Health Care in Italy is Not Free

 

Health Care in Italy is Not Free

 

 

 

I once read an anecdote about a young American woman who was doing one of those “Drive Across America” vacations. She stopped for lunch at a diner and when she was finished with her meal she decided to order the fresh fruit salad. When it arrived, it was obvious to the young woman that the fruit salad came out of a can. She said politely to the waitress, “I don’t understand. On the menu it says ‘Fresh Fruit Salad’ but this is from a can.” The waitress was one of those women, a little more than middle aged, who treat all young people as though they’re her children. Cheerful and courteous, she explained to the young woman, with a big smile, “Oh, Honey! That’s just what they call it.”

I’ve been living in Italy for about twenty years now. I’m not going to do research for this article. What I’m going to write will be mostly about my own personal experience and what I’ve seen happening to others. If the people in power can convince people who have no power, including people who live in Italy and people who do research, that the health care in Italy is free, it’s not worth my time to ask them questions.

They call it “Free Universal Health Care” but it’s not free, it’s not universal, and sometimes the quality of the care is so low that it’s not even health care.

I’ve seen a lot of internet sites about Italy, some of them the official sites made by the government. Each region, province, and most of the cities, have their own official sites. Smaller cities are included on the sites of larger cities. I’ve seen a lot of comments from people saying that the health care in Italy is free, including a few from Italians living in Italy. One American man said that he and his wife were approaching retirement age and wanted to live in Italy, one of the reasons being that the health care is free. I’ve seen videos from Robert Reich who, when he talks about how expensive health care is in the United States, arguing that Americans should have free health care as they do in other countries, often includes a list of countries that offer free universal health care and Italy is always on that list.

One of the problems is that Americans usually think that when you use a word, it means what it means. But in Italy there are times when a word doesn’t mean what it means.

Reality is irrelevant in Italy.

I saw a comment on the internet from an Italian man in the comment section of a Youtube video that said that the medico di base is absolutely free. That much is true. What the Italian man didn’t mention is that it’s also true that the medico di base does absolutely nothing. The medico di base is your family doctor. You tell him what hurts and he’ll give you a prescription for an appointment with a specialist based on what he thinks you might have according to what you told him. You take your prescription to the pharmacy and they look in their computer and make an appointment for you. When you get to the specialist, that’s when you start to pay for your free universal health care.

I added my own comment to that video saying that I saw a meme of a patient on a stretcher in front of a hospital in the United States, trying to get some money from an ATM to pay for his expensive health care. I said that, while that might be a meme in the United States, in Italy it’s reality. If you go to a hospital near where I live, you’ll find, in one of the side entrances, an ATM. An Italian responded: “Where are you in Italy? HaHaHaHa.” I responded with the name of the city I live in, the name of the hospital I was referring to, and ended with “HaHaHaHa” just to show him that I have a sense of humor, too.

The reason you need to have an ATM at the hospital is that fees for health care have to be paid in cash, upfront. Some procedures are so expensive that many people just don’t feel comfortable carrying around that much cash.

You can also pay before you get to the hospital. There’s an office in all the hospitals, and other medical facilities, called the CUP (pronounced COOP). CUP stands for Centro Unico di Prenotazione (Central Office for Appointments). From what I’ve seen, it should be called Centro Unico di Pagamento (Central Office for Payment). You can get various health services performed there, including blood tests which you’ll need to bring with you when you see your specialist, but the main purpose of the CUP is to accept payment for your free universal health care.

They’ve got something called the “ticket.” (They use the English word.) I have an exemption from the ticket because of my low income, but it doesn’t apply for everything and every year the list of non-exemptions gets longer and the tickets cost more. And the list of things that everyone has to pay full price for gets longer.

The ticket is the fee you have to pay in order to get your free universal health care. In my own experience I’ve seen that the ticket can be anywhere from €12 to €500. This was a while ago, so all the ticket prices will have gone up by now.

I went to my medico di base and told him that my back hurts all the time.

He said, without knowing what was causing the problem, that nothing could be done about it.

A couple of months later, when the pain was worse, I went to the doctor again. He wrote the name of an aspirin substitute on a slip of white paper from his note pad, and told me to take one pill that night and another the following night. These were simple pain killers that don’t claim to heal anything, much less stop pain that you’re not feeling yet. Because it was non-prescription, I had to pay €17 euros for a box of ten pills that I knew wouldn’t do anything.

