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At 30,000 feet over the Pacific Ocean, Michael Raymond felt the dreadful, familiar early signs of a heart attack — the shortness of breath, the pain in the center of his chest, the tightness that felt like an eagle's talon was squeezing his heart.

A flight attendant called for a doctor over the plane's intercom. Soon, Raymond was receiving medical attention in business class as the United airliner hurtled toward Tokyo.

"I was in a lot of pain," said Raymond, 62, while sitting in his southwest Windsor home. "I was popping nitro(glycerin) like it was going out of style."

Raymond's ailing heart was the whole reason he and his wife, Christina, last month joined the millions of other medical tourists around the world who venture to distant lands in search of affordable health care.

But nine hours into a 12-hour flight to Asia, it looked like Raymond might not make it to the Bangkok Heart Hospital and the life-saving treatment that wouldn't cost him his house.

When Raymond lost his job as center manager with the Marin Art and Garden Center in Ross five years ago, he also lost his health care. Two years after that, his continuing coverage ended. A badly blocked heart meant that he could not get coverage on the individual market. No one would insure him.

Raymond's first heart attack was in 1998 when he was living in Kona, Hawaii and working as a landscaper breaking lava rocks in the hot sun. He spent a week in the hospital and received a stent — a device that widens constricted arteries — in the right side of his heart.

In 2003, after moving to Windsor to be closer to his wife's family, he was playing a round at the Chardonnay Golf Club in Napa when he felt that tell-tale tightening in the chest. He was swinging so well that he refused to get off the course. He finished with a score of 72 and two more stents in his heart.

"When I'm shooting like that, there's no way I'm getting off the course. I'd rather die shooting par," he joked.

Raymond knew that he needed a long-term solution to his heart problems. But without insurance, his only option was to hope for good health.

Raymond, who is too wealthy to qualify for Medi-Cal, too young for Medicare and too sick for individual insurance, is in one of the groups set to benefit from the Affordable Care Act.

In January, he will be covered by a $581 per month plan. Under the new health care law known as Obamacare, insurers cannot deny coverage due to pre-existing conditions.

But in September, he started feeling that tightening in the chest again, so he saw a doctor at Russian River Health Center, a walk-in clinic in Guerneville. The clinic recommended that he see a cardiologist. Two weeks and $1,000 later, the cardiologist recommended cleaning out the blockages in his heart with a tube inserted through an artery in his leg, a procedure called an angioplasty.

Raymond asked for a quote on the procedure. Four days later, Christina Raymond heard from the hospital: $36,000, and that was just for the operating room. It did not include the doctors, anesthesiologists, medical equipment or recovery room.

"At that point, I said 'We're out of here,'" recalled Raymond, who is bald on top with a silver goatee. "I can't afford this. We're going to Bangkok."

Medical tourism, the act of traveling overseas to find more affordable health care, is a booming industry. The Medical Tourism Association, a trade group, has identified 50 countries as having thriving medical tourism industries. Patients from the United States and other developed countries can save up to 90 percent on medical costs abroad, according to the organization.

Even when Obamacare kicks in next year covering people with pre-existing conditions like Raymond, many U.S. patients are still expected to travel abroad for treatment, either to avoid paying high deductibles or to avoid long waits for some procedures, said Robert Page, co-founder of MedToGo International, a medical tourism company.

"The belief is that initially there will be a decline in people who are going abroad for medical procedures," he said. "But patients who have more money than time are going to say that they don't want to wait and go abroad. We'll see a shift in clientele."

Thailand, with its 30 internationally-accredited hospitals and many western-trained doctors, has a growing medical tourism sector. About 2.5 million people visited the country last year seeking medical treatment, according to a Thai government press release.

Raymond first heard about Thailand as a medical destination when he ran a bed-and-breakfast in Hawaii. Guests from Australia, New Zealand and Europe extolled the benefits of the Thai health care system.

According to the Medical Tourism Association, a basic angioplasty without stent implantation in Thailand costs about $4,000, including round-trip airfare, a fraction of the cost for the same procedure in the U.S.

On Oct. 3, with an appointment at the Bangkok Heart Hospital scheduled, Raymond and his wife flew from San Francisco to Tokyo, where they were to switch planes and fly on to Bangkok.

But Raymond's mid-air heart attack derailed their plans. Upon landing in Tokyo, the plane was met by a crew of firefighters who escorted Raymond and his wife into an ambulance on the runway.

"I was freaking out," Christina Raymond said. "My hair fell out for a week from the stress."

They were whisked to a nearby hospital where Raymond had an emergency angioplasty with three stents. He was cleared to fly on to Bangkok four days later. The Tokyo surgery and hospital stay cost Raymond $20,000 on the American Express card.

The day after arriving in Bangkok, and despite having missed his original appointment, Raymond was in an operating room. Doctors performed two angioplasties and inserted four more stents into his beleaguered heart.

"They fixed everything," Raymond said. "I experienced great service. They keep you pain free."

Five days later, Raymond walked out of the hospital with what felt like a new heart. He and his wife spent the next eight days visiting the gilded temples and colorful markets of Thailand and staying at the Lebua State Tower, a hotel featured in the movie "The Hangover Part II." His wife even had some dental work taken care of.

The entire adventure cost Raymond $59,000 in credit card debt. Adding up the equivalent U.S. cost of all the procedures, stents and nights spent in hospitals, Raymond estimates the ordeal would have cost $300,000 in a U.S. hospital.

"What blows me away is the cost," said Raymond, whose grown son and daughter are helping with the bills.

Raymond said he has since cut out meat from his diet and is now eating "like a rabbit." Though he has experienced a few glitches signing up, he is looking forward to having health care under the Affordable Care Act on Jan. 1.

"I'll be able to relax a little bit," he said. "For three years, I just said 'I hope something doesn't happen to me.' And then, three months away from getting health care, it did. It's pretty sad that I had to go outside of the country to get affordable health care."

On the flight home from Bangkok, Christina was dozing in the seat next to her husband. Over the intercom, a flight attendant announced that the crew was looking for a doctor on board. Christina sat up in a panic.

"She was as white as a ghost," Raymond said. "I looked at her and said 'It's not me this time.'"

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