Thrive, You Weak-Ass Beetches
So, not to complain or anything, but I've been pretty sick the last eight days or so. At first, I thought it was just a summer cold, then the flu, but it wasn't getting better . . . in fact, getting worse. I missed three days of work (more than I've missed for illness in years), and I finally decided that, because my symptoms mirrored those of viral pneumonia, that it was time to go to the doctor.
Now, I have a certain for-profit HMO that shall remain nameless. But they really aren't that concerned with my health, let me tell you that. I had to argue with the scheduler to get an appointment for the same day--if I was breathing, I probably could wait a day to see a doctor, the company thinks. Even then, I could only get in to see a nurse-practitioner, but one takes what one can when one lives with "the world's greatest health-care system." The NP spent about five minutes with me, listened to my breathing, asked me three times if I smoke, and then prescribed antibiotics.
Oh, and if my cough doesn't go away in fourteen days, I should go back. Fourteen days? Won't I be used to a hacking cough by then?
All I can say is, if this is a for-profit system, I'm willing to try "socialized medicine."
(Oh, and this is for Ninophile, particularly: customer service, not so important at unnamed company. The intake clerk acted like she was doing me a favor checking me in. Um, isn't that her job?)
posted by Number Three @ 7:50 PM
17 Comments:
#3,
This probably won't make you feel better, but Madda and I arrived in Italy on August 1 for a 5-month stay (I have the fall off). The day after we arrived (yesterday) we went down to the City Hall (Commune) to get a piece of paper to restore her national health plan. For 25 Euro cents they gave her the necessary piece of paper, which today her mother took to another office to issue her a new health card (tessera sanitaria), which they did on the spot. She now has full health coverage and set up a check up with her doctor, whom she hasn't visited in 2 years, on August 10th, 7 days from now. If she had a cold or wasn't feeling well, she could go down the block to the neighborhood medical office and see a doctor immediately and be given an antibiotic or whatever else she needed, which she could fill for free in the pharmacy next to the office. Or if she had something more serious, they would immediately refer her to another doctor if necessary. It's no wonder the Italian medical system is ranked 2nd in the world, and the US 39th!
Or is the US ranked 37th and Cuba 39th??
PS -- No marathons for the next few days.
The fact that billionaire and former Prime Minister Silvio Berlusconi of Italy decided to go Cleveland for a medical procedure while ivory tower Paul leaves that very city and gets his "free" care in the shitty Italian system is so humorously ironic I almost can't stand it. It's only going to get funnier when Paul has a serious medical problem and needs to high tail it back to the good ole US of A.
But you'd probably almost rather die than admit our system is best, right Paul?
Yes, Lex, Silvio Berlusconi is a billionaire. As soon as we all become billionaires, then the US health care system will work great for us too because we'll all be able to afford it. The fact that the Cleveland Clinic has set up a special heart unit to attract international billionaires and has been successful at making money with it does not mean the rest of system for the rest of us is a good or a healthy model.
By the way, specialized heart procedures for 75 year old billionaire men are not the standard by which any sensible person would judge overall health care. That "shitty Italian" system is excellent at quickly, effeciently and effectively delivering 95% of health care needs to 100% of Italians at far less cost than the US system. That's why they live longer and that's why they're ranked 35 slots ahead of America. If you have a billion dollars and need a specialized operation, then the US is the best system in the world for that. No argument here. If you have basic health care issues like being born or walking pneumonia, you know the ones that everyone has at some point in his or her life, then you're chances are better in Italy, especially if you're one of those 47 million uninsured Americans.
PS -- I have actually used the Italian health care system and for most things it is better. The only reason I would high tail it back to the US is because my health care insurance wouldn't cover enough of some procedure here in Italy, but it would have to be a big procedure because the full price cost here without reimbursement is likely to be less than a plane ticket.
Real world example: 4 years ago I experienced an irregular heart beat while running on a tread mill in Cleveland. Because I had SuperMed Plus (which means the Cleveland Clinic is my hospital) rather than roll me across the street from my gym to University Hospital, I was taken a few miles away to the Cleveland Clinic. In the next week I did a stress test and walked around with a belt and all was OK. If I didn't have insurance, the bill would have been $10,000. Luckily I did. But it was May and my one-year position ended at the end of that month. I was being renewed for the next year, but some paper work needed to be done before they would renew my insurance for the summer and I would have to pay Cobra. CWRU is terrible at doing paperwork and it didn't get done. I was without an insurance certificate in June and July.
