Dear A.M. Costa Rica:
Diego Rodriguez is quite right.
Too many expats come to Costa Rica and expect to benefit from a welfare system they did not spend a lifetime contributing to. The small Caja payments in their declining years will in no way cover the rising medical bills that come with age.
It is worse than that. Many exploitative expats lie about their prior conditions. Even the state-owned insurance company is open to exploitation. As one might expect from a state-run enterprise, it is not very commercial. Younger expats can get insurance with no medical examination. There is widespread insurance fraud in this, too, with lies about prior medical conditions and general health.
Social medicine can work and does well in other countries. Expats need to behave themselves to help it to do so here.