Someone hit the nail on the head when they suggested that petty corruption is the rule of the day.
That's how most of the world rolls. WHen I was in college I had a girlfriend from Romania. We got pulled over for speeding once and I had to quickly stop her from trying to bribe the cop, and she was genuinely confused by the whole thing.
Laziness and apathy are far, far, far more common than anything else, and even in the nastiest, most totalitarian states, the reality is that down at the level of the local officials that you're going to have contact with, nobody wants trouble. For one thing, it's a lot of work to haul someone off to prison and impound their boat; that involves doing more than sticking out your hand and asking for some money. And they don't get anything out of the deal personally. What the harbormasters and pilot boat captains want is a small bribe.
Understand that if you go into port, they're going to do a safety inspection of some kind and they're going to find something wrong with your boat (real or not). What you need to remember is that when it comes to survival for oneself and one's family, people use whatever they have. A harbormaster has authority to do this kind of thing. THat's the resource that they have - authority. What they want from you is a bribe, and when they get it they send you on your merry way.
My dad was a master at these kinds of negotiations and we went to some pretty ridiculous places and never had any real trouble. It helps to speak another language (any other language but English will do) and to have your vessel registered someplace else (mine is registered in Belize) because if they find out you're an American you can expect a surcharge.
Even with the Muslim Brotherhood calling the shots in Egypt, I wouldn't be afraid to navigate the Suez Canal as long as I had a couple hundred bucks or a handful of silver coins. The pilot boat captains don't care who you are or whether you worship Jesus, Allah, or the Great Green Potato God. They just want to take home enough money at the end of the day to feed their families.
As for things like medical care, I might be selective about where I went if I had cancer, but penicillin is penicillin. When I was 16 I got a hallacious upper respiratory infection and my dad put into port in Viet f-ing Nam. Keep in mind that my Dad was a Marine Corps veteran who had fought there a few decades before. He paid the harbor master ten bucks and I went ashore with a twenty spot. I came back with antibiotics and two chickens; I'm not sure the doctor knew a butthole from an elbow, but treating an upper respiratory infection is not exactly rocket science, and I'm pretty sure that even with good insurance it would be difficult to get a doctor's visit, antibiotics, and two chickens in the United States for twenty bucks.
That doctor also made a spirited attempt to sell me a girl that I think was his niece but sexual slavery ain't the way we rolled.
Piracy is a problem in lawless places like the horn of africa but i dont see it plagueing asia or the Pacific. That's China's domain and the Chinese are prepping for americas crisis. In fact there is a good chance that China will choose how and when America's SHTF scenario goes down. They may very well precipitate it. They pretty much have our nuts in an economic lock box at this point and if they want to ruin us they can at any time.
There are a lot of countries that still get most of their needs from within and it is a uniquely american point of view that the world is toast without us. If a place gets its energy either at home or by import from someplace other than the middle east, grows most of its own food, and imports its manufactured good from China, that place will not suffer appreciably from a collapse here in the US. That describes most of the world. We export little, import everything, buy on credit. We will have a much harder time than many other places and we did it to ourselves.
One thing to keep in mind, a lesson that I can pass on from my experiences in other countries, is that probably if you get something like runaway inflation, your dealings with local authorities here in the states will, over time, grow to more closely resemble what I'm going to be doing at sea. People who need to feed their families are going to use whatever they have available to do that. I know a cop, sort of a friend (and sort of not) who lives paycheck to paycheck and is deeply in debt. Food wouldn't probably need to disappear for guys like him to become a problem. It would just need to get really expensive, because he's already barely able to paythe bills. In a real SHTF scenario with runaway inflation where he couldn't keep his family fed, it would probably be only a matter of time before he realied that while he didn't prepare for the event, he does have resources for feeding his family. He has a gun, a badge, a car with fancy blue lights, and authority. All over the world, that combination equals a pretty good source of income from bribes. So you may not have to deal with just gangs taking your food. You're also going to have to reckon with corrupt local cops who are desperate to feed their own families. There's no shortage of people with some kind of badge and some kind of authority in this country, and they can always find a law that you are breaking or a code that you are violating and can make life miserable if you don't make them happy. And shooting them is a good way to find yourself strapped to a gurney with a needle in your arm, at least in most places.