Tessera Sanitaria January 6, 2006


January 6, 2006 Periodically I find it necessary to do battle with the infamous, though improving, Italian bureaucracy. Monday was one of those days and I finally received my Tessera Sanitaria, my Italian medical card.

When I bought my apartment, I was told by the realtor that I was now qualified to receive Italian medical coverage. I didn’t pursue it then, since I figured I had enough coverage through Medicare in the US and emergency coverage over here through Blue Cross. But gradually the wisdom of being fully covered in Italy made sense.

Acquiring a Tessera Sanitaria comes near the end (I hope) of a long bureaucratic food chain. The first step was to jump through all of the hoops necessary for the Residenza Elettiva, the initial visa that allows one to stay in Italy longer than three months. Done in the United States, this involved trips to the Italian Consulate, fingerprints, pictures, FBI clearance, and documents proving medical coverage and adequate income.

At this point, I figured that I was done with the heavy lifting. I was wrong.

The next step involved obtaining a Permesso di Soggiorno per Stranieri (Foreigners’ Permit to Stay) which required an additional 4 passport photos, a number of the same documents already produced for the Residenza Elettiva, and at least two mornings standing in interminable lines–twice in Verona and now once in Macerata. The penultimate document before the Tessera Sanitaria was a Carta d’Identità. To get that, I needed 3 passport photos (not the usual 4), copies of the deed of sale for my apartment, and to pay €5.42. Also, I needed a Certificato di Residenza for Sarnano which I discovered had been awarded me at some point after I had received my Permesso di Soggiorno per Stranieri from Macerata. All this to say, the medical card was merely the most recent item on the list.

So, armed with my Carta d’Identita, a payment form that I had picked up the week before, and €387.34, I headed off on Monday morning for the bank and the clinic. In Italy, one usually does not go to the agency involved to pay a bill, instead you either go to the bank or post office. I knew from past experience to avoid the post office on the first of the month since it is filled with pensioni picking up their monthly allotment. Unfortunately, the bank was filled with pensioners too. But there were three tellers so the line moved quickly. I then hiked up the hill to the clinic with receipt and Identity Card in hand and presented them to the receptionist who I had met earlier when I picked up the payment form. She then asked (all of this in Italian, of course) for my residency certificate. I responded with “Say what, you didn’t tell me you needed that too,” or words to that effect in Italian. When she was insistent that I walk back down the hill, across the town, up another hill to my apartment and then back, I muttered an appropriate Anglo-Saxon four-letter word. When she raised an eyebrow, I said “penso che questa parola significa ‘che cazzo’ in Italiano.'” (I think that word means c. c. in Italian.) For the first time in our dealings, she demonstrated that she knew at least a smattering of English by replying, “I know.” Back at the apartment fifteen minutes later, after hiking down and up the hills–I grabbed the residency certificate, along with every other official document that I could find, just in case.

Returning to the clinic, I was greeted with smiles from the receptionist as we were now the best of buds. She photocopied everything that I had scooped up and then prepared my Tessera Sanitaria. One last hurdle: I had to pick a doctor. I shrugged and asked her to pick one for me. Couldn’t be done, she said, so she wrote down three names. I did an “eenie, meenie, miney mo” number and chose Il Dottore Umberto Tambella to be my physician.

With my new med card in hand, I decided to press my luck and get some prescriptions filled that Dr. Mieras, my San Antonio doc, had given me. The local pharmacist told me that I had to go to my Sarnano doctor who would then change them into the proper form. When I replied to the effect that I was clueless as to the whereabouts of my newly appointed doctor, he took the time to walk me outside, point the way and give me fairly decent directions–up yet another hill, second palazzo on the right. (How does anybody with a heart condition exist in this town??) I found Dr. Tambella’s office on the second floor. I also found eight people standing around in the foyer and another seven or so in a rather dark reception room. While I was looking around for a receptionist, a receptionist window, signup sheet, anything, I noticed that everybody in the room was staring at me, trying to fit me into some sort of a cognitive niche. Since I was already the object of their attention, I asked, “Does anybody here speak English?” There was no response except that they stopped staring at me quite as intensely. So I asked in Italian, “Can anyone here speak Italian v-e-r-y, v-e-r-y s-l-o-w-l-y?” That broke the ice and I was informed that there was no receptionist, that the doctor’s wife would come out shortly, and that I was in line behind that man over there. I looked at my watch, sat down on a bench and settled in for what I figured to be a long wait.

Sure enough, in less than five minutes, the doctor’s wife appeared with a sheaf of prescriptions, handed them around and most of the crowd dispersed. My plight was made known to her and she took my San Antonio prescriptions and disappeared again. I settled in for what I figured to be a long wait. But within ten minutes, she returned with my prescriptions translated into Italian and on the correct form–no charge, no visit with the doctor, niente–and I was on my way back down to the farmacia.

You may not like reading the rest of this story: The pharmacy was now full, largely with the same denizens I had first met at the doctor’s office. There were now nods of recognition all around and even some attempts to include me in conversations. There were two pharmacists so the line went rather quickly. I had three prescriptions filled and the bill came to €1.08, or US$1.28. Earlier, when I had attempted to get two of these prescriptions filled at an HEB in Austin, it was going to cost over $125.00, even with Medicare and “Medigap” coverage with Blue Cross.

Notice also that I paid €387.34 (US$460.68) for the Tessera Sanitaria. That was for one year, not just for one month. American health care costs more than twice as much per person as that of other rich countries and produces worse outcomes. In spite of our having some of the best health care practitioners on the planet, we are among the lowest of all the developed nations in terms of infant mortality. The primary cause of personal bankruptcy is a medical emergency. Major corporations such as GM, American Airlines and Delta are either in or near bankruptcy largely due to spiraling health care costs. Competing corporations in every other industrialized nation benefit because there is some sort of a national health care system in place. Why is the USA the odd man out here?

“Socialized medicine” produces a negative reaction with most Americans. But there is no concern about “socialized transportation,” even though billions of tax dollars are spent every year on our highway system. Isn’t the health and well being of the citizenry as important as getting from point A to point B? Our health care system is not working. Maybe it is time for us to take a look around to see what other countries are doing. (Italian banks could look to American banks for some guidance, but that would be the subject of another essay.) (back)