I spoke to an Italian woman and she said to tell the doctor I needed an appointment with a certain specialist. I went to my  medico di base and asked for an appointment with the specialist.

He was angry but he gave me a prescription for an appointment.

The first time I went to a doctor about the rings I was seeing around lights, thinking I just needed stronger glasses (I’m near-sighted.), I accidently went to a private doctor. When he heard my accent he told me I have glaucoma. He said that I would need to take a test at least three times, maybe four, paying €70 each time, in cash, no receipt, which meant he wouldn’t be paying taxes on the money he received.

I went back to my medico di base and got an appointment with an ASL doctor. The ASL (Agenzia Sanitaria Locale, local health agency) employs doctors who get paid by the State and not by the patient, unless you have to pay the ticket or you need a procedure everyone has to pay full price for.

I told the ASL specialist I had glaucoma. He gave me the glaucoma test once and that was enough to tell him I don’t have glaucoma.

When I told him about the rings I was seeing around lights, he examined my eyes and said I was developing cataracts, saying that I should have an exam once a year, explaining that I needed to wait until the cataracts reached a certain point and then I would need to have an operation.

The last time I went to an ASL specialist for my cataracts, he gave me one of those simple eye tests that consist only in naming the letters you see on a chart. He told me that my vision was a little worse, but it was such a slight difference that, if I didn’t want to, I didn’t even have to bother getting new glasses. (You have to pay for glasses.)

I didn’t say anything to the specialist but I went back to my medico di base and told him what happened. He said that if I didn’t like what the ASL doctor told me, I should go to a private doctor.

So far I’ve had to find a new medico di base about seven or eight times.

There’s a building here called the Cittadella della Salute (citadel of health). There are various health services provided there, including dental care and a CUP. Every time I went to the Cittadella, they refused to help with my teeth.

Once I had an appointment with a dentist at the Cittadella della Salute and when I showed up, the dentist told me that he wasn’t available just then and I should come back in a week. When I got there the following week I was told that he wasn’t in and they told me to talk to another dentist. That dentist told me that he didn’t like to finish up other dentists’ work. I told him that the other dentist hadn’t done anything. I showed him the x-rays and he looked at them for a moment and then said that he didn’t like to finish up other dentists’ work.

Another time I had a cavity. I have a row of crowns replacing about six top teeth in the middle,  right in front. The dentist said that the pain in my tooth wasn’t a cavity, that the problem was that I hadn’t gotten used to the crowns. I said that the crowns had been put in about two years before and my tooth just started hurting. He said that sometimes it takes a while for the teeth to start hurting.

When I got home I felt around in my mouth and finally realized that there was a tooth between the crowns and the tooth that hurt and that tooth between them didn’t hurt.

I went to a hospital in another city to see a dentist. I was told there that I had to bring a copy of my latest ISEE (Indicatore della Situazione Economica Equivalente, equivalent economic situation indicator), a document provided by the State that gives information about your income so that doctors, and others, can determine how much you have to pay for your free universal health care or whatever else you’re asking for help with.

When I had to have a little operation on my foot, the ticket was €40, no exemption. Then I had to buy a weird booty that I had to wear until the foot was healed. That cost me another €40. Not only is that not free, but for some of us it’s not even cheap. I’ve been poor most of my life and I’ve spent a lot of that time practicing how not to spend money. One of the things I learned was how to buy enough edible substances (notice I didn’t say “food”) to ward off starvation for more than a month for €80.

I had gone to an ASL doctor for my foot. My next appointment, I don’t know why, was with him in his private office. I didn’t even know at the time that ASL doctors also have private practices. He took off the bandage, looked at my wound for a few seconds, said it was healing nicely, put more disinfectant on the wound, covered it with a new bandage, and asked me for €200 euros. When he realized I hadn’t understood and didn’t know I was in the wrong place, he told me I didn’t have to pay.

If you go to your medico di base and tell him there’s a bump growing on your thigh just where it attaches to your leg, and he thinks that you might have cancer, you can’t just go to a specialist and get treatment. You have to get a test to make sure you really do have cancer and, if so, you have to know what kind of cancer you have because each kind of cancer requires a different treatment.

