With health care under attack in the United States, we are now having to come to grips with Americans living abroad becoming health care exiles, not only because of pre-existing conditions, but because of quality and cost of health care overall. Jim and Jane P. are both health care exiles. They moved to Germany for work twenty years ago (while in their 50’s) and decided to retire here. However, like many Americans, most of their assets are in the United States as well as their home. While they are proud Americans, they cannot live there. Four years after retiring, Jane was diagnosed with Castleman’s Disease, a rare autoimmune disease affecting the lymph system. They were informed that there were just 2 specialists in the world who could help, one being a German-trained Dutch doctor in Little Rock, Arkansas. The German health care law states that if they cannot treat a disease in Germany, they have to send you where it can be treated. The German system paid for both to go to the U.S. (flight and accommodation) and Medicare paid for the 3-month hospital stay. According to U.S. regulations, Jane could not stay more than 3 months in the hospital as her treatment could technically be done as out-patient. While the cost of the experimental drug was $10, the cost of administering was $10,000 (due to profit and malpractice insurance) per treatment. Jim and Jane would have had to pay this out-of-pocket had they stayed in the U.S. after the 3 months. They returned to Germany where Jane went through two years of chemotherapy (total out-of-pocket excluding monthly insurance premiums was around €3,000 as opposed to an estimated $100-200K in the U.S.) Jane has been cancer-free for the past four years. Jim had a heart attack last year and needed a triple by-pass. His total out-of-pocket cost was €310 for ten days in hospital and three weeks in rehab. Prescription drugs for blood pressure are limited to €10 for a 3-month refill. Their monthly insurance premiums are 15.7% of their gross income with a cap in Germany of €700 per month. Jim is actively lobbying the Senate with his proposal for fully-funded healthcare. The response so far has been null, which means that we all need to step up our efforts to help our Congressmen and Senators understand that this is the “art of the possible” not a pipe dream.