I have a friend who has a house in France, and was suddenly taken ill. A visit to the local doctor would have cost four dollars, and a house call was eleven bucks.  These big spenders decided to splurge and spend the extra seven dollars.  American medical costs are a real problem, and I’m not the one to solve it. There are, however, a few tricks that can help ease the burden.

•    The most obvious way to lower your medical bills is to live a healthy life-style. That means cutting back on the booze, smokes, pork rinds and certain – but not all – recreational drugs. It also means having a daily exercise routine, and walking or biking instead of driving. These are all no-brainers.

•    You can go online and order your medicines from Canada. It’s legal, and safe, and much cheaper than buying the same item here. One southern U. S. senator objected to this practice, warning against using “socialist medicines.” If you are absolutely dedicated to unregulated free-market capitalism, then I think you should stick to your guns and pay full price.

•    My CVS pharmacist, on the other hand, gets Canadian drugs for his mother from Jan Drugs. She is 64 and uninsured, and her monthly drug bill is $500. The Nasty Socialist Canadian medicines cost $70 a month. You do the math. Jan Drugs 1-866-395-3784

•    Medical tourism allows you to get low-price surgery in state-of-the-art hospitals around the world. The cost is a small fraction of what it is in the States. A heart-valve replacement that would cost upwards of $200,000 in the States is $10,000 in India – including round-trip airfare and a brief vacation package. And I’ll bet the food is tastier than U. S. hospital fare. Anyway, the only time I was ever in a hospital I noticed that many of the physicians were Indian – so why not let them treat you on their home turf?

•    I have a couple of friends who had cosmetic surgery in Costa Rica, at great savings. The clinic was in a pleasant suburban villa, and the doctor was American trained and board certified.  Naomi Campbell had work done in Brazil – another center for “lipotourism,” where cosmetic procedures are a fraction of U. S. costs.

•    My friend Penny buys her contact lenses online, at a healthy discount, and I order aspirins and vitamins on Ebay.

•    Most dental schools have low-cost clinics. A student will do the procedure, supervised by a professor. There’s a lot of waiting around in these places, so bring a book.

Should you throw out a medicine after the expiration date? Not necessarily. A vintage pill won’t harm you: it just won’t have the full strength of the original prescription. Pills get weaker with age, just like the rest of us.

Are you depressed, anxious, and broke? Are you depressed and anxious about being broke? There are many mental health centers that charge for therapy on a sliding scale. At the California Counseling Center in L. A., some patients pay as little as fifteen bucks a session – sometimes less in special circumstances. I go to the annual fundraising gala for this center – not just to support their good work, but because I always win restaurant vouchers in the silent auction.