Then you consider that the total unsubsidized out of pocket cost for a surgery at a private hospital in one of the medical tourism destinations amounts to only a few months of premiums. And on top of it the service and hospitality with which the medical care is delivered is unlike any you've ever even imagined in the US.

That’s correct but Medicare is not a viable option for Americans living abroad because it does not cover overseas healthcare.

Medicare should work in Guam and other US territories.