Wednesday, March 17, 2010

maybe they are actually right

The so-called "health care debate" has left me winded. It is one of those cardinal topics that makes me realize how long I was away from the United States, and how much things changed, or didn't change at all, while I was away. Most of all, it has left me defeated, even despairing. It has left me feeling like an alien.

The issue of access to adequate health care is the single biggest problem we have faced returning to America. From a practical standpoint, this means that my husband and I basically do not have the option to take care of ourselves the way that we should, this because we are self-employed. His so-called "pre-existing condition", which consists of a genetic predisposition to high cholesterol for which he takes medication, made it impossible to get him an insurance policy on the individual market, regardless of his actual health, which is very, very good. Far better than the average American, especially in regards to his waistline. So being in Colorado, he was given the privilege of joining a "high risk" pool. I've heard this term knocked around during the debate, and I hope everyone understands what this really means... his premium is extremely high, and his deductible is $7500 annually. Believe me, the incongruity of my husband's situation with the people sitting behind desks in corporate offices chugging Big Gulps and Big Macs without a worry in the world is unnerving.

As for me, I have a measly $5000 deductible per event, and in the 3 years I have been buying insurance here, my premiums have doubled. My policy does not pay for doctor visits. For anyone who thinks I'm getting a raw deal, I should note that I shop insurance regularly, several times a month. The similarity of the premiums and deductibles in the plans offered to me is stunning. They may as well be the same company. And they cover barely anything, can kick me off at their whim, and are guaranteed to continue to raise premiums. Many people have bemoaned that in Italy the taxes are much higher than in America, but I can assure you that our premiums and annual deductibles make our real taxes here much higher. And In Italy I did not loose sleep wondering whether or not I could afford a necessary surgery.

From a practical standpoint, this is huge. I have several nagging health issues which I cannot afford to adequately treat. If the choice is between paying my deductible and then co-insurance or the mortgage, the mortgage wins. If the choice is between self-diagnosing on the Internet, or actually visiting the doctor, who of course then needs blood work, tests, specialist visits to treat my issues, I am forced to choose the Internet.That's just math.

Over the past several months, I have written a few articles and editorials about the subject. Each time I write about this topic, I try to write about my own family, and what the health care system in the United States means for us. I believe I have a unique perspective after living for 16 years in a country that guarantees health care to all of its people. Italy has the epitome of the demonized "government run health care system", and how I sorely miss it. Not only do I miss the ability to just go to the doctor when I am sick, but also the absence of the intense psychic drain that this issue has created in my life here in America.

My letters to the editor and articles have been met with such vehemence, ignorance and despair that I have stopped writing. There are never answers to my predicament in these responses (because there are none, obviously), only replies asking me why I don't "just leave!", and "if you don't like it here, why did you come back?". I can't even begin to respond to these comments, and there is the despair. I am also answered with stories from people who say they work at jobs they hate everyday to have access to health care, why don't I just go get a real job? Assuming that today it is so easy today to just "go get a real job with health benefits", why on earth should I have to do that? I run a thriving, successful business. I pay my taxes. I work long hours and provide excellent service. I am the small business at the heart of American entrepreneurialism that everyone is talking about! The small business person that everyone says they are fighting for. As for the numerous people who have written to me saying they have jobs they hate, I dare ask why is that acceptable in America? What the hell kind of system makes people believe they should give up their potential, not to mention their happiness (the same happiness pursed in the Constitution) in order to have access to health care? What is everybody thinking? What are we settling for?

I do not write these letters any longer. Many of the private responses I received were bordering on threatening, making me realize that this issue has gone far beyond health care, to a place that I do not even begin to comprehend. Several of the letters I received exclaimed that I wasn't "supporting our troops" when I criticized how things work in America, and when I explained why a system in another country was so much better for me and my family. That the entire rest of the industrialized world provides health care to its people is a moot point, probably. And why these people who are so afraid of "government run health care and socialized medicine" do not burn their medicare cards and put their money (and health) where their mouths are is also beyond me. And maybe those people who asked me why I don't just leave, get the hell out of Dodge, are actually right.


Peterson Family said...

What a powerful post.

I think that we need to get off our political platforms and look at it as we are human beings and we should take care of each other. And no one should ever go without medical attention if they need it.

shibori girl said...

The ignorance aired daily on the news networks is shocking - soundbites from "Middle America" proclaiming "keep your government hands off my medihcare" and the like. It makes me so tired.

I wish we could revamp DC and the way it (doesn't) work for us, scrub out the PACs and actually get some important and healthy work done. For all of us.

