• Between 1966 – 1996 the number of Americans living abroad quadrupled, from 70,000 in 1966 to between 3 and 4 million in 1996 (Source: U.S. State Dept.).
• Ten years later, in 2006, estimates were closer to 6 million.

But the word estimate is key here.

When I wrote Living Abroad on Costa Rica, I had the devil of time finding a reliable number for how many Americans made that very livable Central American country their home.

Estimates ranged from 200,000 to almost four times that, but there didn’t seem to be any credible sources with accurate numbers.

It’s just as hard, if not more so, to nail down the number of Americans living abroad in general.

God knows the U.S. government has tried. In 2004 the Census Department did what they called an Overseas Enumeration Test, attempting to count the number of Americans living in Kuwait, Mexico, and France. The program was a dismal failure. In Mexico, for example—where the estimates of American expats ranges from 300,000 (according the the US State Dept.) to over a million (according to groups representing Americans overseas) — only 250 people completed a census form! The response was also weak in France, where 2,600 people filled out a form of an estimated American population of 112,000.

Census official Louis Kincannon admitted that issues of confidentiality and taxation might be at play here. “There are people who have a disinclination to be identified to any government,” Kincannon said.

In other words: Those who want to lose themselves often don’t want to be found.

Right now, retired U.S. citizens cannot claim Medicare benefits for treatment received in Mexico—or Costa Rica, or France, or anywhere else in the world, for that matter–even though they paid into the Medicare system throughout their working lives.

Crist, a former aid to Sen. Paul Sarbanes, D-Md., recently founded the non-profit Americans For Medicare In Mexico, which has lobbied 85 members in the U.S. Congress to get Medicare accepted south of the border.

Estimates of how many Americans live in Mexico (and abroad in general) vary, but the influential Association of Americans Resident Overseas puts the figure at 1,036,300. Crist says perhaps 200,000 of the Americans living in Mexico are eligible for Medicare, with about two-thirds of those seniors returning to the U.S. for medical treatment.

Not only would extending Medicare to Mexico be the right thing to do—if you pay into the system, you should receive the benefits—but Crist maintains in a Forbes article that such a program would also save the U.S. government a lot of money. Studies show that health care services are up to 70% less expensive in Mexico than in the U.S.

In Mexico, a visit to a doctor’s office often runs between $30 and $40, according to MedToGo, while a hospital room costs $90 to $100 a night. Besides private health care insurance, the Mexican Institute of Social Security (which goes by the Spanish initials IMSS) provides affordable, if basic, health insurance for all Mexican residents, regardless of nationality.

If Medicare were accepted in Mexico, says Crist, many of the American retirees currently flying back to the U.S. for expensive care would instead opt for treatment nearer their homes, cutting Medicare’s overall costs.

Program would need controls

An article in the Guadalajara Reporter notes that if Medicare is extended to Mexico, the program would only work with health care providers with Joint Commission International (JCI) accreditation . The JCI provides a certification process for health care facilities throughout the world.

Crist says ten hospitals in Mexico already have JCI accreditation and another 23 are seeking approval. Among those already approved are the American British Padre Hospital and the Santa Fe Hospital in Mexico City and the Christus Muguerza Hospital and the Hospital Tec de Monterrey in Monterrey.

Mexico would no doubt welcome Medicare funding, just as they welcome the increase in medical tourism to their country.

Research done by the Association for Private Hospitals in Jalisco reveals that of the 21.5 million tourists who visited Mexico in 2006, about 160,000 – mostly Americans – came for medical attention.

Response from Congress

Crist say that response to his plan to bring Medicare to Mexico has been  “quite positive, especially on the House side.”

But Forbes reports that the offices of Reps. Jim McDermott, D-Wash., Carolyn Maloney, D-N.Y., and other sympathetic legislators have also told Crist that this year they have too much on their plate, and that it would be politically wiser to introduce a stand-alone Mexico-Medicare bill next year, separate from the complex health care reform package currently working its way through Capitol Hill.

There are also calls for an in-depth three-year Mexico-Medicare pilot project to determine whether Mexican health care meets Medicare’s quality standards and determine if the payment system is sufficiently free of fraud.

Photo by Linda Parker.

If you seriously consider what it would be like to stay behind every time you travel, you may be a closet expatriate for whom a week at the beach or 10 days in Europe just don’t cut it anymore.

You find yourself dreaming longer-term dreams: a top-floor apartment in an old-world capital. An open-ended stay in a ramshackle village on some forgotten coast. Opening a bed-and-breakfast in a mountain town.