There’s no ticket for that test because everyone has to pay full price for it. If you don’t have enough money to pay for the test, there might be an organization that will pay for it for you. But you have to find that organization in time to get the money in time to pay for the test. If you don’t find such an organization in time, or they decide not to give you the money in time, all you can do is go home and wait to die.

If you need a procedure done, you’ll be put on a waiting list. The list is long but if you have the money, you can go to a private clinic and pay full price for your free universal health care. If you don’t have the money, and you have no one to help you, you just have to content yourself with being on the waiting list. Sometimes, people die while they’re on the waiting list just because they don’t have the money to pay for their free universal health care.

I’ve seen Italian videos on Youtube about people who have such a problem, with actors playing the various roles. These characters include one who has a certain health problem but doesn’t have the money to pay for the operation he needs. It’s usually an older man who has the problem. He and his older wife are totally stressed out and don’t know what to do.

In one of these videos, an older man who needed an operation to save his life and didn’t have the money to pay for his free universal health care, was visited by his son who wanted to introduce his new girl friend to his parents. They’re upset because she’s a foreigner. That is, she speaks Italian very well but with a foreign accent. She might actually have Italian citizenship, but she’s considered a foreigner, and treated like one.

Many Italians don’t take kindly to foreigners.

But it turns out that the young Italian man’s girlfriend has the money for the operation the older man needs and is happy to pay for it. This saves his life and then the parents like her and everyone lives happily ever after.

The moral of the story is: Be nice to foreigners, but not because they’re human beings who shouldn’t be discriminated against and deserve to be treated with respect, but because they might be able to help you someday.

There are private doctors and insurance companies in Italy that sell health insurance. How do they stay in business? You pay them full price. There is no ticket when it comes to private doctors. I don’t know what the insurance rates are in Italy but I would have thought that free universal health care would make health insurance unnecessary.

That’s just the “free” part of the lie. Then there’s the “universal” part which is tangled up with the “quality of care” part.

The reason for the “universal” part being tangled up with the “quality of care” part is that the quality of care you receive is based on racism, on whether or not you’re Italian or one of those horrible foreigners who come to this country and cause all the problems Italy has.

Foreigners are limited in the “free” health care they can get in Italy. Sometimes they have to go back to their country of origin to get medical care. People who emigrate to other countries usually can’t afford such luxuries. So they just have to die in the land of free universal health care.

Once I was waiting to be seen in the emergency room at the hospital. They had a chart on the wall (red for big emergencies, orange for middle size emergencies, and I think it was white  for little emergencies), explaining that people would be seen in emergency-size order. But they didn’t explain what they meant by “people.” While I was sitting there waiting, a nurse came out to the waiting room and said, “I want the foreigners to sit on this side of the room and the Italians to sit on the other side of the room. We’ll be seeing the Italians first.”

Not only are immigrants limited in the free universal health care they can get in Italy, but so are their children who were born in Italy. There is no such thing as birth-right citizenship in Italy. If your parents were born outside Italy, and you were born in Italy, your father (because your mother is still in the hospital after having given birth to you) has to go to an office to apply for a visa for you. The visa has to be renewed until you’re eighteen years old when you can apply for citizenship, going to an immigration office where you’ll be treated as though you just arrived in Italy. Although you were born in Italy, you’re a native speaker of Italian, you’ve gone to all Italian schools, most of your friends are Italian, you eat mostly Italian food, and maybe you even found a job through an Italian employment agency that finds maids, delivery people, people who break their backs picking tomatoes for a salary that’s so low you have to wonder how they get away with calling it a salary (There’s no minimum wage in Italy.), in order to get Italian citizenship you have to be living, and working legally, in Italy for at least ten years. I think you have to take a test, too.

The likelihood of a foreigner born in Italy and getting Italian citizenship at the age of twenty-eight, with all the delays, lost papers, appointments missed by the real Italians who just don’t always show up for work, bureaucracy, prejudice against foreigners, resentment against foreigners who come to this country and take jobs away from real Italians who don’t want to do the jobs the foreigners are taking away, is pretty slim.

In the meantime, you can’t vote, you’re expected to pay all your taxes (Real Italians aren’t expected to pay all their taxes.), and you’re expected to obey all the laws (Real Italians aren’t expected to obey all the laws.). And, of course, you’re not getting free universal health care.

