Americans’ Phobia of Socialized Medicine

I am baffled by the people I encounter in this country who think that “socialized medicine” is evil. I’m not sure how they arrive at this conclusion. It seems that, for some, anything they can label “socialist” is automatically frightening. But we have state-run fire and police departments and military (among many other things), and the vast majority of Americans would agree that these areas of common human endeavor are best run by government.

Why, therefore, do so many instantly discard the idea that governments can effectively provide health care? Other countries’ governments are managing national health systems quite well. Do we have so little faith in the abilities of our own government?

I’ve seen socialized medicine working for my own family. I lived in Italy for 17 years (my Italian husband is still there), and have written about my (mostly positive) experiences with Italy’s national health system.

My father lives in England with his British wife, and the UK’s National Health Service (NHS) has done very well by them. Just a few weeks ago, Dad had a $60,000 operation – paid for by the British government, and he’s not even a citizen! – to implant an electronic device which interrupts pain signals from his body to his brain: a last-ditch remedy for ten years of extreme, chronic pain due to arthritis. And it’s working.

In Italy, my mother-in-law had a mastectomy within days of a tumor being discovered, and her chemotherapy and related medications were free. When our daughter broke her arm, a compound fracture requiring surgery, the surgery, hospital stay, and follow-up care were free. When I had my own cancer scares, all the tests were done within days, and I paid less than 100 euros for the biopsy. I’ve been under treatment for glaucoma for years; with my doctor’s prescription in Italy, the medicine costs 2 euros a month.

Because health care is universal in these countries, medical privacy need not be a huge concern: you’re going to get treated, no matter what you’ve got. Whereas, in the US, you must jealously guard information about any chronic or genetic condition you may have, for fear that it will damage your chances for employment and insurance.

The Problem of Choice

Some Americans fear that a government-run health system would limit their choices, which is likely true. But is that such a bad thing? Too much choice can be as bad as too little, especially when it requires so much time and knowledge to understand what’s on offer and make an informed decision.

One of the most difficult transitions for me in moving back to the US has been precisely this. I’m an intelligent and highly-educated person, but simply comprehending my health insurance options (and, thank Sun, I have options!) has been largely beyond me so far. I have insurance, but that’s about all I know, pending further study that I haven’t had time for. I can imagine how overwhelming this must seem to someone much younger (or older) and/or less experienced than I.

In Italy, things are a lot simpler. You choose a family doctor from a limited list of local practitioners, most likely someone whose office is convenient to your home. When you’re sick, you visit that doctor during his/her office hours (some by appointment, some you just sit around and wait). If you need a specialist or tests, the family doctor writes an authorization and you schedule an appointment, which will be available later or sooner depending on how busy your local providers are and how urgent your medical situation is. I once scheduled a routine mammogram 8 or 10 months in advance, but when I needed one in a hurry for a suspicious lump, it was performed within 24 hours. (NB: Bi-annual mammograms are free for all women over 45. Socialized health systems are big on preventive medicine, because it makes economic sense.)

And if you want choice in Italy, you can pay out of your own pocket to go to whatever practitioner you like.

Of course, no system is perfect. Malpractice can happen anywhere. My father-in-law was probably killed in Italy by an anesthesiologist too old to be administering an epidural. My aunt’s botched hiatal hernia operation (in Austin, Texas) led to ten years of agony and, eventually, her death. Malpractice suits are rare in Texas, so she never got the money needed to help fix what the doctor screwed up. Penny-pinching by the Medicare system (America’s version of national health, available only to the elderly and used only by those who have no choice) likely exacerbated her problems and also contributed to her death. Being poor and uninsured limits your choices far more than a national health system does.

Given all this, I don’t understand why so many Americans have such a knee-jerk negative reaction to nationalizing health care. Can anyone explain this to me?

The Land of Illness

Another “country beginning with i” which is unfortunately very familiar to me is Illness. I have spent a lot of my life being ill.

Perhaps the earliest memory I have (of any kind) is of green bathroom tiles, and myself screaming. I had a high fever, so my parents thrust me into an ice-cold shower. An icewater bath was what you were supposed to do when small children had very high fevers, to get the body temperature down and avoid convulsions and brain damage (I don’t know if this is still medical wisdom today – Ross never had a fever that high).