More and more of us are doing it. Between 1966 and 1996, the number of Americans living abroad grew from 70,000 to 4 million, according to the U.S. State Department. By 2006, the number was an estimated 6.6 million. And those are the official counts. Other expats are living under the radar, having dropped off the map.

If you’re past the dreaming stage and want to check out a place for its long-term potential, here are some tips on how to do it.

Stay put. If you’re thinking of moving to a particular place, you’ve probably been there at least once or twice. This time, choose the town or city you liked best and stay there. Rent a villa, find a cheap hotel with a kitchenette or stay with friends.

If you dash around too much you’ll never get a sense of the country’s rhythm. And rhythm is all. It may be love at first sight, but if the beat of the place doesn’t move you, this affair won’t last.

Do everyday things. Forget the monuments, the guided tours or running those Class IV rapids. Instead, get a haircut. Do your laundry. Go with the woman next door to pay her electric bill. Shop for food and make dinner. Gossip with the man selling fennel root. Take in a church service or go to the all-you-can-eat fundraiser for the town’s fire department.

If these activities are difficult because you don’t speak the language, that tells you what you would be up against if you moved there without some language study.

Sit and watch. Find a good perch at the center of it all, and stay there. Have some props — a drink and a book — to make you feel less conspicuous. Practice the lost art of noticing. Does everything shut down between 2 and 5 p.m.? Does the town consist mostly of older women, the men and younger people having fled to the city in search of work? Is it so hot that people work the edges of the day, leaving the midday for naps in the shade?

Take photos of mundane things. The state of the roads. Highway signage (or the lack of it). The prices on menus. What’s available at the local market. The lines at the bank. The cleanliness of the beaches or streets or fields. The smiles or scowls on locals’ faces. The wildlife and insect populations.

Back home, these shots will remind you of the quality of everyday life in your dream destination. Memory plays tricks on us, and once you get home the trip will soon be shrouded in a fog of generalization. We tell friends the trip was life-altering, but we have forgotten (or altered) the particulars. This will help.

Talk to other expatriates. Find them in the market, at Internet cafes and on that traditional expat perch, the bar stool. Ask them when and why they came to be there and how it’s turning out for them. And then listen.

Try not to let your own excitement amplify their positive comments or mute their complaints. Nod when they say making the move was the best decision they have ever made. But also really hear it when they tell you it has taken three years to get permission to renovate the old castle they bought for a song. Or that they’re so starved for English they go out of their way to use the one bilingual ATM in town, just to savor the words, “Would you like a receipt?”

Wherever you go, do some of the very non-vacationy things listed above and you may come back knowing that, yes, you really do want to make the big move and soon. Or you may return with a newfound appreciation of home. Sometimes all it takes to value what you have is to seriously think about giving it up.

And consider what author Alain de Botton discovered on a trip to Barbados. “A momentous but until then overlooked fact was making itself apparent,” he wrote in “The Art of Travel.” “I had inadvertently brought myself with me to the island.”

This article by Erin Van Rheenen first appeared in the Los Angeles Time.

Photo by Robert Doisneau, 1966

White noted,  “There is a belief that capitalism leads to unhappy people. However, when people are asked if they are happy with their lives, people in countries with good healthcare, a higher GDP per capita, and access to education were much more likely to report being happy. The frustrations of modern life, and the anxieties of the age, seem to be much less significant compared to the health, financial and educational needs in other parts of the world.”

While happiness levels may have shifted in the last 3 years, it’s interesting to note that in 2006, Western European countries garnered most of the top spots, though two nations in Latin American and the Caribbean made it into the top 15–the Bahamas at number 5 and Costa Rica at number 13. The USA didn’t do too badly, weighing in at number 23.

The 20 happiest nations in the World were:

1 – Denmark
2 – Switzerland
3 – Austria
4 – Iceland
5 – The Bahamas
6 – Finland
7 – Sweden
8 – Bhutan
9 – Brunei
10 – Canada
11 – Ireland
12 – Luxembourg
13 – Costa Rica
14 – Malta
15 – The Netherlands
16 – Antigua and Barbuda
17 – Malaysia
18 – New Zealand
19 – Norway
20 – The Seychelles

Other notable results included:
23 – USA
35 – Germany
41 – UK
62 – France
82 – China
90 – Japan
125 – India
167 – Russia

The three least happy countries were:

176 – Democratic Republic of the Congo
177 – Zimbabwe
178 – Burundi

Method
The 2006 world map of happiness used data from he Veenhoven Database of World Happiness (which Eric Weiner visits while researching The Geography of Bliss), along with UNESCO, the CIA, the New Economics Foundation, the WHO, the Latinbarometer, the Afrobarometer, and the United Nations Development Program.