I hope you and your family can find a solution to your nightmarish problem soon. And thank you for writing your experiences,


Jennifer Rafferty said...

Beautifully written. Thank you for this post. Having lived in Europe with family in Italy, I know where you are coming from. It just seems absurd that we should have to struggle this much for what should be a human right to all.

G in Berlin said...

I ran a small business for 10 years in America, employing up to 30 people. After the 5th year, I could finally afford to join the Chamber of Commerce and have health insurance myself. Of my employees, only 6 could afford to pay their share: the rest did not join. This is not an expat view: this is reality. I didn't need to leave the US to feel exactly as you do, and as I think every decent person should. The viciousness of the "debate" is frightening, and shows the absolute stupidity of the masses. Really, I grew up believing we were all decent, but the last election and this debate make it clear that views and beliefs that I thought were gone are still there. Sorry you need to deal with this- if you haven't looked at the buying pools of the CoC, check it out.

meredith said...

Health care (or lack of access to it) is probably one of the reasons I wouldn't go back to the USA to live should my personal life go down the drain here in France.

caroline said...

I know that feeling of hopelessness all to well. I'm a liberal in a family of conservatives. Trying to explain to them what big bad government-run heath care would do for their own daughter, sister, grandson, they don't understand, even though it's so close to them.

Sylvia said...

I lived in Italy for 13 years, my daughter was born there, and I once had surgery there. I got FIVE DAYS in the hospital after giving birth, plus all the scheduled pre-natal and post-natal visits - and there was no such thing as a co-pay. It was just 100% covered. For my own surgery, I picked my surgeon and my hospital - again 100% covered. The peace of mind that comes from knowing that you have decent medical care when you need it is really impossible to describe, and in the 10 years since we've returned to the US, I can only wonder at the sheer mulish ignorance of those who think we somehow have the best health care system in the world. No, we don't. Not even close.

Diana Strinati Baur said...

Absolutely powerful.

I lived in Germany for nine years, and have lived in Italy for the last six. The SINGLE thing that keeps me from even remotely contemplating moving back to the States is health care. It's a crime, a sin, a national shame, a black mark on America's soul.

I had six days in the hospital for endoscopic gall bladder removal in Germany. SIX DAYS IN!!! It's done often as ambulatory surgery in America. I will tell you, get huge bubbles of air stuck under your shoulder the day after that surgery and you just hope you have an IV in with something powerful attached to it. Ambulatory. I cannot even remotely imagine.

It is such a crime, what has happened in my country and it shames me and worries me.

I am very, very sorry that you have had this to contend with. I certainly appreciate going to my local ASL and getting my blood tests, and to my regular physician to get annual checkups. I also live in a thermal spa town so if my sinus problems act up, I get six free rounds at the "terme" including hot baths and inhalation treatments. Geez. Heavens. It's unbelievable, isn't it.

anna l'americana said...

So well said...every word. Please do not be discouraged by the whackos out there that just don't get it. I would hope that you might find your way to developing a thicker skin that could enable you to keep writing and ignore the negative feedback from those that are just too stupid to see how badly effected they are by the current situation, most of them just parroting what idiots like Limbaugh and Beck spew without actually understanding how they are shooting themselves in the foot...

There are others like myself, and everyone who has commented here that agree with you wholeheartedly and would support your efforts to keep preaching to the unconverted. Sharing the words help diversify the argument so that maybe even one more person can be converted to reason.....

That alone would make my day, and maybe yours too?

naltieri said...

Thank you for your article.
We have insurance through my wife's union which is the United Food and Commercial Workers ( grocery stores) and often we are told it is "Cadillac" insurance. Well maybe at one time it was and compared to what I am reading it still may be. But the out of pocket expenses can be $2500 a year, which isn't as bad as others. But when one of us is out of work and we are struggling to make the house payment and keep the heat and water on, well hell we can not pay the deductible and co-pays. Sorry to both hospitals I had surgery in last year, you awill not get paid. But my credit will suffer terribly.

Jeni said...

