There are a lot of reasons people leave the United States.

Some leave for weather.

Some leave for affordability.

Some leave because they want a different pace of life, a different culture, a different daily rhythm.

And some leave because they look at the American healthcare system long enough to understand something deeply unsettling:

It is not always built to help you when you need help most.

That is what makes the story of Eric Tennant so hard to read and so hard to dismiss.

Eric Tennant was a 58-year-old man from Bridgeport, West Virginia. He had stage 4 cholangiocarcinoma, a rare bile duct cancer. After chemotherapy and radiation, his doctors recommended histotripsy, a noninvasive ultrasound treatment that they believed could target the largest tumor in his liver and potentially buy him more time. His insurer repeatedly denied it as “not medically necessary.” The treatment was eventually approved only after media scrutiny, but by then he was too sick to receive it. He died on September 17, 2025.

That is the part people need to sit with.

This was not a man without insurance.

This was not a man outside the system.

This was a man inside it.

And still, the system stalled long enough that the window closed.

His widow, Rebecca Tennant, put it more clearly than most policy analysts ever will: the insurer’s decision “did not simply delay care, it closed doors.”

That sentence explains a lot about why healthcare drives so many expat decisions.

In policy language, prior authorization sounds procedural.

Administrative.

Clinical.

Reasonable, even.

In real life, it often means a patient with a serious condition is forced to wait while an insurer decides whether the doctor’s recommendation is worth paying for.

In Tennant’s case, the treatment was estimated at about $50,000, and the Public Employees Insurance Agency of West Virginia repeatedly denied it. KFF Health News reported that West Virginia’s PEIA, which partners with UnitedHealthcare, covers nearly 215,000 people and that the new law inspired by Tennant’s case was designed specifically to reduce harm tied to these delays.

That’s the thing people outside the U.S. often find hard to believe until they see it up close:

American healthcare can be world-class in capability and still deeply hostile in access.

Those are not contradictory statements.

They are often the same system.

This distinction matters.

The United States absolutely has some of the best hospitals, specialists, research institutions, and advanced treatment capacity in the world. If you need a cutting-edge intervention, a highly specialized oncology center, or top-tier trauma care, the U.S. has real strengths.

But the infrastructure around getting to that care is where the system often breaks trust.

Not always.

But often enough.

Tennant’s story became nationally visible precisely because it felt both shocking and familiar. KFF Health News framed it not as a bizarre one-off, but as part of a broader pattern in which prior authorization delays can meaningfully harm patients.

That’s why this story matters beyond one family.

It is not just tragic.

It is recognizable.

This is the moment where a lot of Americans abroad start looking at healthcare differently.

Not emotionally.

Structurally.

Because once you live outside the U.S., you realize healthcare systems can be organized around very different assumptions.

In Colombia, for example, the private side of the medical system is one reason the country keeps attracting international patients. Joint Commission International’s accreditation database lists accredited healthcare organizations in Colombia, and hospitals like Fundación Santa Fe de Bogotá and Hospital Internacional de Colombia actively market international patient services.

That does not mean Colombia is perfect.

It does not mean every treatment is cheaper, easier, or better.

And it certainly does not mean serious illness becomes simple just because you crossed a border.

What it does mean is that in some countries, the path from doctor recommendation to patient action can be much more direct.

Less committee.

Less insurer choreography.

Less waiting for somebody far away to decide whether your case qualifies as urgent enough, proven enough, billable enough.

That difference matters most when time matters.

A lot of Americans still hear “medical tourism” and think of dental work, cosmetic surgery, or elective care.

That picture is outdated.

Countries like Colombia and Malaysia have spent years building private-sector capacity for international patients, especially in hospitals that want to compete on both quality and price. Colombia’s private hospitals and international patient offices are not pretending to be backup options. In many specialties, they are actively presenting themselves as serious alternatives for complex care.

Again, that is not an argument that every patient should jump on a plane.

It is an argument that Americans often underestimate how many legitimate treatment options exist outside the U.S. — especially when the barrier inside the U.S. is not medical capability, but payer behavior.

That is a very different problem.

One reason this story stayed in the news is that it did produce a legal response.

On March 31, 2026, West Virginia Governor Patrick Morrisey signed HB 4965, a law that allows PEIA members who already received prior authorization for one treatment to pursue an alternative medically appropriate option of equal or lesser cost without starting the process over again. The governor’s office described it as a patient-choice measure, and legislative tracking confirms the bill was signed that day.

That is real progress.

It is also too late for the man whose case helped make it happen.

And that’s what gives the whole story its moral weight.

The reform is welcome.

The timing is still brutal.

People sometimes assume that moving abroad for healthcare reasons is irrational, dramatic, or somehow disloyal.

I think that is the wrong frame.

For many expats, the healthcare question is not ideological.

It is practical.

Can I afford to be sick here?

Can I access specialists without being crushed by layers of approval?

Can I get treatment before a billing or authorization process eats the window?

Can I pay directly if I need to?

Can I build a life in a place where the system feels more like care and less like negotiation?

Those are serious questions.

And the longer you live abroad, the more normal they start to sound.

Not because the U.S. has no strengths.

Because strengths and usability are not the same thing.

Eric Tennant’s story is not just about cancer.

It is not just about insurance.

It is not even just about prior authorization.

It is about what happens when a system that is supposed to protect you is optimized for something else.

His doctors recommended a treatment.

His family fought for it.

The insurer delayed.

Approval came.

Time ran out.

That sequence is why people leave.

Not always forever.

Not always angrily.

But often with a new understanding that the American healthcare system is not the only system in the world — and not always the most livable one.

That realization changes people.

Sometimes it changes where they retire.

Sometimes it changes where they buy insurance.

Sometimes it changes where they decide to get treatment.

And sometimes, sadly, it comes too late for the people who needed that realization most.