06 May 2012

LIFE: An Apple a Day

SARONNO, Italy – A few weeks ago I had to go back to the National Health office and have my “pink card” updated. A pink card is a list of codes related to tests and treatments connected to a person’s chronic diseases. It is used by family physicians when they are writing prescriptions to indicate that the person receives the test or medication gratis. Otherwise, in my case for example, I would be required to pay what is called a “ticket”, a surcharge for every prescription or test, which for me would be $2.00 per prescription.
 Entrance to Gaslini Children's Hospital, Genoa, Italy
The latest chronic disease to be added to my “pink card” list is high blood pressure. I’m happy it’s only that. I’ve had some pretty scary tests the past few months, including a PET scan. The idea of having a radioactive substance injected into my body and then traced by sliding me into the maw of what looks like a space capsule, well, let me say this, one of my Italian daughters had to go with me and hold my hand. So much for my frontier, independent, I can handle this myself spirit.

When I became a legal resident, I was issued a National Health Card but never thought much about it. I just continued to make private appointments just as I had always had in the United States. But then my rheumatologist asked me why I didn’t use the National Health System (Mutua) instead of paying to see her privately.

“It’s the same,” she said. “When you call to make an appointment with me and they ask you if you want a private or a
Mutua appointment, just tell them Mutua. "Nothing changes," she said, "it's always me and it's always this office, it's always this hospital and you won't have to pay anything.” So that's what I did.

Some of the doctors and researchers at Gaslini Hospital, Genoa, Italy
I have had CAT scans, sonograms, MRI’s and all sorts of specialized exams over the years and have paid for none of them. I've spent a week in the hospital, have had physical therapy, eye exams, visits to the dermatologist and the list goes on, all covered with no additional out-of-pocket costs for me now that I am officially retired. The system really works, and it works well. 

There are a couple of things I really like about the Italian health care system. One is that you keep your own records, test results and X-rays, and pick the doctors and the care facility, be it public or private, you want to go to. It wasn't like that when I lived in San Francisco. I had to travel across the city to go to the HMO that was listed on my company’s plan. Not only was very inconvenient but I had no choice of anything. I had to be satisfied with the HMO facility and the doctors who worked for that HMO.  

I thought perhaps things had improved in the years I've been gone so I was shocked the other day when an American friend of mine told me that she tried to renew a prescription and the pharmacy told her the insurance company would not allow it. The insurance company would not allow it? The pharmacy told her the renewal had been refused. The insurance company, or better yet a clerk at an insurance company gets to decide what prescriptions can be refilled and which cannot? And America is OK with this? And the latest scam is the drugstores in her area (Buffalo, NY) refill your prescription on their own and then call you to come and pick it up. I can only imagine how many people feel obligated to pick up prescriptions they may not even need any more. It's disgraceful.

 Laughter is still the best medicine
Americans are against a single payer health care system where you and your doctors make the decisions because of why? Have they forgotten what the word 'choice' really means?

This is the same friend who told me her primary care physician 'gets mad' if she wants to see a doctor outside of his medical group. Besides, she said, they don't like to share information with other doctors who are not part of their group. When I suggest she might want to keep her own records and see whatever physician she damn well pleases she told me she doesn't want to ask for her records because her doctor will be upset. The doctor will be upset? So?

Gaslini Hospital - They Saved Him
I think some Americans are reluctant to embrace a national health care system because no one tells them how these things really work. The insurance companies hire lobbiest to lobby Congressmen to oppose the system simply because they want to keep the status quo. It's in their best interest - but it is not in America's best interest, not by a long shot.

With a national health plan you eliminate the middle man - the insurance company - and when you do that health care costs go way down. Not only that, but then you get to decide where and when and who takes care of you not a clerk in an insurance company who is under orders to cut costs because the company is more concerned about their quarterly profits than your health  - and I don't know about you, but  for me that’s what health care choices are really about.  

I actually do know a thing or two about insurance companies, I've worked for several in my day. I have heard with my own ears insurance salesmen telling clients that when their insurance policy was paid up they had to cancel it and get another, because it was only valid if they were paying on it. I have seen with my own eyes two sets of rate books, one for blacks and one for whites, used to calculate the amount of money a policy holder could borrow against their policy. Guess who got the lower rate? I have seen a lot of things when I worked for insurance companies, and none of them were ever in the interest of the policy holder.  

Is the Italian health care system perfect? Not by a long shot. It's only Number 2 in the world according to the World Health Organization. Perfect no, but then again, what is?

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