To bring some diverse experience into the discussion on health care reform here in the USA, I’ve asked my friends in Europe to share how health care works in their lives. In this third of four entries, here are comments from my Italian friends:
From Susanna in Italy:
The system in Italy is faaaaar from being perfect, but the idea behind it is the right one: Everybody has the right to have health care — it’s really one of those things that makes a democracy, a real democracy.
In Italy, I pay for the national health care system through taxes. The rate depends how much you make per year (there are income brackets to determine how much you are going to pay). Recently, the government decided to ask for a payment for examinations or medicines (we call it a “ticket,” in America you call it a “co-pay”). There are some categories — such as retired people with low income, people with chronic diseases, and the unemployed — who don’t have to pay.
What I really dislike about the system is the long lines to get appointments for any kind of tests (from basic to more complex). It depends on the region, but it’s a problem all over the country.
Italy is a country of paradoxes. We have, on one side, excellent doctors with incredible training, and, on the other side, we have “scandals” involving important Italian hospitals in which the hygienic conditions are poor and dangerous. The other problem is that Italy has an “aging” population. We have fewer people working to support the retired population, which is living longer and longer. Because of that, health care costs to our society as a whole have gone way up, while tax revenue has not.
Overall, I’m satisfied with the system, but it must be said that I’m in good health. When my father had cancer and later died from it, I have to say that we were so lucky to meet such fantastic people (doctors, nurses, and volunteers) that it made this traumatic experience less severe. Moneywise, we didn’t have to pay a penny for all the treatments he went through.
From Donald in Italy:
The Italian health system has the usual diversity of standards from north to south. In my tour guiding over the years, I have assured dubious tourists in Sicily that the hospital we were in was perfectly competent (whilst hoping they did not notice the crunch of the cockroach I had just stealthily stood on). But I have also been hospitalized in an institution in the Italian Alps where I was given a private room with balcony and mountain view, four-star meals with my choice of dishes, and treated with medical equipment worth thousands — all on national health. In the end, I would rather have national health care than be without it.
In Italy, you have to know how to work the system. A few years ago, I was spending a fortune at a private optician in Milan, who kept trying to convince me to have laser surgery costing thousands of euros per eye. I didn’t have much confidence in him, so I did the Italian thing — I talked to everyone I knew until I found a friend of a friend who knew a brilliant Russian optician working nearby. A couple of phone calls and a couple of days later, I found myself in the Russian’s office where, in half an hour, I was given excellent, unbiased, and free advice about laser surgery and a prescription for contacts and glasses. When in Rome…
I know critics will say that there is less inefficiency in a private system. Would the critics of nationalized medicine advocate the privatization of other government departments such as the ministry of defense? Might that not lead to a series of business-driven wars being fought…ooops! Call me naive, but I would rather support a country which spends more money on inefficiently curing its citizens rather than on inefficiently destroying its perceived enemies.
From Nina in Italy:
I have dual citizenship and have lived abroad for 13 years. I have experienced health care systems in the US and Italy. For me, one particular misconception about the US system is the notion of choice. It seems to be a topic that elicits such strong emotions. In the US, we are led to believe that buying into a private insurance plan means that as consumers we have more choices. In reality, the choice of care is never ours, and not even left to our doctors to decide. More often than not, it is insurance companies that decide when, where, and for how long we can receive treatment.
Here in Italy, everyone has access to a government-run system that is funded through taxes, with some private alternatives for those who want to or can afford to go beyond our public service. Health care decisions are not made by someone worried about making a profit. Even the language we use to discuss health care in America (patients are “consumers”) echoes the fact that in the US we rely on a system meant to generate profits — whereas in Italy health care is viewed as every person’s right.
It seems impossible to me that a country as wealthy as the US cannot find a way to guarantee access to health care for everyone. There are so many ways to cut costs, including eliminating all of the frills. In the US, when you walk into a hospital or doctor’s office, you are greeted by a nice reception area with art on the walls, plants, matching chairs, etc. In Italy the paint may be peeling off the walls, and the chairs in the waiting room may not be the most comfortable — but the care you get is good and thorough.
I don’t think any system is perfect. You hear a lot of complaints here in the US also. I know where live if you need a new doctor it is almost impossible, and you will have to wait months to see a specialist. My kids have Kaiser Permanente and they have already had the H1N1 Vacine and the rest of us have to wait in two hour lines if we can get it at all. I think we really need some consistancy in this country. I have great insurance, but it may not last for long with the economy. And I know so many who have none at all. Which costs us all alot of tax dollars, go sit in the ER sometime and see how many people are there with a sore throat.
