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Health Care Under the Tuscan Sun

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"If Italy, a country with a reputation for a certain amount of drama and chaos, can manage to organize and maintain a solid health care system for all of its citizens, along with other European Union countries, why is it so difficult for the United States to do it?"

At first glance, the cross-eyed doctor with thick glasses and tight jeans did not inspire confidence. I could never tell for sure what he was looking at. Add to that my struggles with the Italian language, his total lack of English, and you can understand why I was uneasy at first.

When you spend months at a time in a small Tuscan village with guests of all ages, it is inevitable that you are going to need to see a doctor now and then. I am now a master at accompanying people to the clinic in our village. Located behind the World War I memorial to the young men of the town who lost their lives in it, the clinic is open every day from 5 to 7 p.m.

The doctor we see works mornings at the new state-of-the-art hospital in nearby Montevarchi. In my experience, with one exception, he shows up at the clinic promptly at 5 pm. The waiting room will already be filled.

The procedure works like this: you enter the clinic and take a seat. New arrivals make a note of those in the room, asking who was the last to be seated so they will know their place in the line. There is no receptionist, no sign-in sheet, nothing. You wait your turn. It works remarkably well.

Italy's health care system provides low- or no-cost health care to all citizens of the European Union. That includes tests, surgery, hospitalization, out-patient care, visits to family doctors and specialists (with a referral from the family doctor), dental care, and a part, if not all, of prescription medicine. Emergency care is available to anyone, EU citizen or not. It is possible to buy additional private insurance in order to avoid waiting periods for surgery, or for more creature comforts.

Italian doctors are dedicated and well-trained, and the best private hospitals in the country would rank among the best anywhere in the world.

Let's go back to our little clinic. There was a summer when two visiting children developed mal d'orrechi (earaches). The local dottore was gentle with them, and reassuring (though one of them asked loudly, "Why are his eyes so weird?"). Each had a slight febbra (fever), and they needed antibiotics. He wrote out the prescriptions, which we filled at the local farmicia (pharmacy), and told us to come back in a few days for a check-up. The charge? Nothing for the EU citizens. He asked the Americans for trenta o quaranta euro (thirty or forty euros), their choice. There was no charge for the check-up.

Among our family and guests, the dottore has tended to a skin sfogo (rash), hardened earwax, urinary tract and sinus infections, strange insect bites and migraine headaches. My medical vocabulary has grown to the point where I can discuss these ailments with ease. I am also prepared for any guests who may develop calcolo di renale (kidney stones).

We have had a few occasions when we needed the Pronto Soccorso (emergency room) at the immaculate new hospital in Montevarchi.

On the night before my sister's family was to return to the States, we went out for dinner in the magnificent square of Figline Valdarno. Bob, my brother-in-law, was playing with his little son under the stone arches when he slipped and fell. Hard. He hit his cheekbone and wrist, and it was obvious that the wrist was broken.

As we drove to the Pronto Soccorso, I was searching for the Italian word "to break." Rompere. But I knew it was an irregular verb. Finally my brain released the stored information, lo ha rotto (he broke it).

Upon arrival at the hospital, it was apparent that Bob was in pain and he was seen right away. His name was taken but no one asked for an insurance card. A technician took x-rays and called for the orthopedic doctor, who was at home, but arrived promptly wearing shorts and a tee shirt. Thankfully he spoke English ("I studied English medical books," he told us). He confirmed that the polso (wrist) was broken, reset it and applied an old-fashioned plaster cast that went above the elbow. Bob was told to keep his arm at a right angle and to wiggle his fingers to keep the blood moving. "If the fingers turn blue, you must come back," the doctor said.

Before we left, Bob asked for the bill. Everyone looked confused. Il conto (the bill)? No one knew how much the treatment cost. Could he come back tomorrow? No, he was leaving the country. They were befuddled. He insisted that he had to pay something. After all, he had x-rays, reset bones, a plaster cast, and something for pain. They all shrugged. This was not a problem they had encountered before.

After much confusion, the orthopedic doctor smiled, waved his hands at us and said, "Don't worry. Just consider it a gift from the people of Italy."

You have to love this country.

A follow-up: Bob spent many uncomfortable hours with his arm at a right angle, wiggling his fingers, flying back to Texas. Upon arrival, he went to an orthopedic doctor for a second opinion. The cumbersome cast was replaced with something smaller and lighter, but first the wrist was x-rayed. The consensus was that the reset bones were "spot on, perfect, could not have been done better."

Question: If Italy, a country with a reputation for a certain amount of drama and chaos, can manage to organize and maintain a solid health care system for all of its citizens, along with other European Union countries, why is it so difficult for the United States to do it?

I got an answer of sorts in our local caffe bar. I met an American man renting a house in the area with his young family. We began to chat over our cappuccinos and I mentioned how discouraged I was about the health care battle in Congress. I guess I assumed that anyone who was attracted to the Tuscan hills for a vacation must share my political views.

He smirked and said in a know-it-all way, "We need to fix our economy first. I don't want to have to pay more of my money in taxes to provide health care for the homeless."

Got it.