Fortuneatly in May I had left for Italy and the symptoms continued in June and July. I had 3 doctors' visits at the hospital and one at home during which time I had 3 electrocardiograms, an ultra sound (echografia) and a gastroscopia (they sent a tube down my stomach -- I can't remember the English word for this -- and probably some other things I have forgotten. Total cost out of my pocket at full price? 200 bucks! That's right, it was 200 bucks. If I had know that the price would be so low, I wouldn't have worried so much, but of course I was scared shitless because I had no insurance.
Diagnosis? Stress. Gee, I wonder what contributed to my stress? O yes, my insurance in Cleveland? Once they got the paper work in at the beginning of August, I then had to go back and pay 2 months of cobra coverage during June and July, during which time I technically did not have coverage, otherwise I would have had to exclude pre-existing conditions and I would have had a waiting period for some other items. The cost of the cobra was $600 bucks! They then paid my 200 dollars in bills and I was out 400 bucks for cobra -- twice the amount of the bill in Italy. Yeah, Lex, that's a great system we have in America.
Yikes! You're practically a Michael Moore character in waiting. For a scientician, you really do love your anecdotes.
First, I don't know why you're talking about the uninsured. #3 isn't uninsured, so that wasn't his complaint. And, of course, adding your 47 million to the equation ain't gonna make his problem get better.
But more importantly, my short-sighted friend, there is your strange inability to add. You mention the price of your bill in Italy, as if that's how much health care costs in that government-carousel-utopia. Why can't you understand that, though they don't actually see the money disappear from their wallets, Italian citizens pay those bills one way or another. Whether they write a check to a hospital or the government, it's the same money.
I'm sorry about your heart condition, Paul, but surely you realize that most people who have bad hearts or lungs or livers are responsible for their bad hearts/lungs/livers. If you're comfortable subsidizing their poor health choices with your paycheck I'm happy to have you do it. But I've never understood the impulse to ask other to do the same.
If you want to subsidize those cheesy-fry eating, beer guzzling chain smokers who can't pull themselves off of a barstool long enough to take a shower, I encourage you to do so. But why do you want to take my money and do it? Cause it's the right thing? Well, I've got some things I think are the right thing. Can I have some of your money to subsidize those?
Should we help out people who can't help themselves? Yes. Should we give free health care to people who choose not to help themselves? No.
Here's an anecdote for you. I, like you, once found myself uninsured. Instead of wringing my hands about it I - gasp! - paid for health insurance. Did it mean I went out to eat less? Yep. Did I see fewer movies? Yep. But, as a bonus, I lost weight and read more books. Now that's win/win.
I bet that 47 million could be trimmed in half overnight if they made similar sacrifices. But, then, who would nanny them and tell them how to think?
Finally, you do realize that a great many Europeans (the ones who can afford it, that is) have "top-off" insurance, right? That's because the richies over there don't want the same shitty medical care as the hoi polloi, so they pay extra to get the good stuff. You have heard of that, right? Or maybe you actually have to live in Europe more than five months to get the low down. You know, like me.
Why don't you do some long, long term investigating on how great Europe is. Long term. Seriously. Long term.
Finally finally - you've got to admit that Berlusconi thing was pretty funny, right? He leaves Italy to go to Cleveland and you do the opposite. Give me some props for that - it's Greek comedy stuff, right? C'mon bro - give me some love.
Hey, CL, have you seen SiCKO?
Haven't/wouldn't, and I'm saddened that you did. I like my documentaries less fictional.
And, #3, I stand by the claim that your bad experience would not be helped by adding more peeps to the list.
So I know the CL is not loved here in the center of the smugosphere ("Seriously, how did #3 ever stand that guy?") but I fear I get far too little credit for being so often correct. Does everyone remember the whole Michelle Wie tiff way back when? The CL had the temerity to question FFB's point that the young female golfer wasn't getting enough press for her amazing "accomplishments." (I pointed out that she was long on press and short on accomplishments.) For those who haven't been following her career very closely, last time she was heard from she was faking an injury to avoid losing the right to compete on the LPGA tour; if you shoot poorly enough, even the LPGA yanks your card.
