Frank Viviano's World View

  Like almost every other American expatriate I know in Europe, I've been following the debate over President Obama's proposed health care reforms with astonishment, dismay and mounting anger.

Astonishment, because what passes for a health care system in the United States is so clearly broken and needs fixing. This ought to be the debate's central point. But it has been lost in a fog of shrill assertions that the administration is planning a "leftist" coup, meant to deprive citizens of medical choices and in some cases – the celebrated and utterly invented "death panels" – their very lives.

Dismay, because the assault has been orchestrated by a well-documented cabal of highly paid public relations firms and Congressional lobbyists. "These guys are pros, this is an industry," says MSNBC anchorwoman Rachel Maddow. "They are experts in fake grassroots campaigns that promote corporate interests."

Anger, because it is our state of health, the care and treatment available to more than a million U.S. citizens legally resident in Europe, that is often presented as a dire "warning" against the supposed evils of public health care.

We have news for you folks back home: very few of us would trade the system that serves us abroad for the one that is manifestly failing you in the United States.

FIRST CLASS OR CABOOSE?
I've lived for nearly 20 years in France and Italy. In the most recent comprehensive survey by the World Health Organization (WHO), they were rated number one and number two on the planet in health care. The United States, by contrast, is ranked number 37, well behind Morocco and two places below the Caribbean island of Dominica.

There are many substantive reasons to account for that gap, measured in extent of coverage (or lack thereof) and the stark numbers of cost-benefit analysis – what Americans get for their expenditures on health care, which are the highest on Earth by a significant margin. But to my mind, one of the greatest dividends of systematic, universal health care is measured in something that can't really be quantified: peace of mind.

Almost every step into the chaotic jungle of medical treatment in the United States is fraught with anxiety. Worries about the strangling limits and byzantine terms of private insurance. Worries about the immense burden of premiums for those who do not enjoy access to a job-related group policy –$15,000 per year for a family of four is common and more than $20,000 by no means unusual. Worries about the ever-present danger of a lost job or a policy's sudden cancellation.

Nobody loses sleep about these things in Europe.

Indeed, no one worries about them in the rest of the Developed World. Contrary to what you hear from the opponents of reform and their corporate bankrollers, we are not talking about crypto-Communist totalitarian states. Universal public health care is taken for granted in all but one of the globe's affluent capitalist societies. The United States is the pathetic caboose on that luxury train, the only modern democracy without a universal health care system.

I'll get personal here, because it's evident that the opponents of such a system either don't understand it or are deliberately lying to you about it.
When I'm sick, I simply give a call to my physician, Dr. Enrico Gonnella, whose office is less than half a mile from my home. I've never waited more than 15 minutes to see him. If I need prescriptions, the pharmacy downstairs fills them on the spot for free. If I need to be hospitalized or examined by a specialist, Dr. Gonnella makes all of the arrangements, with the most qualified colleagues available nationwide.

The rightwing pundits on Fox News and their pals in the U.S. Congress claim that people like me are trapped in a socialist medical gulag, with very few options when we are seriously ill and all of them lousy.

Last year, I had a cancer scare, and wound up a week later in the close care of a Milan physician certified in both thoracic surgery and internal medicine. The hospital was Italy's equivalent to the Mayo Clinic. The doctor had completed residencies not only in Italy, but in France and the United States. Over three days, he spent eight hours with me before determining that the problem was benign.

It dizzies me to think of the cost of similar treatment at home, in dollars and insurance anxiety alike. In Italy, I could concentrate on the more important matter at hand, my physical health.

THE COST OF BEING 37TH
Several years earlier, when I was living in Paris, a publicly-funded neighborhood doctor saved my life. I'd returned from an assignment in the fetid refugee camps of war-torn Kosovo, with a fever so high and a headache so indescribably crushing that I'd lost consciousness for 36 hours.

When I came to, it was all I could do to dial the telephone number of my local physician, Dr. Edouard Bonhomme. He had done a rotation in Africa, and immediately recognized the signs of cerebral malaria, one of the leading causes of death in the Third World. Within an hour, Dr. Bonhomme was at my apartment – French and Italian doctors in the public system make house calls – administering medications that brought me back from the brink.

I don't think it's an exaggeration to say that most Americans can only dream about such attentive, unrestricted care, entirely unburdened with concerns about the bottom line.

Yet in the United States we spent more than $7,000 per capita on our health in 2007, while Italy spent $2,400 and France $3,000.

An astronomical 15.3 percent of the U.S. gross domestic product (GDP) went into health care costs in 2005, a figure that has since risen to 17 percent.

Health care cost the French and Italians – the gold and silver medal-winners for international health performance – 11.1 percent and 8.9 percent of GDP in 2005. They are treated, respectively, by 337 and 420 physicians per 100,000 people. The figure for the United States is 256.

That puts us on nearly equal footing with Moldova (264), but badly outpaced by Lebanon (325) and way behind Cuba (591).

In France, infant mortality is 3.3 per 1,000 live births. The United States, at a shameful 6.2, is the world's one and only developed nation with an infant mortality rate above 6.

"The Institute of Medicine estimated that perhaps 18,000 deaths a year among adults could be attributed to lack of insurance," The New York Times recently reported.

Often, the insured are just marginally better protected. The Commonwealth Fund, the Times went on, found that 25 million Americans in 2007 had policies with such onerous deductibles and restrictions that they were obliged to postpone necessary treatment or go into debt to pay their medical bills.

SAME OLD
So yes, I'm astounded and dismayed that my fellow citizens may fall for the snow job they're getting from the same irresponsible operatives who sold them the Iraq War. The same people who tried to dismantle both Social Security and Medicare – the most popular domestic programs our government has ever launched, according to opinion polls. The same giant insurance firms that killed health care reform 15 years ago, and all but bankrupted the U.S. economy with their shifty investment deals under the empty gaze of George W. Bush.

And I'm damned angry, furious, that I've been making annual U.S. Social Security payments for 46 years, since I was teenaged stockboy in a Detroit supermarket, but have to buy private short-term medical insurance every time I visit home.

Only a fool would risk falling ill in America without an insurance policy to wave at the hospital reception desk. By contrast, as a resident American citizen in Italy, I have full medical coverage in each of the 27 member nations of the European Community. That contrast is offensive.

But much more offensive is the fact that one of my neighbors, born and raised in New York, wonders if he can go home at all. His adolescent son is diabetic. Although the boy is covered automatically in Europe, no U.S.-based health insurance progam would accept him if the family repatriated.

It was a matter of great pride, to the vast majority of Americans abroad, when our compatriots ignored centuries of terrible history and another irresponsible smear campaign to make a black man their president last November.

We're waiting, now, to see if similar courage and clarity will shift U.S. opinion away from the fear-mongers, and toward a health system that makes both medical and fiscal sense.

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