Comparing Health Care in Italy, the U.S. and Under the VA

The most important and instinctive thing to every human being is to stay alive. That said, what is necessary to sustain life? The answer is very elementary: clean air, clean water and health care. Yes, some food and shelter are also necessary but are not as vital to sustain life in its most immediate sense. Some additional thoughts along this line need to be considered. Once you've effectively lost your health, all the money in the world cannot restore it. It will only help you be more comfortable while you deal with it. Why can poorer countries provide care to all citizens and, yes, even immigrants and tourists? We have marketed the "MBA" all over the world but a country like Italy, reputed to have the most disorganized and labyrinthine bureaucracy in the history of man manages to provide more than just basic care to everyone. Is it perfect? No, it does get bogged down in the big cities and in remote rural sites, but on the whole it does work.

I lived in Italy for over 35 years and depended on their health care system. My family was assigned a primary care doctor who took care of minor ailments and referred us to specialists as needed. He also issued prescriptions, his own and those ordered by the specialists. For many routine exams there were long waiting periods. Mammogram appointments, for example, were set up year by year. For most exams and prescriptions the patient pays a small amount. For prescriptions it is about $5.00. For exams, like mammograms, it could be as much as $60.00. If the patient chooses his own specialist, he pays the doctor privately. Medication and treatment for life threatening conditions like high blood pressure, cancer and diabetes, however, are absolutely free. We complained often about the high taxes withheld from my husband's pay for retirement and health benefits.

Then in 2002 I was diagnosed with breast cancer. I was put on a fast track at the cancer research hospital near my home. I was scheduled for surgery and all of the exams that accompany the treatment. I never had to pay even one cent. I was given preventive chemotherapy for six months. Medications to relieve the side effects were free. I discovered that Italians living in other regions came to this hospital at no charge. They only had to take care of their travel and personal arrangements outside the hospital. This applied to in-patient and out-patient care. The hospital was very modern with electronic record keeping, appointment making and lab reporting. Research was shared with interacting hospitals all over the world.

I found the doctors to be very competent and efficient. My treatment was just as avant-garde as what I see in the U.S. I researched on-line every treatment I was given and what I received was in line with what U.S. doctors were using. I have found that many Americans think that other countries have lower standards and this was not the case. I was followed up carefully and my clinical record was detailed, a fact much appreciated by the U.S. doctors that reviewed it later.

After a year of preventive medicine, I had a recurrence. The next six months of chemotherapy were more difficult since the drug used was more toxic, requiring heavy doses of cortisone. I was dealing with even more serious side effects. I had to have a port implanted in my shoulder to facilitate the administration of chemotherapy. After this round of treatment I was given a different type of medicine, much easier to tolerate and I went into remission. After a year, at one of the hospitals specializing in plastic surgery, I had breast reconstruction. Again, I did not have to pay for this additional care.

How do they do it? The health care system is broken down into more manageable parts. There are the regional, provincial and local offices. There are boards to determine eligibility for disability status. Diagnostic equipment is divided out among the hospitals of a region and many hospitals will have certain specializations besides basic emergency and chronic illness care. Many hospitals work in conjunction with a university to extend the amount of available professional help and to provide experience and training to students.

Can this happen in the U.S.? It already does. The VA takes care of millions with a similar system. A year ago I moved to the U.S. to live with my mother. Knowing I had a serious "pre-existing" condition, I did not expect to find any affordable health insurance. I applied for Social Security disability and was denied after an appeal. My income was low enough for the state basic care, but that did not include specialists, and I needed oncology follow-up on a regular basis. I was too young for Medicare. Fortunately my military service qualified me for VA health care. I discovered to my pleasant surprise that I was assigned a primary care doctor and was referred to all the needed specialists. I was given all of the diagnostic tests and prescriptions I needed. Sometimes I had a long wait, but that has been true in many other hospitals and clinics as well. Some of the VA facilities may lack funding to upgrade their buildings and equipment but it does not hinder the staff in giving the best possible service. The VA also makes use of neighboring university staff to supplement the service. The doctors follow up phone calls the same day. When I moved to another state my records followed me through the computerized database system.

Could health care be managed at state and local levels rather than through the federal government? I think it is possible. There would be a better handle on the financing and organization and it would be easier to find and fix the many problems inherent in this task. Will it be expensive? It won't be cheap. If the patient is making a contribution, the tax increase may not be so high. With a centralized system the cost of materials and medications would drop. It is likely that some salaries would not be so high. However, the doctors in Italy are paid quite well. What are you paying for insurance anyway? Does it cover everything? Could you lose it if you change jobs, lose your job or have to retire early? I don't think it would be that much more expensive to pay a bit more in tax. Isn't it worth a try? As for expenses-I don't see European countries going bankrupt these days. Have you seen the dollar/Euro exchange lately?

With government supervised health care there would, at least, be some elected officials you could badger or vote out of office if things weren't working right. We have all heard the stories of people getting left outside the emergency room door for lack of insurance. Americans are not quiet when inefficiency and corruption are exposed. The media keeps the whole country involved with timely crusades.

Why was health care expected to be among the most important issues of this political campaign? I have not seen one article or even heard one of the candidates mention it with any detail at all. It seems that they are tiptoeing around the issue since voters are in fear for their wallets. That may be what the vote really comes down to. Illness or injury will happen eventually to most everyone. Death will come to absolutely everyone. We will all need care sometime. I never heard of a man on his deathbed counting the change in his pockets.

So why has this issue been avoided? If a candidate can't bring this up for fear of losing votes, then I fear we have wimpy candidates. Can we afford that? I don't think so. I want to know how they stand very clearly. We are known as the richest, strongest country in the world. We give millions in aid to 3^rd world countries. Can't we take care of our own sick? Shouldn't "pro-Life" really mean everyone? How will it help to just make insurance cheaper? Those without jobs or with pre-existing conditions are still left out. The insurance companies' primary interest is to pay out as little as possible. They are not working in the customer's best interest. U.S. citizens deserve more than that. Aren't provisions for emergency care and hospice the minimum of decency?

So what is essential to life? Clean air and clean water are big global issues. But health care is "up close and personal". The Italian health care system saved my life and now the VA is taking good care of me. Is your insurance taking good care of you? Will it be enough for your whole life? In any case, I wish you "Good Health"! Salute!