In four years of trying, career victories against men? Zero.
Women? Zero.
So just think of this healthcare thing as this year's Wie debate.
I want to assure Paul that I didn't know about the following article until just now. I usually read the newspaper every day but yesterday (Friday) I spent my afternoon and evening making poor, unhealthy choices. I wouldn't have treated what I thought were your informed opinions as seriously as I did if I'd only read the Wall Street Journal yesterday instead of today.
In an article title Sicko Europe, Daniele Capezzone of Rome, president of something called the productivity committee of the Italian Chamber of Deputies (seriously, he's got to be making that up) holds forth on just how - to use my words now - shitty the Italian system is fast becoming. Here's the pull out: "We Italians are getting the medicine we pay for - and dying as a result."
Now, you can read the thing yourself, but here are some highlights about the #2 health care system in the world.
He sets the whole thing up with this statistic (I was hoping for an anecdote, but got this instead): In the US the annual death rate from cancer is 196 per 100,000 while in Britain it's 235, France it's 244, 270 in Italy and 273 in Germany.
(I found that strange since I would have thought that the USA was good at the hypertechnical, money making procedures but not the regular longterm care stuff. But I'm sure Paul's right, in general.)
He goes on to explain why Italians die at such a high rate and why the problem is getting worse as they refuse to spend the money other countries spend.
Here's a little charmer called "reference pricing.":
"New drugs are grouped with existing drugs used to treat the same medical condition, and the government typically limits reimbursement to the cheapest price in the reference group. This way, patients are discouraged from using the most modern and more expensive medicine."
"The Italian regions [in opposition to the central government] are taking reference pricing one step further by grouping together drugs that do not necessarily have identical therapeutic effects. This way...the regions can save more money. But patients are forced to choose between paying high out of pocket expenses or the risk of taking the wrong medicine."
Money? What's this strange thing called money? I thought this was all done without exchange of money, somehow. You know, cause of the anecdotes.
Just fabulous, Paul. At least you were right about them being number two.
Lex,
WHO statistics:
ITALY:
Life expectancy at birth m/f (years): 78/84
Healthy life expectancy at birth m/f (years, 2002): 71/75
Probability of dying under five (per 1 000 live births): 4
Probability of dying between 15 and 60 years m/f (per 1 000 population): 89/46
Total expenditure on health per capita (Intl $, 2004): 2,414
Total expenditure on health as % of GDP (2004): 8.7
UNITED STATES:
Life expectancy at birth m/f (years): 75/80
Healthy life expectancy at birth m/f (years, 2002): 67/71
Probability of dying under five (per 1 000 live births): 8
Probability of dying between 15 and 60 years m/f (per 1 000 population): 137/81
Total expenditure on health per capita (Intl $, 2004): 6,096
Total expenditure on health as % of GDP (2004): 15.4
Theoretically those statistics should cover deaths as a result of cancer. As for Italy's public health system, yes it has taken a dip in recent years primarily because Berlusconi's government spent 5 years gutting public programs to pay for tax cuts for the wealthy. We've all had a recent lesson on what happens when that is done -- things begin to collapse.
PS -- Homing in on one disease such as cancer is a particularly inapt way to make a comparison between two health care systems. Enviornmental factors such as genetics, greater crowding, greater pollution, older dump sites, 2 World Wars... may play a role. The best way to compare is to look at overall statistics.
PSS -- If you're going to argue that Italian genetics may play some role for higher life expenctency rather than public health, which of course may be true, I suggest you look at Canada's statistics. Though genetically similar if not identical to much of America, amazingly their life expenctency rates went up after they switched to public health care in the 70s.