Once, at the hospital, I was sitting in a waiting room while one of the doctors was in his office filling out forms to determine how much money the State should pay for my free universal health care and how much should be paid by me. The doctor came out and, to avoid having the other people in the waiting room hear my personal business, politely whispered to me, “I’m sorry I have to ask you this, but do you have Italian citizenship?”

Another time at the hospital, when I was waiting my turn to be seen, a foreign woman was crying loudly, wailing in agony, because she had just watched her young child die. The child might have died of negligence on the part of the doctors. Of course I don’t know that for a fact, but from what I’ve seen I’d say it’s a pretty good guess.

The Italians who heard the foreign woman wailing didn’t respond with comments like: “Oh, the poor child! So young! Think of how the mother must be suffering! It’s such a terrible, terrible thing for a parent to have a child die.” Instead they said things like, “Will somebody shut that woman up? This is a hospital. She’s disturbing everyone. Some people give no thought to the feelings of others.”

But all that would come under the heading of “Bedside Manner” and that’s not the responsibility of the patients.

Once, when I was having a tachycardia, I called for an ambulance.

All I said to the man who answered the call was “Ho bisogno di un’ambulanza.” (I need an ambulance.) But that was enough to let him know that I’m a foreigner. (I have Italian citizenship because every gene in my body is Italian.)

He said, “Cosa?” (What?)

“Un’ambulanza.”

“Cosa?”

“Un’ambulanza.”

“Cosa?”

“Un’ambulanza.”

I would have thought that people whose only job is to receive calls from people who need an ambulance and send one out quickly, would have ears ready to hear and understand the word “ambulanza.”

When he got tired of the game, he took my name and address, which he had no difficulty understanding the first time I said it.

When I finally got to the  hospital, a doctor came out and talked to me for a couple of minutes in a room that looked like a cross between a waiting room and a supply room. It was late by then and I had no way to get home except to walk, which would take about forty-five minutes. I told the doctor that but she just ignored me.

There was no examination. I wasn’t hooked up to any kind of heart monitor. The doctor didn’t even press a stethoscope against my chest. She just walked out the door without a word and left me standing there.

It was about three o’clock in the morning. There are no street lights on one long stretch of the road back to my home. If there hadn’t been a full moon, I might have gotten hit by one of the rare cars that passed or I might have fallen off the little bridge I had to cross.

If you think that’s health care, you need to have someone explain to you what health care is.

Once, my medico di base sent me to the hospital to make an appointment for tests for a serious life threatening illness. I don’t know why I couldn’t just go to the pharmacy to get an appointment. But I had a one-day urgency which meant that I’d be lucky if my appointment was only for about three weeks away. When I got to the hospital I was told that someone would call me to tell me when my appointment was.

When the lady from the hospital called, a couple of weeks later, the first thing she did, after hearing my accent, was to ask me whether there was anyone else at home. I said no, I was alone. Well, she said, she couldn’t tell me when my appointment was because I wouldn’t know what she was saying. I told her to just tell me when my appointment was. She kept insisting that I wouldn’t understand her. We had a little conversation that lasted about two minutes and it was obvious to me, as it should have been obvious to her, that we were understanding each other.

What was I supposed to do? Should I have gone back to my medico di base and start the whole process over from the beginning, wasting more time just hoping that I’d be called by someone who’s not a racist?

Finally, I got so pissed that I said, in the nastiest voice I could, “Ma’am, tell me the day and time!”

This time, she said, in a meek little voice, “Thursday at 11 a.m.”

“Thank you,” I growled and hung up.

On another occasion, I was told to come into the hospital on a Friday afternoon for some tests. When I arrived, the woman who had the bed before me hadn’t checked out yet. I had to wait in the hall for a couple of hours. When I got into the bed, I asked the nurse whether I would have the test that afternoon. She said it was too late in the day for tests. I said, “So, I’ll have the test tomorrow?” She said, “No. We don’t do tests on Saturday or Sunday. You’ll have your test on Monday.”

So why did I have to go to the hospital on Friday afternoon?

The hospital gets paid by the State according to how many beds are occupied, how many tests they do, how many other procedures they perform, every bandage they change, all their office equipment, all the meals they serve, anything their staff has enough imagination to come up with, including tests you don’t need, repeating tests that only need to be done once, and letting student nurses do their homework on you.

