Daily English
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180 Topics: Medical/dental tourism; warehouse club stores; yell versus shout; to be depended on; to last; kind versus kindly

Complete Transcript
You’re listening to ESL Podcast’s English Café number 180.

This is English as a Second Language Podcast’s English Café episode 180. I’m your host, Dr. Jeff McQuillan, coming to you from the Center for Educational Development in beautiful Los Angeles, California.

Visit our website at eslpod.com. Download this episode’s Learning Guide, an 8- to 10-page guide we provide for all of our current episodes that gives you some additional help in improving your English. You can also take a look at our ESL Podcast Store, with additional courses in English, including our new Introduction to the United States course. You can also see our ESL Podcast Blog, where we provide even more help in improving your English.

On this Café, we’re going to talk about two ways that Americans try to save money. First, we’re going to talk about something called medical and dental tourism, or the way that many Americans are starting to go to other countries when they need medical or dental services, because they are cheap in other countries, or at least cheaper than the U.S. Then we’ll talk about warehouse club stores, where Americans can buy things less expensively (more cheaply) than in other stores. And as always, we’ll answer a few of your questions. Let’s get started.

This Café is going to focus on ways that Americans save money. One thing that is expensive than the United States is “healthcare,” meaning going to the doctor or the dentist for some medical reason. “Health insurance” is the most common way for people to pay a small amount of money to an insurance company, usually each month, so that if they do get sick or hurt, the insurance company will pay most of their medical costs. Unfortunately, health insurance in the United States has become so expensive that millions of Americans do not have any health insurance at all, which means if they get sick, they have to pay all of these very expensive bills.

Getting healthcare (going to the doctor) is often cheaper in other countries. This has given rise to medical and dental tourism, as it’s called. To give rise to something means to cause something to happen; to bring something about we would say; to make something happen. You could say that the cost of gasoline increasing has given rise to American’s interest in smaller cars or in electric cars. The difference in the cost of healthcare in the U.S. versus other countries has given rise to this medical and dental tourism, where Americans travel to other countries to get medical care. It isn’t exactly tourism, which is usually something you do on a vacation – you go somewhere else. But it’s called medical tourism because people are traveling to another country in order to get medical care.

Obviously this doesn’t work in emergencies, situations that are very serious or dangerous where you need medical care immediately. If you’re in a car accident and break your leg, you’re going to go to the nearest hospital; you’re not going to take a trip somewhere in order to get taken care of. But if someone has an illness or injury that doesn’t need to be treated immediately, then he or she might decide to go to another country for the treatment. To be “treated” means to be taken care of by a doctor.

Let’s imagine that you’ve always had lots of problems with your “knee,” the middle of your leg that bends, that lets you walk and sit. Your doctor recommends that you have something called knee replacement surgery, where the surgeons (the doctors) will take out parts of your knee and replace them with plastic or metal parts. The most painful part of this is finding out that the surgery can cost you $40,000 if you don’t have health insurance. Even if you do have health insurance, you may still have to pay $5,000 to $10,000 currently for this kind of surgery.

So instead of paying all that money, you decide you’re going to get your surgery in another country, perhaps where you go on vacation but you’re also going to go to the doctor. You might find out that it’s possible to have a knee replacement surgery in another country, for example Mexico or India, where it costs a lot less money. Of course, you need to pay for your transportation to that other country, and you’ll need to stay there long enough for you to recover (to get better) after the surgery. But you could go have a very nice and get your surgery for a lot less money than you would pay for the surgery here in the U.S.

This is just an example, I’m not saying these are the actual costs for these different kinds of surgery, but you can see how when medical care is expensive people might want to go to another country where it is cheaper.

Of course, some people worry about the safety of medical and dental tourism – the safety going to other countries. Perhaps they might think the quality of medical care is not the same, not as high. In the U.S., people have to study for many years to become a doctor or a dentist, and healthcare is highly “regulated,” meaning there are many rules and laws that the government makes about medical services. Some Americans might think that the medical care in another country is “inferior,” meaning not as good as in the U.S. But other people say that the medical care in many countries, even though it is cheaper, is still good quality care.

Some Americans are also getting their drugs that they need to take from other countries. Even if they don’t go and see a doctor in another country, they might order their drugs through the mail from, for example, Canada, where it is often cheaper to buy certain drugs. This has become very popular now, especially with the Internet, where you can easily find companies that will sell you these drugs that you may need to use. Of course, we hope we hope that you are only getting the drugs you need. That can be a little dangerous, taking drugs that you don’t need or drugs that are illegal, of course.

Another way that Americans can save money that doesn’t require going to another country is to shop that what we call warehouse club stores. A “warehouse” (warehouse) is a very large building where many different things are kept (or stored). If you order a book, for example, from a company like Amazon.com, the book will come to your house from a warehouse, from a large building that keeps all of the books. Warehouses are often next to factories. A “factory” is a place where you make things. These things are then put in the warehouse, and then sent to the stores or to the customers. A warehouse store is a large store that seems more like a warehouse than a regular store. This warehouse store buys things in very large quantities, meaning they buy a lot of each thing. Because they’re able to buy so many, they’re able to get a lower price for these things. The warehouse store then passes along the savings onto the customers. “To pass on savings” means to lower your prices so that you customers don’t have to pay as much for something.

