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.