Health Care

By the time we arrived in Austin, Rosie had been moved from the Austin Heart Hospital to the “rehabilitation” wing of St. David’s hospital, where she had previously passed two four-month periods. I hadn’t been to that particular wing before; when I visited in November, 2003, she was in St. David’s intensive care. Both times I was impressed by the kindness of the staff. Rossella observed that, while the people who cared for her in the Lecco hospital were competent, they weren’t particularly nice, and always seemed to be in a hurry. The St. David’s staff were busy, but they took time to be nice about it, even a little too nice at times: “Hi, I’m Keith, I’ll be taking you down to radiology this evening” – he sounded like a waiter.

The St. David’s staff were always careful to explain what they were doing and why, sometimes too simplistically. The doctor used a medical baby talk that didn’t tell us much: “The tests on your liver showed results in three areas that we’re not happy about, so we want to investigate some more.” If she’d been a little more specific, we probably could have handled the information. I suppose in rehab they’re accustomed to dealing with confused old people who are easily overwhelmed by medical details; Rosie is sharp as a tack, no problem there.

I was surprised at the number of different kinds of staff it takes to run that wing. Not just doctors, nurses, and orderlies, but also nurse practitioners and a case manager, occupational therapists and physical therapists. Having been through it all so many times, Rosie has no patience with the therapists. She knows by heart their “use it or lose it” speeches: “If you lie in bed and don’t use your muscles, soon you won’t be able to use them, so we’ve got to get you up and moving.” Up and moving is what you don’t want to be when you’re nauseated for reasons the doctors can’t even explain, but when Rosie refused to get up, the therapists would threaten her with: “We’ll have to discuss this with your doctor.” These strong-bodied and strong-minded young women had to learn the hard way that they are dealing with a woman who, while frail in body decades beyond her 76 years, is far stronger in character than anyone they’ve yet had to deal with. Faced with Rosie’s stubbornness and her son Guy’s constant, protective presence, the therapists eventually withdrew from battle. They remembered her from last time, and doubtless will remember her this time as well.

Most of the staff love Rosie, though, and who wouldn’t? In spite of years of severe illness, repeated surgeries and hospitalizations, she manages to maintain a sense of humor and a joy in people that are rare anywhere in life, let alone in a hospital ward. As one of the nurses put it: “We’re sorry you had to come back, but we’re glad to see you.”

You Want Me to Put that Where?!?

Cultural Differences in Medication Methods, US and Italy

There are cultural differences between Italy and the US even in seemingly small things, such as how medicines are administered. I got through a childhood of many, many medicines without ever using a suppository – except once. That once is still imprinted on my mind as one of the more humiliating, not to mention uncomfortable, experiences of my life. So I was unpleasantly surprised to find that suppositories were routinely prescribed for Rossella‘s childhood fevers. I guess the logic is that it’s easier to ensure that a small child gets the correct dosage that way, but it wasn’t fun for anybody.There are even adult-sized suppositories, though I’ve never heard of anyone actually using them. But then I don’t suppose that’s something you’d discuss in casual conversation…

The favored medicine format for adults is the bustina (little envelope), of a powder which is mixed with water, forming a fizzy and more or less palatable decoction. Beyond that, it’s plain old pills – none of these wimpy American capsules or gel caps, just swallow it down and quit complaining.

Then there’s my once new, now old, friend – the aerosol. This is a machine with a noisy little motor that compresses air. You attach a rubber tube to it, then a glass “nebulizer” into which you put liquid medicine. The final glass piece, connected by a rubber joining ring, can be a nasal “fork” (in two sizes), a mouthpiece, or a soft plastic mask that covers nose and mouth. The compressed air is forced through the nebulizer, where it mixes with the medicine to create an aerosol which you then breathe in – excellent for getting the medicine to where it’s actually needed for respiratory problems. A beneficial side effect, for people like me who often won’t sit still long enough to rest even when we need it, is that you are tethered to the machine for the half-hour that it takes to inhale all the medicine. But that’s a drawback when you have to treat a small child.

Because I am often clumsy and drop things, I was initially nervous of handling all that delicate-looking glass, but it turns out to be not as delicate as it looks, and in any case you can buy replacement parts at the pharmacy.

Another area of cultural difference in medicine is how you obtain it. It pays to make friends with your local pharmacist, because, once she learns to know and trust you, she will often let you have things that technically are supposed to be available only by prescription – very handy when you know exactly what you’ve got and how to treat it, but can’t get hold of your doctor to write the prescription.

You do eventually want to get the prescription so that you can get some money back. Most pharmacies will sell you something on an emergency basis, then refund your money when you come back with the official prescription form which allows them to charge it (in whole or in part) to the national health service.

