t cover the surgery unless I have proof of a medically supervised weight-loss program lasting 3 years. This is not what I call encouraging better health. This is more like looking like we care while not paying for surgery.

If you read this, you know that I went ahead with the surgery. I had it done in Costa Rica. It cost about a third of what it would have cost in the states. It cost me about double what I would have paid out of pocket if insurance had kicked in. It didn't - I'm healthier without the insurance.

I realize that my situation is *nothing* compared to so many others. I don’t have cancer, I don’t need a transplant, I don’t need anything experimental. But this is just one more item showing how manipulated we are.