Please, DO NOT stop writing about this issue! Please, please, please stay on target and write, write, write, as much, as often as you can about this problem and the terrible NEED that DOES exist here for decent, affordable health care. I can relate fully to those who say they work at jobs they hate purely to have benefits. I worked for many years at positions I disliked immensely and did it for NO BENEFITS -simply so I could have a job and try my best to support myself and my family. The errors in the way so many people regard health care are so ludicrous and it is more than obvious those people have never had to buck against the health care system and the assistance too that is available to those who earn below minimum wage for medicaid. That avenue, contrary to the belief held by some -in the media -that I have read lately thinks that the people who can't get anything in the way of affordable insurance are merely those in the "middle class" who earn between $40 and $85,000 a year. Those earning less than that, it has been said can get help through state medical programs and that is one of the purest, most outrageous lies I've read. Quite frankly, since I have been low enough -with zilch income and had cancer at that time -I did qualify then for the state medical program but was only able to survive because my daughter and her family moved into my home with me! Today, I'm on social security, qualify for medicare and I have a supplemental plan too -that doesn't look at any pre-existing conditions and the like -which too many younger people have to contend with and it's at a rate that isn't cheap, but I can cover it however, for a working person, earning on the bottom tier -the very bottom tier -it would be a struggle for them to afford even coverage like I have. People need to learn what life is really like and how the lower income folks have to make ends meet before being so bloody judgmental about what they view as another form of "social welfare" -for openers. Oh, and by the way, I'm also a college graduate, with a B.S. that I've never had the opportunity to use because I was age 50 when I got it and couldn't get a job in my field but I saw lots and lots of fresh-out-of-college kids getting hired whose degree wasn't even in the same field as mine for jobs in my field of study. So those who tell people like you, like me, that there is no problem, that we should leave if we don't like it here, or ask us, "Why don't you go get a job -or a 'real' job, the thing I do take comfort in is knowing the odds are that some day, what goes around, comes around and they may just find themselves walking in our shoes and then, with no prior expertise in how to live on a pittance, won't be able to survive nor will they be able to get the care/coverage they very well may be in dire need of having then!
It's about the only thing I can think of that might someday bring this message home to those naysayers who think the rest of us are just looking for handouts, ya know! (Sorry for writing a book but this issue just rankles the living daylights out of me when I see the level of ignorance that exists in so many!)

jennifer said...

I am grateful for all of your comments. I am traveling today, and reading your comments as I drive and fly has been heartening.
Many of you writing here have not followed my blog, so you may not appreciate the great irony of my yearning for anything Italian. I missed home so much after so many years away, but now I can only say that I am grateful that my children and I enjoy dual citizenship, so should I ever fall truly ill I can return to Italy. I am actually planning a minor surgery there this June.
I truly believe America to be a brash, immature and basically ignorant country. After all, we haven't been around all that long... Americans who fought for civil rights, ending the war in Vietnam and women's rights were also asked why they didn't "just leave"... makes you think what would have happened if they actually had left!
And the irony continues, as I now see my husband and myself returning to Italy as our permanent residence when my children finish school- there's no way we can wait around for medicare.
I think I will keep writing...

Keith said...

Excellent post, very well stated.

nyc/caribbean ragazza said...

Please keep writing.

I moved to Italy two years ago. While I know Italy has a lot of problems, I am relieved as a self-employed writer I do not have to worrying about going into debt because I get sick

I have dual (French and American) citizenship but have not paid into the French NHS. I grew up in American. Therefore I have to pay for private insurance until I've been a residence here for 5 years (I think). Anyway my cost for insurance in a year is what I paid per month back in America. Crazy.

I agree with you that the health care debate back home has turned into something else. I'm not sure where this ignorance is coming from. We are the ONLY industrialized nation that doesn't have some kind of national health care. Clearly our current system is not working. I was lucky my parents both had excellent insurance through their jobs. I went my dentist and pediatrician every year.

As an adult when I couldn't afford insurance I waited and waited to take care of a cavity which ended up turning into a root canal. I put it on a credit card. Root canals/crowns are not cheap.

I am sorry to hear what you and your family is going through. It's not right.

All these people screaming about socialism, communism and what not need to educated themselves. While America maybe be the richest country on the planet, look at the quality of life indicators. Wake up people.

Kataroma said...

This is so sad. As you say - the small business entrepeneur is supposedly the backbone of American capitalism - yet it's so hard to run a small business when you need to pay for health insurance.

I live in Italy and grew up in Australia and the US. I had emergency open heart surgery last year here in Rome and 4 months off work - all covered and paid at my full salary for sick leave (I'm one of the lucky ones with a permanent contract).

I assume it would be impossible for me to get health insurance in the US with a goretex ring now inside my heart, even if I were to get the holy grail - a 'good' job with health insurance -so I don't even consider moving back to the US with my family at this point. We'll probably move to Australia or the Netherlands (my husband's native country) eventually - both places have much better health systems than the US.

Judith in Umbria said...