A “club” is a group that has many members. For warehouse clubs, you have to usually pay a monthly fee. It could be $50 or $70 a year, maybe more, maybe less. This fee gives you the right to go into the warehouse and shop. In other words, if you are not a member of the club you can’t shop at these warehouse clubs stores. The membership fee goes to the warehouse store so that it can, in part, afford to have lower prices. When we say they can “afford” (afford), we mean they have enough money to do something.

The two most popular warehouse stores in the U.S. right now are Costco and Sam’s Club. Right now, I think a Costco membership costs about $50, a Sam’s Club membership costs about $40. You get a membership card, and then with that card you can enter into the store and go shopping.

The stores carry lots of different items. We have a Costco store near where we live, and we have a membership so my wife and I will go there maybe once a month to buy things. The store carries a lot of different items. To “carry” here means to have things to sell. “Carry” can also mean to pick something up and hold it in your arms. But when we’re talking about a store, we say a store carries something, we mean they have it available for you to buy. Warehouse club stores carry a lot of different kinds of food – “groceries,” we would call them. They also are very popular for what are called “toiletries,” things that people use in the bathroom, such as toilet paper, shampoo, makeup, and so forth. These warehouse club stores also have things that you would not normally find in a grocery store, things like electronics: computers, big TVs. They also have clothing, toys; they often have books. All of these things are sold more cheaply.

Now when you buy something from a warehouse store, you usually have to buy a lot of it. You can’t go in and buy, for example, one can of corn or one box of cereal; you have to buy several of these things. We say that you have to buy them “in bulk” (bulk), which means in very large quantities. You have to buy, for example, a huge container – a very large container of something, or several boxes at the same time. When I buy razor blades, for example, I can’t buy just one or two razor blades; I have to buy 15 or 20. But, the blades are still cheaper. What we would call the “unit price,” the cost per item or per ounce or per gram is much less than what you would pay at a regular store. However, you have to buy things that you can keep, things like paper products: paper towels, napkins, toilet paper, tissues (what we would call Kleenex – what you use to blow your nose, for example). These are all things that you can buy a lot of because you can store them in your garage, you don’t have to use them right away. Of course, this means that you have to have space in your house to store these things – to keep them there.

Warehouse club stores aren’t very “practical,” meaning they’re not necessarily a good idea if you live by yourself, or you live in a small apartment where you don’t have room to store things. But they’re a very good way for a family or someone who has a large apartment or house to buy things cheaply. If you live in a place that has a large “pantry,” a special room for storing food and other kinds of products, then going to the warehouse club stores can be a very good idea because you can save a lot of money.

Some these warehouse clubs stores also have stores in other countries; you might have heard of Costco or Sam’s Club. But in any case, they’re quite popular here in the U.S. in almost every part of the country.

Now let’s answer a few of your questions.

Our first question comes from José (José), originally from Cuba, now living in Mexico. José wants to know the difference between the verbs “to shout” (shout) and “to yell” (yell).

“To shout” means to say something in a very loud voice, usually as a way to get attention. A teacher might shout at her students to get their attention, maybe because they are all talking to each other and not doing their work. That’s what students do!

“To yell” is also to say something in a very loud voice, often, however, because you are in pain or angry or are fearful of something. We also use “to yell” when we are talking about speaking loudly in order to encourage someone to continue doing something. The verb we would use here is “to cheer” (cheer). If you’re at a sports game, you might be cheering for your favorite team. You would be yelling out: “Go! Yeah! Hit ‘em harder!” or whatever. This is also a kind of yelling: “They were yelling in support of their team.”

“Shout” and “yell,” however, can usually be used interchangeably. You can both shout when you’re angry and yell when you’re angry. So for most situations, these two words are basically the same.

Alessandro (Alessandro) in Brazil wants to know the meaning of the expressions “to be depended on” and “to last.”

“To be depended on” means to be relied on. Someone is relying on you; someone is expecting you to do something. It’s what we would call the passive form of this verb. For example: “The car cannot be depended on,” meaning we cannot depend on this car – we cannot rely on this car. Or you might say, “Billy cannot be depended on to do his work on time,” meaning you can’t depend on Billy; he’s not reliable.

The verb “to last” (last) means to continue to exist; to endure, we might say. To be enough for what you need is another definition of “to last.” Often, we use this when we are talking about something that you are using up. For example: “Do we have enough milk to last until the end of the week?” meaning will we run out of – will we no longer have enough of this thing several days from now. You could also say, “We brought enough music to last us for three hours,” meaning it will continue – we have enough music to listen to for three hours. Someone may also say, “How long did the meeting last?” meaning how long was it; that’s another use of this verb “to last.”

Our next question comes to Ricarda (Ricarda) in Germany. Ricarda wants to know the difference between “kind” and “kindly,” with an “-ly” at the end.

“Kind” is an adjective; it means basically nice, treating people in a nice way: “It was kind of our neighbors to tell their dogs to stop barking” – because they’re always barking, really! It was kind of them to make sure their dogs were not barking – it was a nice thing.