PSSS -- Daniele Capezzone. He's a founder of the the Italian polictical party called Radicali Italiani. His first book, Uno shock radicale per il XXI secolo was translated into English by none other than The American Enterprise Institute, which of course has close ties to the Wall Street Journal, whose editorial board is against public health. Lex, you can always find at least 1/4 of any population who believe just about anything and often you can even find one of them with an impressive title and quote him/her as an expert. Every Italian official has an impressively long title. That the WSJ had to dig around to find such a lowly official in Italy who has no background in medicine (Capezonne graduated from a humanities-dominated high school and went to a college where he studied jurisprudence and social science) is pathetic. As for Capezzone's definition of "high out of pocket prices", for an Italian when you have to pay anything the price is considered high. The out of pocket prices here are lower than copays for most insurance plans in America.
PSSS-- Comment on Comedy: Yes, keep up the parody of the likeable yet woefully ignorant and easily duped American. It is funny.
Final comment on Capezzone's OpEd piece. Lex, if you reread it carefully, no where does Capezzone say that he thinks Italy and Europe should jettison their public health system and that America's is better. What he is advocating is that Italy should spend more government money on research and getting the most advanced techniques and medicines to Italian citizens. Is it really surprising that an Italian would believe that Italy's public health system could be improved in some areas? Capezzone is young -- only 34 years old. In his youthfulness he probably wants to criticize the Italian health system to shame it into spending more public money (he's a "radical" socialist who now belongs to the recently formed Rosa nel Pugno party), but he does not realize that his words will be taken out of context and simply misinterpreted by American audiences as a severe critique of public health care as opposed to private health care (which is exactly the miss-impression that the WSJ wants to give).
That Michelle Wie thing was on the blog? When? I couldn't find it.
Alright, so I'm still confused. Italy's health care system has taken a dip in the past five years but it's still #2?
Maybe I don't understand the way this ranking works. Because in order to still be #2 (with America in the high 30s), Italy must have really, really been something six years ago.
Or maybe the discerning reader will realize that, like most such rankings, this is all bullshit designed to convince "the woefully ignorant and easily duped American" how awful their system is.
The common sense answer is this: for people with health insurance, the American system is the best. For people without it, it kinda sucks. But since #3 has and does have health insurance, he's better off here than anywhere (except, I'll allow, Italy).
Can we be friends again, Paul? I hate it when we fight.
#3: I think it must have gotten memory-holed. In fact, that's been the fate of more than a few of my comments, sadly.
I can't actually remember that much about it (except my essential correctitude) it's been so long ago. Do you have a friend who was a college golfer? Is that TMcD?
Or maybe I completely made the whole thing up. My brain is a fever swamp.
Lex,
I'm all for kissing and making up.
"Dip" was probably the wrong word. Italy's "free" health care has taken a hit with more and more copays as a result of tax cuts, which for now has kept the quality in place, but many Italians are complaining about the extra fees.
I think a good example of what Capezzone was talking about with drug pricing may be found with drugs for sinus problems. 8 years ago when I first started visited Italy regularly, my then girlfriend's sister had allergies and she used Claritin (spelled Clarityn here but it's identical) or Clever. Those were the latest sinus drugs back then and with a prescription she would copay something like 4,000 lire or 2 bucks for a month's supply. I happened to have sinus problems and had no insurance at the time, but I had heard of Claritin (who couldn't with all the adverts), but it was 60 bucks for a month's supply in the US so I couldn't afford it. Well the unsubsidized price in Italy for me was 10 bucks, so I started buying it here.
Then new spray drugs came along like Flonase (called Flixonase here) and Nasonex. She tried Flixonase and liked it much better and told me about it and yes, it works much better. Well once I got insurance I found out that my sinus problems were not allergies but something else, and I had to take Flonase or Nasonex. I prefer Nasonex. The price for one bottle (= 1 month's supply) of both Flonase and Nasonex in the US without insurance is $80. My prescription copay is $30 for each. I have to have this stuff, so I pay the copay. Here in Italy Flixonase and Nasonex are considered the latest drugs and so they aren't covered. My wife's sister must pay the full amount for those. But if she wants to use Clarityn or Clever she has to copay only 2 Euros. The unsubsidized price for an identical bottle of Nasonex here? 15 Euros. It is thus cheaper for me to buy an unsubsidized bottle of the identical size of the identical medicine in Italy than to have a copay for it in America. The reason is that the Italian government negotiates the price of the medicine and buys in bulk and passes the savings along to Italian citizens or anyone who enters their pharmacies. They do this without costing the taxpayer a dime. In the US since there is no negotiating power the price is higher and there are several middlemen that further mark up the price of drugs.