Health care is my main reason for saying no when my kid asks me to come back. Whenever this issue becomes the subject on groups I frequent, I very quiety tell my personal experience with Italian socialized medicine. The truth is there is practically no one in the US who wants to know the truth. They are all lined up on the edges of a huge pit called "fear of communism". Not even the toppling of almost every communist state has defused this and I don't know why.
Italian health care in my experience is good. People who bitch about it seem egotistical types who think they should have been given the cutting edge response before it was even decided that a simpler treatment wouldn't work. Because they asked for it. Sort of like the screamers in the US assembling a wheelbarrow in a factory seem to think everybody should just get a job like theirs and earn their health insurance. They don't even notice how many of their cohorts have been dumped for having a sick kid. It hasn't yet happened to them personally.
Sharing a society with people like that is the second biggest reason why I can't go back.

Betsy said...

Since when is your job not considered a "real job"?!

Great post, as usual. And as one of your long-time readers (fans) the irony is not lost on me. And yet, it's just part of the yin and yang of life-- that every coin has a light and a dark side...

Catherine Bolton said...

Hi Jennifer!
As you know, I agree with every single word. As a cancer patient twice over, I'm lucky I got sick in Italy and operated in Italy and treated in Italy. As a freelancer, I would not have been able to afford it in the U.S. So Italy's healthcare system has saved my life.
Just so you know, since I reposted your blog yesterday on FaceBook it has gone viral (apt term, eh?).

kre8peas said...

The lady is right on. Keep on writing! The word socialism carries such a negative load that people can't get past it, to see the benefits that already exist because of it's incorporation in many areas of our "commons"...our fire departments, libraries, public schools (though there is a lot of repair needed in that system!) our national parks, police departments, our military (unless it goes private too & it all becomes Blackwater....we see how well that works, right?!) Imagine calling to report your house on fire & you're asked for your insurance card or credit card....?! Or a burglar is attempting to break into your house & you call the police...."insurance, please....?" It is nothing short of insanity that we don't treat the need for medical care, acute or chronic (which perhaps could have been acute, if treated in time) in the same fashion. The element of our "tribe" who are so afraid of giving up something of theirs to someone who "doesn't deserve it," indicates a very different world-view, which is based on fear. Fear often involves irrationality which then feeds upon itself. It's a type of paranoia..."I have to stop them before they get me." There are many aspects of government that I don't like....not because it is government (supposed to be "us!") but because it is corporate controlled. The bottom line is profit & protecting those who are invested in that profit. "It ain't me babe!" A tribe (humanity) that does not act in ways that take care of all it's members will suffer, as a whole.The elite rich may be able to escape some of the blow-back for a while, but not for always. Who wants to live a life in hiding?! We need to make the world safe for all & that starts with the basics. Clean air, water, food, shelter & the ability to go to the "medicine person" when ill. When people have those basics, they can be educated & an educated populace is a blessing to all. When we discover the power & force of love (justice) in this world, we'll be able to put out the raging fire of fear.
We each have to do our part to "pull out as many weeds as we can, while tending the plants we wish to grow!" It all starts within! In the place of despair that most of us find ourselves, at least some of the time, if not all, regarding this issue, it is important to know that self-improvement is a powerful action & does influence the outcome. For those who can do more, great! It takes only enough hope, the size of a mustard seed, after all (I sort of borrowed that!)

Believe that those who care outnumber those who don't!


Julie @ jublie's blog said...

Great information. I passed it on to some friends. I'm an American living in Italy. I have been here for 15 years and no plans to go 'home' anytime soon.

Just wanted to add that even though a lot of people say they go to the doctor's here for 'free', we are paying taxes as high as 40 percent.

Plus, I'm curious to know how much a kid's education costs in America, since cost of keeping my two boys (5 and 8 years old) in public schools for their school lunches is $5 euro a day ($6.76 each). It adds up QUICKLY.

What I mean to say is gira ri gira, and it's all going to cost someone somewhere something.

The squeaky wheel gets the grease.

jennifer said...

Hi Julie- thanks so much for visiting. I have 2 children in public school here. Their total daily lunches come out to about $10. I think it is also important to consider the costs of "higher" education. My high school sophmore is already seriously considering attending an Italian university for his undergraduate degree to avoid graduating with a cloud of debt hanging over his head.
As for the tax rate in Italy, yes it is much higher than in the US, but I can assure you that our combined premiums make the money we pay out monthly a huge chunk of our income. And in return, we are not insured at all, really. If either my husband or I became gravely ill, our annual out of pocket expenses with premiums, co-insurance and deductibles would put us into certain bankrupcy. And the psychological cost is extreme.
In an ironic sense, we are still lucky... we are all also Italian citizens, and if we are physically able we could hop on a plane to seek refuge in "socialized medicine"... so why was it that I am paying those premiums? To fatten the backside of the CEO of my insurance company? I truly can't even figure that one out myself...