Apr 27, 2004

Mike Looijmans says re. suppositories: “The Dutch words for those are many, and translate into things like “ass grenade”, “plug-in” and “stick-up”. I cannot even recall the official word for them…”

He and others rightly pointed out that they’re often used for children (and sometimes adults) when they might be expected to throw up any medicine taken orally.

Hospital Stay

I have suddenly landed a temporary but demanding job: nursing my daughter. Ross fell off her horse Sunday afternoon, onto hard ground, and broke her humerus just below the shoulder joint.

The emergency room was humming – it was a beautiful day, everyone was out getting hurt. Just before we got there, an ambulance had brought in a young man in motorcycle leathers, who looked pretty severely injured. According to a conversation I heard among the nurses, Lecco gets a lot of motorcyclists – and accidents – on sunny weekends. Another young man had been out hiking in the mountains, slipped on a patch of ice, and banged his head and chin.

They quickly got Ross through an initial examination and x-ray, drew blood, then took us up to a room on the orthopedic ward. Ross was trembling when the anesthesiologist came to talk to her; given recent family horror stories with hospitals, we were all terrified that she had to go under anesthesia. But those stories took place in the US and the UK. So far, I have no complaints about Italian health care. [later on, we had an Italian horror story to add to the family history]

The anesthesiologist gave her a sedative, and off we went to surgery. Ross told me later that, by the time they actually got her into the operating room, she was giggling and wondering why she had been so scared. She lay there looking at all the bustle around her, wondering if they had a machine that goes “ping!”

We had arrived at the emergency room at 5:15; by 7:15 she was under. The surgeon had to pull the bone back into place, and then put in three wires to hold it while it heals; Ross is also wearing a sling-and-strap to hold her arm against her body. Her right arm. No drawing in art school for a while.

Giulio (owner of the private stable where we now keep Hamish) and Viola (his daughter, Ross’ classmate and riding buddy) came racing down from their ski weekend to be there, and passed the time during surgery regaling me with stories about their numerous family sports injuries (they ride and ski, Giulio and Viola compete seriously at both). As Giulio pointed out, it’s lucky this happened right before Christmas vacation, so Ross won’t miss too much school.

Giulio also demonstrated the usefulness of the small-town grapevine: when he heard the name of the surgeon, he called his sister-in-law, who happens to work at the hospital as an orthopedic surgical nurse. She said that we were lucky: this surgeon’s a good one. And she came by the next morning to see us in person. If we need any inside information on this case, we’ll know where to get it.

There was a spare bed in Ross’ room, so I was allowed to stay with her. The first night she was in a lot of pain, understandably, but since then has bounced back with most of her usual energy and sense of humor. They let her out yesterday (Tuesday), and today she’s gone back to school (the doctor said there was no reason she shouldn’t, as long as her arm doesn’t get bumped). She’ll need to have the bandage changed every 3 or 4 days, to ensure that no infection enters where the wires are; those will come out after 25 days, and she has to keep wearing the sling til then. So I’ll be accompanying her to doctors a lot, as well as helping her dress, wash her hair, etc. As I said, it’s a job. But that’s what moms are for.

Jan 19, 2004

Rossella‘s arm has healed well. The wounds (from the surgery) were so clean that her bandage needed changing only three or four times over the month. Last Tuesday we went in for a final x-ray and, seeing that everything looked fine, the doctor pulled out the wires, using a pair of common (even somewhat rusty) household pliers. According to Ross, it felt weird, and the idea was gross, but it didn’t actually hurt.

So now she’s down to band-aids over the holes, and only needs to wear the sling at night. We’re trying to schedule physical therapy; in the meantime, she can use her right arm again, as long as she avoids swinging it out from the shoulder – no dancing the Funky Chicken..

The hospital staff were amused: Ross is the only patient in their experience who wanted a picture (while the wires were still sticking out – her arm looked like a construction site), and to keep the wires as a souvenir. But, as they noted, this attitude coincided with the Clockwork Orange t-shirt she was wearing.

Of course she wanted to keep the wires; she couldn’t wait to tell her schoolmates: “Piercing? Hah! I’ll show you REAL piercing.”


Apr 27, 2004

Ross has healed up fine from breaking her arm in December, and is back in the saddle of her beloved Hamish. She’s had some moments of fear, but is gradually feeling comfortable riding again (it was totally up to her to do so; her father and I might have been just as happy for her to give it up now).