Neither here nor there. No perfect system.

I finally watched Sicko this past weekend. I usually agree with Michael Moore’s overriding theme but seeing as though he's neither a documentarian nor a journalist, I find his films to be a bit heavy handed for my taste. I agree with the fact that a civilized society should offer universal health care to its citizens and the fact that we don’t have it in the U.S. is an embarrassment. And I also think it is obvious that the insurance companies and pharmaceutical companies are for-profit businesses whose aim is not to ensure the health of their “customers” but to make as much money as possible while keeping costs down. If that means killing people, so be it. Personally, I always had great health care through my insurance in the U.S. and never had any major claims denied, but right before I left the country, I noticed that the companies seemed to be getting greedier and greedier and care seemed to be getting worse.

The only negative situation I had in the U.S. involved having blood tests done through my doctor. Right before leaving for Italy, I was working for an Internet start-up and the insurance offered by the company was fine but was definitely not the best I had had. At one point, I had some blood tests done at my doctor’s office, which was a pretty routine thing as my doctor ordered blood tests on almost every office visit. What was different was that this particular time I got a bill at home for $800 for the blood tests and a note from the doctor’s office saying that my insurance company had denied payment. Upon calling the insurance company, I was informed that my doctor had sent my blood to the lab it always used in a New York hospital as opposed to the insurance company’s own special lab “in the beautiful state of Washington.” Seeing as though I had never thought about where my blood went before and nobody had informed me that the blood had to be sent to Washington, the insurance company agreed to pay the $800 but I was told that from then on out, my blood would have to go to their lab.

A few days later, I received a wallet-sized card in the mail from my insurance company containing a little printed spiel I was supposed to recite to my doctor (as if I were not a patient but one of the company’s marketing representatives!) the next time he ordered blood tests. It read something like, “Dear doctor. I’m sure you understand the importance of testing. That’s why X lab in the beautiful state of Washington is the choice for you…” The next time I went to the doctor, I showed it to him and we had a good laugh about it. He was not happy about sending my blood 3,000 miles away “to the middle of nowhere to a lab I don’t even know” but said he would tell the nurse to do it. Unfortunately, the nurse did NOT do it and my blood once again went to the usual lab. Understandably with all of the patients that come through the doctor’s office with various insurance plans, how can the nurses keep track of whose blood goes where? Again, I received a bill in the mail. I fought it with the insurance company saying, “Look, I told the doctor where to send the blood but I was not with the nurse when she FedEx-ed it out so I can’t be held responsible for her mistake.” It took months of going back and forth with my insurance company and billing in my doctor’s office (and I even received threatening phone calls from some collection service saying “This could affect your credit for life! You better hope you don’t need to buy a house or a car!”) but I finally resolved the issue without paying.

I would love to say that I came to Italy and lived happily ever after with “free” state health care, but I’ve had wildly mixed experiences. I agree with the Italian system on principle (access for everyone) but the overly bureaucratic infrastructure and set-up are horrible, leaving patients to feel lost and confused. That's not to mention the almost total lack of any kind of human element or bedside manner. And it is NOT free. Not only do I pay a ton in taxes, my yearly health care costs are greater in Italy than they ever were in the U.S.

And this is where I began to have problems with Sicko. There’s a scene in the film where Michael Moore sits down to dinner with a group of American expats in Paris and they rave on and on about the great French health care system, all of the vacation time and the free university, etc. Unfortunately, Michael Moore does not delve into the flipside of all that. Aside from all of the taxes one must pay to sustain this type of system, a system where employers are forced by law to give their employees extremely generous benefits (in the film one French cancer survivor tells of how he asks for a doctor’s note so he can take three months off to relax in the south of France even though he could have technically gone back to work) makes for employers who are wary of actually hiring people and turn to low-paid freelance workers to whom they legally don’t have to pay benefits. This is what has happened in Italy, and unfortunately, so many hired employees abuse the system (including the many women who get a doctor’s note so they can spend their entire pregnancies at home paid a full salary even when they aren’t technically sick, thus creating a chilling effect whereby no company wants to hire a woman of childbearing age) that companies will do anything to avoid having employees on the payroll to whom they must pay benefits.

Also, university is not free in Italy though it does cost much less than in the U.S. But new college grads here struggle to find jobs and when they do find work, it is usually in the form of an unpaid “internships” that last for years on end, forcing them to live at home with their parents well into their 30s. And as for paid vacation when you are doing one of these “internships” or working freelance? There is none. I have no direct experience in France, but at least in Italy, it is not this utopia of “free” health care, “free” university and endless vacation time (I, for one, pay out of pocket for my health care, have no paid maternity leave and no paid vacation time) for the masses. Taxes are very high, salaries are very low and finding work is a struggle. The protections and generous benefits are there for some (typically those who are older or have older contracts written before Italian companies discovered “internships” and “freelance work,” which are concepts used here not to offer opportunities or flexibility to employees like in the U.S. but merely to further financial gain) but definitely not for all.