SAN MIGUEL DE ALLENDE, MEXICO -- Universal healthcare -- some call it "Obamacare" -- is the center of a heated debate in the United States, but in neighboring Mexico, it’s now a reality.
And a few Americans living in that country are among those who have enrolled in the insurance plan known as “Seguro Popular.”
“I just felt that we needed some feeling of security if something happened to us in an acute way,” said Albert Lerner, who signed up for the plan with his wife in case of an emergency.
"I have chosen not to have U.S. medical care or coverage," Rhonda Lerner said. “In the past, I’ve paid for medical care here, and it’s been superb.”
In Mexico, like the United States, most insurance was linked to employment.
Mexico’s congress created the “Seguro Popular” to offer coverage to people who are self-employed, work odd jobs like street vendors or are too poor to pay for insurance.
It took nearly a decade and two presidential administrations, but the country reached its target of enrolling more than 52 million people this year, achieving nearly universal coverage.
The Lerners enrolled in the plan in September.
A few weeks later, Albert Lerner was at a backyard gathering with a friend in San Miguel de Allende and “we both fell over, and I had a glass in my hand, and we both got serious lacerations."
Two days later, his wife Rhonda was leaving a dinner party after dark and didn’t see a small irrigation ditch.
“And she fell into it and twisted her ankle and we were up there at twelve, one, two in the morning.” Albert Lerner said.
“The doctor in charge, she was perfectly bilingual” Rhonda Lerner said.
The Lerners paid nothing for the two emergency room visits because they were enrolled in "Seguro Popular."
“No cost. And if you own a home we think it’s only $300 a year if it’s that much,” Albert Lerner said.
Premiums are charged on a sliding scale. Home ownership is one of the deciding factors. The Lerners are renting a place in San Miguel.
Anyone who is not covered by another insurance plan can enroll.
Patients do not have to be Mexican citizens but do have to prove legal residency.
Most people pay little or nothing. Children are fully covered under the government-funded plan.
The Harvard School of Public Health examined the plan in a paper published online in The Lancet in August.
Among the findings: "Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor.”
Mexico’s former health minister, Julio Frenk, now is the dean of the Harvard School of Public Health and was behind many of the reforms that led to the creation of "Seguro Popular."
Access has expanded, but the quality of medical care in Mexico varies widely from state to state and is not as good in poor, rural areas.
And there are questions about accountability for states that get funds based on how many people enroll in the program.
But in central Mexico, American patients seem pleased with their care.
“I fell and fractured my knee cap, and they have been so excellent. First of all, it cost almost nothing to have this work done,” said Joann Edmunds, 84, a homeowner in San Miguel de Allende.
She paid for her medical expenses out of pocket.
The Lerners say since they started sharing their experience with friends in San Miguel de Allende, many are asking how they can sign up for the "Seguro Popular."
Albert Lerner is not just a patient: he’s also a retired medical doctor.
“He was in practice for 40 years, and when our friends and acquaintances hear he was happy with the care he and I received, it’s a great seal of approval,” Rhonda Lerner said.
Even so, universal health care remains a controversial issue the United States, while in Mexico many consider it a milestone.
“I feel like the United States should start following Mexico,” Albert Lerner said.