Michael Walters had just started his first full-time job out of university when he was diagnosed with non-Hodgkin lymphoma, a blood cancer.
His doctors in Auckland, New Zealand, tried several rounds of chemotherapy, radiation and immunotherapy. None of it worked.
Then they told him about CAR-T, a treatment that takes a patient’s own immune cells out, re-engineers them in a lab to attack the cancer, and puts them back in.
A hospital in Melbourne, Australia, quoted him as much as $600,000, far more than his family could pay.
So in late June, Walters flew to Shanghai, where the same therapy costs a fraction as much.
It’s not that the Chinese invented it; CAR-T is an American technology.
But China is running the exact same playbook that Japan used on American technology after World War II— copy the American invention, perfect the manufacturing, and flood the market with cheap, state-subsidized products.
CAR-T’s big breakthrough came in 2012 at the University of Pennsylvania, where a 6-year-old became the first child to beat leukemia with it.
China took it from there. Its regulators let hospitals launch their own trials with far less central oversight than America requires, and by 2017 China was running more CAR-T trials than the US.
“China has basically done to CAR-T cell therapy the same thing that it’s done to other industries, which is, they’ve industrialized it,” said Dr. Sairah Ahmed, who runs a CAR-T program at MD Anderson Cancer Center in Houston.
According to Ahmed, CAR-T costs $150,000 to $230,000 in China, versus $550,000 to $850,000 in America. She has even advised some of her overseas patients to go to China for it.
Michael Walters did his CAR-T in China. And on August 18, he learned his lymphoma was in complete remission.
In 2021 China opened CAR-T to foreign patients, and now they’re flying in from all over. Walters’ hospital alone has treated patients from 12 countries.
To be clear, we’re not lamenting this at all. If China can take American research and sell the treatment for a fraction of the price, that’s a win for humanity.
But it also highlights how China has been working on its global image as a tourism hotspot.
Citizens of dozens of countries can now visit China for up to 30 days without a visa. Nearly 23 million foreigners entered China in the first half of this year, up 20% from a year earlier.
With their medical advances, they’re trying to push into medical tourism as well. It’s the same idea: open the doors and bring in foreign money.
It’s strange when you think about it— advanced medical tourism in one of the world’s most authoritarian regimes. No one had that on their bingo card 20 years ago.
Because that’s the crazy thing about China— while foreign tourists are arriving in record numbers, any Chinese national with the means to leave is moving out of the country.
Moreover, wealthy Chinese are flooding overseas “citizenship by investment” programs in places like Antigua and St. Lucia in order to quickly obtain a second passport.
They’re not stupid. They know their wealth and prosperity exists in China only as long as the government says it does. They know their freedom exists only as long as the government says it does… which is really to say there’s no freedom or prosperity at all.
They know they’re only one misstep away from being disappeared like Jack Ma, the Alibaba founder who criticized state regulators.
Or tennis star Peng Shuai, who disappeared after accusing a senior CCP official of sexual assault.
Or real estate mogul Ren Zhiqiang, who disappeared after speaking out against China’s COVID policies.
Or countless others.
Wealthy Chinese can also see the crumbling fiscal facade. Behind the modern skylines and futuristic robotics, they know that China in deep financial trouble, especially at the regional and provincial levels.
By Bloomberg’s count, 21 of China’s 31 provincial governments have budget deficits exceeding 100% of tax revenue. It would be like the US government having a $6 trillion deficit every single year.
Last year China’s general government deficit (national, regional, local) was roughly 10% of GDP… which is just absurd.
And local tax officials are now turning their sights on China’s rich (and eventually middle class) to make ends meet.
According to Bloomberg, Chinese tax authorities have formed special squads to hunt down the wealthy; sometimes an entire team is assigned to target a single individual.
Often these tax bills are not even based on the law, or any sensible calculation of taxable income. Instead it’s just demands and extortion: give us money, otherwise we’ll confiscate your assets and send you to a reeducation camp.
All of this is prompting wealthy Chinese to hit the exits, or at least prepare their Plan B’s.
China certainly does have some shiny bright spots. But they’re vastly outweighed by an authoritarian government of central planners.
America’s government is also weighed down by debt and bureaucracy, and some American politicians are already proposing similar ideas: wealth taxes, plus exit taxes on anyone who gives up their citizenship to escape them.
The difference is that America’s problems can still be fixed with some rational thinking. China needs a time machine. Nobody can go back and reverse the one-child policy or undo decades of communism or vote the Communist Party out of office.
But hoping the politicians come to their senses is not a plan, and that’s exactly why it makes sense to have a Plan B.
P.S. The Chinese families rushing for foreign passports now are doing it in a hurry, with a tax bill already on the table.
Schiff Sovereign’s flagship research service, Plan B Confidential, covers second residencies and citizenships, foreign banking, and legal tax strategies, with boots-on-the-ground reports from all over the world, so you can put the pieces in place before you’re scrambling.