“Kindly” is an adverb which means, usually, in a kind way. For example: “The students were treated very kindly by the teacher.” The teacher was nice to them. “Kindly” is also a way of being polite, saying “please,” although this is not very common anymore, but you might read it in a novel or you hear it in an old movie. It’s still used by some people, for example: “Would you kindly close the door when you leave?” That means would you please close the door when you leave.

The word “kind” can also refer to a group of things that are similar. Someone might ask, “What kind of car do you have?” “I have a Ford (or a Mazda, or whatever).” So, “kind of” something is a type of something. We also use “kind” to mean a little bit: “He’s kind of crazy,” meaning he’s a little crazy.

We hope that we treat our listeners kindly here on ESL Podcast! If you have a question about something in English you’d like us to answer, you can email us. Our email address is eslpod@eslpod.com. We don’t have time to answer all of the questions that people send us, but we do the best we can. Remember that it takes us usually several weeks before we will be able to answer your question, because we get so many questions.

From Los Angeles, California, I’m Jeff McQuillan. Thank you for listening. Come back and listen to us next time on the English Café.

ESL Podcast’s English Café is written and produced by Dr. Jeff McQuillan and Dr. Lucy Tse. Copyright 2009, by the Center for Educational Development.

health insurance – a way for people to pay a little bit of money to an insurance company each month, so that if they get sick or injured, the insurance company will pay most of their medical costs

* I need to find a full-time job with health insurance to cover the costs of my wife’s treatment.

to give rise to (something) – to bring about something; to make something begin to happen

* The government’s new tax laws gave rise to many businesses moving from the U.S. to other, less expensive countries.

to be treated – to be taken care of by a doctor or other medical professional; to get medical care

* How long will we have to wait to be treated by a nurse or doctor?

regulated – controlled by many rules and laws that are made by the government

* Some states have made gambling legal so that it can be regulated by the city and state governments.

inferior – not as good as; of lower quality

* The service we get in this hardware store now is inferior to the service we used to get under the former owners.

warehouse – a very large building where many things are kept

* Our store keeps most of its merchandise in a warehouse.

to pass the savings on to (someone) – for a store to buy things inexpensively, and then resell them to customers at a slightly higher price so that the store still makes money, but customers are buying things much less expensively

* I like shopping at this grocery store because the owners always pass the savings onto the customers.

to afford – to have enough money; to have the money to buy the thing that one wants

* Can we afford a new car and a vacation this year?

to carry – for a store to have an item to sell; for an item to be available in a store

* We called three stores before we found one that carries the car parts we need.

in bulk – in large quantities; with a large number of the same thing

* Sheila always buys frozen chickens in bulk because everyone in her family likes eating chicken dishes.

unit price – the cost of an individual unit or measure of something; the price of one item

* To see which product is cheaper, let’s compare their unit prices.

pantry – a special room for storing food and other things used in the kitchen and other parts of the home

* You’ll find the canned soup and flour in the pantry.

to shout – to call, cry out, or laugh in a loud voice, usually as a way to get attention

* You’ll need to shout louder if you want your friends down the street to hear you.

to yell – to cry out in a loud voice, often crying out in fear, pain, or anger; to talk loudly when cheering (speaking loudly to encourage others to do well in an activity)

* Bella let out a yell when the dog ran into her and she fell down.

to be depended on – to be relied upon; to be expected to

* Oscar can be depended on to get very upset and yell every time his team loses a game.

to last – to continue to exist; to remain fresh; to endure; to be enough for what is needed

* Is there enough wine to last the entire evening?

kind (adj) – warm-hearted; gentle; treating other people in a nice way; not mean

* It’s very kind of you to call to ask how my mother is doing after her surgery.

kindly (adv) – in a warm-hearted way; gently; in a kind way; please

* My favorite professor was a brilliant and kindly man, who spent a lot of time with his students.

What Insiders Know
Top Five Medical Tourism Destinations

Americans wanting to avoid the high cost of medical care in the U.S. may travel to other countries to get treatment. Which countries “attract” (get the interest of) Americans the most?

One of the major concerns of any “patient” (person getting medical treatment) is that he or she can communicate with the medical “staff” (workers). The top five medical tourism “destinations” (a place where people travel to) all have English-speaking staff, “for the most part” (mainly; mostly).

In 2008, the most popular places are:

Costa Rica
Panama offers medical treatment that is 40-70% less than in the United States and it has the advantage of being more like the U.S. culturally and patients may feel more comfortable here. However, Asian countries offer even bigger “bargains” (very reduced prices) for treatments and surgeries, although airfare to Asian may cost more and should be “taken into consideration” (remembered and considered) when doing a “cost analysis” (looking at the cost in a systematic way).

If it’s “cosmetic surgery” (surgery to make you look better) you want, Brazil has a major “clinic” (medical center) where many “plastic surgeons” (doctors who perform cosmetic surgery) “cater to” (offer services especially for) Americans. For dental, cosmetic, “cardiac” (heart) surgeries, Malaysia and Costa Rica are two places that many Americans go. Finally, many say that India offers the lowest cost in medical care, with the highest quality.