Thank you, thank you for writing.

Live From Tuscany said...

I also had never seen your blog before Michelle from Bleeding Espresso posted your article. The blog is great, and I totally understand the give and take of plusses and minuses in Italia and the U.S. - intimately!

I shared this post and totally agree with what you say. But (also in response to Judith's comment) some of us Americans living in Italy have had some crazy experiences in the health care system here - no soap in the bathrooms, waiting months and months on a list to have a cyst removed (that was to be taken out to see if it was benign or malignant - this happened to me), just this Christmas two newborns died in Foggia, Puglia of simple infections because the nursery was clearly not clean. I have seen and heard some scary things. It's not utopia.

There has to be something in the middle of the systems that is the ideal. The best solution may be a balanced compromise.

One thing that blows my mind, however, is the price of prescriptions. How is it possible that you pay 12 Euros for a medicine here, just buying it straight from the pharmacy privately, not through the public health care system, but you would pay 30 to 50 dollars for it in the U.S., WITH insurance?! I did a bit of research on it, and found out that each country (or the E.U. I belive in this case) does a separate agreement with each of the big pharma companies. So basically per the agreement that the government has done, i.e. the FDA, Pfizer and friends sell prescriptions to the U.S. for more money.

It is a similar situation to the banking crisis. People that scream about the "socialist" policies of Obama need to know that we are in this mess because of capitalism out of control, with no limits to how much you can gouge the consumer. Everyone needs medicine - many pharma companies are the only ones that make certain medicines, and the FDA is allowing them to charge astronomical prices, since the market "supports" it. Every freshman econ major knows that without any competition, the consumer overpays. Someone got a long and high payday off of this system for quite a while now, and it has to stop.

Julie @ jublie's blog said...

Dear Jennifer,

My husband and I talked about health care at dinner. I couldn't come up with a good translation for the word deductible. Have you got one?

If you have to pay $5,000 deductible for cost of any serious operation then it would be worth it to jump on a plane. How crazy is that?

I believe the best quality health care is US, although, the truth usually lies somewhere in the middle. I find the hospitals clean here, however OLD and generally unstructured, much like Italy.

As far as your children doing University here. Yes, long run cost is MUCH cheaper in Italy, yet compares with a US state education. I'm a junior high school teacher here in Italy. One thing I find that is seriously missing here is job preparation.

Kids go to university here but usually live with their parents who foot the bill, and have an EXTREMELY hard time finding work while going to university at the same time, like I did in the States.

If your son decides to go to Uni in Italy, I think he will love it. My question is how can he pay for his expenses if there is such little job opportunity? I suppose he can always teach English!

Good luck to all of you. Don't be shy about your artwork.


Catherine Bolton said...

Hi Julie,
For "deductible" I'd say "franchigia". That's the term I've always used in explaining how this works and people get it then.

jennifer said...

Hi Julie-
I look forward to reading your blog when I am back at my office and a big monitor screen on Monday... my Blackberry screen makes things tiny.
One of the best ways I have found to translate deductible in Italian layman's terms is a really big "ticket". Catherine had the offical translation spot on.
Everything you stated about the difficulty finding work through university studies in Italy is true. My older son here has a part time job on the weekends already... I also well know the cling-on mentality between kids and their parents in Italy! And while I know that many university students stay at home while studying, the reasons behind that decision are many and very complex... :-) Many are also still with their mammas at 35! As I'm sure you know.
To give you an idea, total in-state tuition and expenses at the University of Colorado in Boulder is running about $13,000.
I think my son will most likely do his undergraduate studies in Italy, and likely study in the US after that... but don't we all know how the best laid plans of mice and men wind up...

Anonymous said...

Read this and maybe you'll understand why most of us don't want government run health care.

Bill and Kelli Nixon said...


I found your site by way of the Expats in Italy forum. My family and I have considered an opposite move from what you made three years ago. That is, from Colorado to N. Italy. I love what you write and you sum up the problem our country has. Very few here can have a decent debate about "health care" without calling one another names, or saying things like they said to you, "Just go back" "get a real job" "you are a racist" etc.

I appreciate your perspective more than you know and would love to have a more personal conversation with you and your husband.

We have lived in Europe before, speak Romanian with some skill and have our own "work from home" businesses. We would love, even for the adventure, to experience Italy. The close culture to Romania is appealing, but there are so many differences from here that we truly appreciate.

Please feel free to contact me. I know, like me, you are probably extremely busy sometimes, but I really would love to sit and speak.

I am leaving my url here, not to spam but as a means to easily contact us.