Those places have for several years been busily changing their tax and visa rules in order to attract American doctors to set up off shore clinics and practices.
Increasingly, health care can be provided remotely. Video exams, remote testing & evaluation, doctor consultations can all be done from outside the USA. Medical R&D need not occur on US soil.
Decades ago, if you wanted a VW Van, it was cheaper to buy it in Germany & ship it to the USA, while enjoying a nice vacation, than it was to buy that same VW Van in the USA.
Obamacare could be so expensive & so bad that elective or non-urgent surgery becomes cheaper & safer in Martinique, plus you & the family get a nice recuperation/vacation on a tropical island.