First of all, “Hello” to Donald and Nina. It was a pleasure meeting you on past travels, and I hope to see you again in future. It’s been both interesting and enlightening reading the differing points-of-view on health care, and the manner in which “universal health care” is provided by countries in Europe. One thing that’s apparent from the comments so far is that everyone with publich health care seems to be reasonably pleased with their respective systems, despite the fact these systems are paid for with tax dollars. Hopefully there will also be an entry from France in the Blog, as they have the No. 1 health care system in the world (according to the W.H.O.). The majority of modern countries in the world seem to treat health care as a basic human right, rather than a service to be delivered on a “for profit” basis. It’s interesting to note that U.S. residents pay significantly higher Health Expenditures as “Share of GDP” than countries with “universal health care”, yet have lower life expectancy and higher infant mortality rates than many similar countries. For example, according to the CIA World Factbook, life expectancy in the U.S. is No. 50 at 78.11 years, just ahead of Albania. I’ll be the first to admit that our health care system in Canada isn’t perfect. As Judy said in the previous post, “I don’t think any system is perfect”. The Canadian system has been a bit strained in the past few years due to a rapidly aging population and increasing demand. There are still some wait times for elective and non-urgent procedures, but this seems to be improving. However, from a personal perspective the system has always worked well for me and I’ve received excellent care whenever I’ve needed it. Services like Fire protection, public schools, Police service, water & sewer, Libraries, etc. are all “taxpayer funded”, so it seems reasonable to include health care as well. I don’t mind paying taxes for this, as I benefit as well.
Don’t confuse “Basic Human Right” with entitlement. No one is denying health care to anyone in the united states. Don’t confuse being denied health insurance with being denied health care. If you are passionate about helping the poor get better healthcare then donate your money. You are free to make that choice right now. I am sure there are many agencies out there that work in that area. http://healthcarecharities.org/ I have a right to have a gun, but I don’t expect the government to raise taxes and start handing them out to every citizen.
I presume everybody who writes to RS about healthcare in various countries realizes how lucrative end-of-life treatment is in the US to doctors and hospitals? An informed guestimate on my part is that 75% of all the health care dollars in the US are spent on people in the last year or two or three of their lives. No conclusions are drawn from these statistics. Just be aware that healthcare in the US is big business. And health care stocks reflect that. Bill Kester
As an expat living in Italy and retired, I’ve had several dealings with the Italian healthcare system – all positive. Before we moved here, while visiting in the Pienza area, my wife broke her foot. I took her to the Pronto Soccorso (translate: Emergency Room) at the hospital in Montepulciano. We were seen within fifteen minutes and she was informed that she needed surgery. The surgery was scheduled for the following Tuesday (this was on Friday). Surgery a success, she was now told not to put ANY weight on her foot for four weeks! She did it! A year and four months later, and she’s doing great – walking all over the place. We couldn’t be more please! On September 3rd of this year, I was diagnosed with bladder cancer. We’d moved to Pienza and, after obtaining our residency, had subscribed to the national healthcare program. Good thing. We had an appointment within one week, tested, and referred to one of the best doctors in Italy (nearby). Tests with up-to-date equipment and wonderfully trained technicians. Surgery (one week hospital stay – also wonderful)! Clean bill of health! Treatment to prevent recurrence is ongoing, but also very, very consistent with the kind of treatment I’d get in the U.S. Additional cost to me: €0,00! We’ve had no complaints – none! No lines. No language barriers. No technical problems. No medical issues. There’s much more to these stories, but the “comment character limits” prevent my going on and on… Thanks.
Nina touched upon it in her comments. I think one of the best ways to improve our system now before taking drastic action is to remove the anti-trust exemption for insurance companies. You want them to cut costs? Then open up the market to true competition. If companies have to compete and can’t keep up, they fail or merge. You won’t see companies propped up by red tape, beaurocracy, and high costs if they actually have someone competing with them. Call me a cynic but I believe in the laws of supply and demand, even with the motivation for profit, over the inefficient and ineffective government who overspends and doesn’t understand the concept of watching costs or operating on a budget. Whether it be war, legistlation, or programs, we can find example after example of govt ignorance and incompetence sustained by those only interested in their own ego and power. So give true competition a chance and make govt sponsored health plans a small option in this. I think everyone will benefit in more competition and fewer taxes.
Regarding Ken D’s comments above, France is actually a hybrid system of both public and private insurance. I think that would probably be the best route for those here in America. It keeps the costs down on the taxpayer by having a hybrid sort of system. I think too many people see this as extremes. It’s either one or the other. And I just don’t think a purely socialistic system like many countries have in Europe with high taxes is ever going to work here in the US. You are also talking about different economies of scale. The economy in California is one of the biggest in the world. One state is bigger than most other countries and I speak from experience when I say the govt can’t even manage the govt here in CA very well. And I am supposed to trust the govt, with all their failed programs, policies, and overspending, to effectively run healthcare? Yes, the govt does provide vital services. However, we also pay to fall behind many other school systems in the world. If the govt actually showed they were competent enough to run this system effectively, efficiently, and within a budget, I might be willing. Call me a cynic but when the govt and the politicians involved can’t manage their own households or manage the money of the govt, I surely don’t want them taking more of my money to try and do so with another program when I work hard, sacrifice (one income household with 2 kids in California), and manage to live within my means.
I know I have said a lot on this matter but I want to close with this. For as long as I live and til the day I die, I will never see the govt as savior of people or the world. The source of most wars and controversies throughout history have been govt and its leaders. The true way to make a difference is when people make a choice to help others and work to help themselves. The answer is found in people and not govt. I know that may be a bit idealistic but a study of history and the ego, power struggle, incompetence, and ineffectiveness of the govt to make our own country a better place only fuels my cynicism. The govt never can and never will be a savior.