Once, I was in the hospital because I had a life threatening illness. The young woman in the bed next to mine was a foreigner. I never asked but I would have guessed she was Romanian.

Although she had a foreign accent, she spoke Italian pretty well. When I arrived, she said she had been in the hospital for about three months. You could easily tell she had been there for a while because of all the half-finished bags of chips and snacks on the little table that was meant for any of us to use, and the piles of clothing, some of it from the season that had just finished.

She was there for tests. After three months, the doctors still didn’t know what she had and they didn’t even care enough about her to suggest another hospital that might be able to help. If her illness was so rare, the doctors should have figured out at least that much. But she was content where she was because she was fully confident in the doctors. She believed everything they told her and knew that, someday, they would cure her. But she was pretty young.

On the other side of the room was an Italian woman, that is, a real Italian woman, not like me. The day she arrived, two or three doctors came in to talk to her. They told her what they suspected she had, told her what tests she would have, when she would have them, and not just the day but the time. They did the tests when they said they would and she was out of the hospital in about a week.

Also, her husband was a doctor in that hospital. In Italy, even if your problem is that you might have a life-threatening illness, it always helps if you know someone.

I was diagnosed with lymphoma. When I asked them whether that was cancer, they were horrified.

“No, no!” They assured me. “It’s just a light form of lymphoma.”

When I got out of the hospital, I looked for lymphoma on the internet. I found out, reading a medical site written by doctors, that lymphoma is a type of cancer. There are about 1,000 kinds of lymphoma, divided into three main groups. One group will kill you pretty quickly, no matter what you do. Another group can be controlled; if you get the proper care, you can expect to live almost as long as you would have if you didn’t have lymphoma. The third group can be cured.

I wasn’t told by the doctor at the hospital what group I was in. I figured I was in the second group because I had to have blood tests every six months. Then, after about a couple of years, the doctor told me to get an appointment for the following year. I took that as a good sign.

But, after that, I was back to having blood tests every six months. Why? Although I’ve never been too good at arithmetic, my guess is that a blood test every six months gets the hospital twice as much money from the State as a blood test every year does.

I’ve now been in remission for more than eleven years. Wondering whether it’s possible to be in remission that long; wondering why first I was told have a blood test every six months, then given a new appointment for a year later, and then I was back to appointments every six months; wondering whether I was put into the wrong group and was actually in the group that can be cured, and I was cured, I got onto the internet site of the American Medical Association to ask. I typed a question into their special private question box and got an automatic message saying that they weren’t allowed to give information to people living outside the United States.

I found an Italian organization on the internet that does research on cancer. I couldn’t find any place to ask a private question. Half of the information on their site was about cancer but it only gave very general information which was useless to me. The rest of the site was about the important work their organization was doing, how great their organization was, and all the people their organization was helping, along with detailed information on how to give the organization money, either in donations or in your will.

Now there’s a new ddl (disegno di legge, a bill) that the Senate has already passed and now it’s going to be voted on in the Camera (House), called Autonomia Differenziata (autonomy differentiated), that Vincenzo De Luca, the president of the region of Campania where Naples is located, has been talking a lot about lately. According to the ddl, each region will decide what they do with the tax money they receive, how much of that money will be for health care, schools, environment, energy, and other things people need help with to make their lives better. Autonomous regions wouldn’t necessarily have to share that money with the rest of the country.

According to De Luca, and others, the tax money received in the rich north will enable the regions there to raise the salaries, by €2,000 a month, of doctors and nurses working there. He says that doctors and nurses, attracted by the raise in pay, will leave the south and go up north to work. That means that the people in the north will get health care and the people in the south will drop dead.

Remember Marie Antonette? Remember eating cake? Well, in Italy, it’s going to be “Let them take an aspirin.”

So why do they call it “Free Universal Health Care”?

Just taking a wild guess, I’d say that the health care in Italy, in the beginning, really was free universal health care.

But language doesn’t always keep up with the reality it’s supposed to represent. We still say “hang up the phone.” We still call it a “cold” even though scientists have known for many years that catching a cold has nothing to do with the weather.

And if an expression makes the people in power look good, there’s no reason for them to try to update it.

Free universal health care in Italy? Oh, Honey! That’s just what they call it.

 

© 2024 Rose Romano (malafemmina press)

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