No Medicare for ex-pats so Uruguay is out of the question

I thought I'd better check on whether I can get Medicare as an ex-pat. Nope. Of course the Medicare premium is garnished from SS before you even get paid but Medicare will not pay for any health-care outside the USA. And of course Medicare is mandatory. If you chose not to have Medicare, you forfeit your entire SS. Who the hell thought of this? Stalin? It's no wonder that only the very rich can afford to retire outside the USA.