One other note about Capezzone. I visited a professor friend in Padova last night and I know he follows Italian politics closely so I asked him about Capezzone. He just rolled his eyes and the first thing out of his mouth was about how he's a young up and coming politician who loves to have his face on every magazine -- you know the type of politician whose penchent for self-promotion is recognizable everywhere in the world. He told me that Capezzone has really bought into this idea that great, big effeciencies can be wrung out of the Italian social system that could justify lowering taxes... I guess that's what it means to be a "radical" socialist here -- arguing for tax cuts! At any rate his ideas are so "radical" that his party is considering kicking him out and he too is exploring joining one of Berlusconi's colation parties, and a far-right one at that. No doubt these facts made him an attractive spokesperson for the American Enterprise Institute and WSJ.
For those of you wondering what ever happened to a Wie little argument on this blog, you may find this link interesting.
Cheers: To Paul, for finding and linking to that post. And I was worried I made it up.
Jeers: To #3, for not finding (or linking) to that post. And for in any way agreeing with the original sentiment and thinking it was right. And for general political correctitude of the 3rd degree.
Jeers: To CL, for even hinting that that ultra-PC post might have been from the pen of TMcD. Sorry dude.
And further jeers to CL for what turns out to be a charitable assumption that Wie was a decent professional golfer. I believed the hype, a little.
She remains a perfect example of this proposition: those who the media wish to destroy they first make popular.
It looks like she's going to Stanford in the fall. I hope she's allowed to play for their team; after a few more years she might yet be able to re-start her career the normal way.
I searched the blog for the words "golf" and "Wie," and neither located the post (I guess Blogger doesn't search the comments). Btw, I still think Sam has a good point--that the headlines tended to be negative, although Wie's accomplishments at that time were quite remarkable.
CL, I've never quite understood your resistance to female golfers competing with men. Both Sorenstam and Wie have drawn your scorn over the years. So much so that you bring up a pretty minor discussion from wa-a-a-ay back--like you actually think and care about how well or poorly Michelle Wie is playing. Why? What's up with that?
The funny thing is, I was the only one making reasonable and logical remarks. Re-read Sam's nutty thoughts. That's an angry, angry post ending with the sentiment that she'd "KICK YOUR ASS!"
So here's "what's up with that":
Sam and you (and a great many people in the press) clearly WANT that to be true but my point was that there was really no evidence that it is true. I was merely saying that we should withold judgment until we get some proof. Now we have it: she was, as I suspected, a media creation.
My question is why did you want it to be true so much?
The line about beating or getting beat by "a 16 year old girl" is so clearly mysoginistic that I can't believe this PC crowd didn't condemn that remark as tantamount to saying "throws like a girl." In case you're too warped by smugness to see it, Sam inserted "girl" to drive the point home. Instead of just saying "a 16 year old beat" or "beat the 16 year old" he inserts the qualifier that she's a girl to make the point. (And don't respond with the lame and disingenuous remark that she is a girl; she's also Asian, and he didn't feel the need to point that out. It, like gender, should not relevant.)
So Sam's point is that there is some shame in getting beat by a 16 year old GIRL.
How can an otherwise subtle thinker like you even pretend you don't see that?
This is a fetish, this recent press-made impulse for women to compete with men in professional sports. It is so strange and fraught with disaster that I can't believe anyone who pretends to support women could support it.
In the professional (physical) sports arena, women competing with men is a sorry idea. It undervalues women's sports ("Ooh - she's dominating the LPGA? Well let's see if she can compete against men." "Ooh - Gino's good at coaching women? When's he going to coach men so we really know how good he is?"), making success in men's sports the only definition of success. And it sets women up for acceptance of mediocrity ("Hey - she almost made the cut! That's pretty good!").
Pool and poker and car racing are different; there is no reason at all why women can't compete professionally on equal ground in those "sports."
But "competing" with men in physical professional sports is a disaster for women.
At some point your thinking on this subject changed, #3. I wonder why that is.
Golf is a "physical" sport?
I think that much of the Sam post in controversy was intended somewhat, ahem, ironically.
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