That is actually the anarchist credo. “Anarchism is a political philosophy encompassing theories and attitudes which consider the state, as compulsory government, to be unnecessary, harmful, and/or undesirable, and favors the absence of the state (anarchy).” http://en.wikipedia.org/wiki/Anarchism Government –although not perfect– is necessary to organize human affairs when actions, if left to individuals, would be insufficient. Fire departments, disaster relief, police departments, national defense, infrastructure (such as streets), consumer protection such as drug testing and certification, health standards, basic education… the list goes on and on, all require some sort of organized action. Usually this means some sort of Government. There are simply too many people on earth, requiring too large a level of organization, to allow for the total gutting of government. The question then becomes how to make it fair, non-corrupt and how to maximize efficiency. In regard to the health care debate, the question is: Are the gaps in the current system (20% uninsured, high drug costs, main purpose being the generation of profit) so large and so egregious that the government needs to assist those who are not receiving adequate care because of it? Does the problem pose threats to societal stability, productivity, and our core beliefs of justice, fairness and freedom? These are the core questions. A dogmatic anarchist would say “no. Any government involvement is bad.” As has been suggested, given the culture and history of the United States of America, some sort of mixed system might provide a workable and fair solution.
I posted on a previous blog entry (number 2)and still stay with my contention. If insurance coverage costs(either company paid or privately paid)were added to an individuals total taxes per year, that total would result in a nearly if not more then the 30% to 50% taxed level mentioned by many. As for one of the writers who has a problem with government, I recall Lincoln saying something about government of the people, by the people and for the people which seems to indicate to me he felt government has some answers to an individuals problems.
I’m afraid these comments make me more resolute to not have nationalized health care here. Throughout the installments are comments about higher taxation, freedom not being free from taxes, paying more if you earn more and long waits. All of these things make healthcare worse under a national program than what the vast majority already have.
Murray, Following the same line of thought as “Retired” mentioned in the previous entry, you might find that your health care costs might decrease under a universal health care system. If the funds paid both by individuals & families as well as companies were directed towards health care, it’s possible that you might pay less? Removing the aspect of “profit” and sharing the costs between all users would most likely create a more efficient and cost effective system. Unfortunately, I’m not able to get an accurate picture of the amount paid by the average person/family in the U.S., as there seems to be a lot of variables. From the limited information that I have, I suspect that on average the majority of U.S. residents are paying more than residents of countries with universal health care. Whether you’re paying this in the form of taxes or health insurance, the net result is the same – it’s money out of your pocket! It’s interesting that virtually all of those that live in countries with universal health care (whether “single payer” as in Canada or “hybrid” as in France) are pleased with their respective systems and accept the costs. If the U.S. system was superior, it seems logical to assume that more countries would have adopted similar systems. Interesting discussion…….
Of babies and bath water..who said anything about anarchy? No one here favors that I don’t believe.
Two problems with your theory Ken. Taking profits out of healthcare would be a serious ding to an already wounded economy. Healthcare is a rather large part of America’s economy. Probably larger than it was in any of these European countries when they went to public funded healthcare. It’s fun for bleeding hearts to imagine sticking it to drug corporations or rich Drs but, the reality is lost profits in healthcare would ripple throughout the economy in lost jobs, loan defaults, etc. The assumption that out of pocket would lower is also wrong. My corporation pays most of my insurance. They are not likely to raise my salary by that amount once they no longer pay it. My out of pocket increases because my taxes have to cover not only my costs but the costs of the unemployed as well.
To Jeremy B and Murray. Lets get rid of Medicare and the VA then? Afterall these are government programs. See how popular that idea is with veterans and seniors. WHile you’re at it lets get rid of our socialized military and our socialized education system. Nothing like a good old fashioned race to the bottom. its time we learned a thing or two from the rest of the world. We have always been good at incorporating good ideas. Remember the Enlightenment started in Europe and we perfected it.
I live in Italy and want to share these U tube health care stories made by myself and other Americans residing in Italy. That health care is a universal right is part of the fabric of the culture in Italy as say healthy food is. And I think this outlook makes for healthier living. These stories speak for themselves: http://www.youtube.com/user/userAirConnect#
What I love about the Italian Health Care system is that spa treatments can be prescribed by a doctor to ease the pain of arthritis, help respiratory problems, etc. In America, these types of treatments are still often considered “alternative” and doctors would rather just have us popping pills. I recommend that all travelers to Italy check out an Italian spa, to see a side of the health system that is working beautifully–AND pamper yourself for lower prices than you’d pay for the same thing in the USA. You’re right Stephanie: it’s Healthier Living!
Thank you for your nice posting Bathmate
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Who wants not lead a healthier life? Obviously everyone. Most important part of our healthier living is healthy food. I think naturals are always better than other. So, I like to be stick with any type of natural food not only milk. I believe the most important part of our healthier living is healthier food. http://www.ourhealthierliving.com
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