What everyone fails to take into account is what plagues everything nowadays: fraud. From shoplifting to outright CC fraud we all pay more for things due to dishonesty. Sure, VA healthcare and Medicare would seemingly be much cheaper if we could receive and be reimbursed for care in Mexico. It's difficult enough to investigate and then prosecute fraud in the US with laws that protect privacy and then the reluctance in many areas of the US to not prosecute property crime. Imagine Medicare or the VA trying to investigate and prosecute fraud against Uncle Sam in Mexico. Yeah, sounds like a joke, eh? Remember, Willie Sutton said he robbed banks because that's where the money is. Uncle Sam is the biggest bank. Many moons ago I worked for a major insurance company in San Diego. On occasion they asked me, unofficially, to take a ride to Tijuana and investigate a certain doctor who was claiming to treat cancer with a remedy called Laetrile. Being a good little employee I did as asked and got some good info for them. One Saturday morning I opened my copy of the San Diego Union newspaper to see my name on the front page. The story said I was being investigated for being the "front" for stolen cars being shipped to Tijuana. That ended my sub rosa work over the border. The dishonest people would have a field day with healthcare payments from the US. It's the reason we had to leave Mexico since our world wide health insurance through BP where my wife is retired from gave us a 9 month warning that our premium would increase from $325/mo. for both of us to $1450 if we did not move back to the US. That was a no brainer as we could not afford hat kind of increase. That was in 2018 and so far that $325 has not increased so it was not an idle threat just to mask a general increase that they had planned. An unofficial chat with the company that administers that plan, Aetna, confirmed fraud was the reason for the huge increase. We all pay one way or the other for fraud.