Dreaming In Italian

More about the the national health system SSN (Sistema Sanitario Nazionale)

Tuesday, November 3rd, 2020

I now have significantly more experience with the SSN. Since I am not an Italian citizen I enroll each year by paying a sum based upon my last year’s income. Since my basic income is Social Security that has averaged about 1650 euros a year or just under 140 euros a month which at today’s rate of exchange is about $160 which is incredibly cheap by U.S. standards. Visits to the primary care physician are free for everyone. Visits to specialist or for things like X-rays usually require a copay but since I am over 70 I pay nothing. The cost of prescription drugs in general are much lower and again in my age range they are often free. All of these things are very positive.

Now let’s look at the negative side. First, it is definitely not very convenient to see even your primary care physician. Often they have more than one office and the one nearby has limited hours. Some accept reservations and many do not. My first doctor, Dr. Barbiere, has 3 periods a week in his office nearby, each for about 2 hours, no reservations. I found him reasonable to work with but I always arrived at the door of his office at least 15 minutes early and even then there were often a couple of people ahead of me. But still the wait was not very long. If, however, I arrived at the beginning of office hours there were often 5 or 6 people already in line and the wait could be 30-45 minutes. My current doctor is worse in many ways. He requires reservations for much of his office hours but then makes it incredibly difficult to make one. He’s not as pleasant as Barbiere but seems quite competent and has reasonable patience with my limited Italian.

Specialist visits are definitely a problem. Often the first appointment available in the province (like a county in most states in the U.S.) could be a month or more away and even then physically distant. I already wrote a blog post about seeing ophthalmologist in Bentivoglio which was a similar distance with sparse bus service. To see an SSN orthopedist I had to go to a little city Loiano, 30 km away through secondary roads and required about an hour by car (thankfully Laura has a car here). I found that orthopedist quite unpleasant and wound up going to a private one here in Bologna. For the private guy who was recommended by a friend I had to pay 118 euros but I could make an appointment a week in advance. Recently I had an MRI and for that I had to go to Castiglione dei Pepoli which is about 60 km distant but with better roads so the trip was less than an hour. Another alternative is, of course, to go to the emergency room (Pronto Soccorso) if the problem is urgent. I had an ear infection that became increasingly painful and following this route I could see a specialist fairly promptly. In any emergency room if you are not badly injured there is always a wait probably in every country but I received excellent care and resolved the problem completely in about a week with various measures taken.

Prescriptions for medications tend to be much less convenient here than in the U.S. I had a Medicare Advantage plan with Kaiser and could refill prescriptions online easily and have them arrive in the mail after 3 days. Now if I have a way to contact my doctor without going there physically I can get a prescription on-line but still must go to the pharmacy to get it filled.

In summary the system works but with many inefficiencies. If only there were a system to make an appointment online with your primary care physician that would help things a lot and is clearly doable through appropriate software even if the doctor has no staff – which is usually the case. Similarly easy communication via email and/or text messaging would alleviate much of the problem. The long waits for non-urgent diagnostic tests or visits to specialists is endemic to the system. The only way to resolve that would be more doctors and specialists and inevitably higher costs for the system. To me that would seem a reasonable tradeoff. But on the other hand the health coverage is universal without regard to wealth – although if you are willing to pay you can always see a competent specialist much more quickly.

One other thing is the over-the-counter medicines like aspirin, as an example, cost significantly more than in the U.S. but balancing that against the lower cost of prescription drugs seems much better to me.

Other asides for today’s post. I am writing this while it is still early morning on election day in the U.S. with all of the turmoil there like nothing I have ever seen before. If I were religious I’d be praying for a positive outcome and no violent reaction. The pandemic is still raging without pause in the U.S. and the second wave here in Italy has been a veritable tsunami. Laura and I are going out only for necessities and with an N95 mask. It’s something of a perfect storm.

At least I can end on a positive note with another Baci citation.

L’amore è un bellissimo fiore, ma bisogna avere il coraggio d coglierlo sull’orlo di un precipizio.
Love is a beautiful flower but you must be brave enough to pick it from the edge of a precipice.


P.S. If I have any Italian readers I’d like their opinions on the SSN and correction of any misunderstandings that I have about the system.

And a final note “this too shall pass”.

Surfing the (second) wave

Tuesday, October 20th, 2020

Here in Italy the second wave of covid is very active. It has gone from an average of 200 new cases a day in the summer to an average of about 8,000 in the last week after creeping up slowly during August and September with an average of 1500 cases a day. The problem here as in just about all of the world is that people are weary of the limitations. While in general people follow the rules on wearing masks and avoiding large gatherings much of the uptick in cases seems to come from those ignoring those rules, or more accurately, recommendations. So now those are becoming rules. Usually those who are lax about the recommendations have been the young, teenagers and 20 somethings. This has been especially true on weekends when people want to be out and about and party with friends. On weekends the very center of Bologna is closed vehicular traffic, T-days. They’re called that because the major roads in the center that become pedestrian-only form a T. So about two weeks ago the mayor issued a decree that on weekends masks are mandatory even in open air. On the first weekend the police issued 14 tickets to people in their 20s for flaunting the rules. These tickets really get people’s attention since they are 400 euros each – that’s about $470. Word gets around and now everyone is wearing masks. And it’s not just the financial penalty; nobody wants to go back to a lockdown. As in the US the rate of deaths is much lower than in the spring partly because of greatly increased testing so that those infected receive treatment sooner. One of the hard lessons that they learned earlier and also because they are more testing capacity now. It is interesting to look at the charts. The first lockdown was very effective here in Italy and in much of the rest of Europe. The summer was almost normal here while the number of cases in the U.S. steadily grew. I’ll be interested (vitally interested) in the shape of the curve going forward. I expect it to continue to decrease but probably not as rapidly as it rose.

Number of new cases in U.S.
Number of new cases in Italy

We had hoped to have a little party at our house with under 10 total people to celebrate our marriage but decided to postpone that until the wave subsides. I’m hoping that things seem less scary in December.  I’ll end on a positive note with one of the quotes that come with the Baci.

Only he who has overcome his fears will truly be free.
Solo chi ha superato le sue paure sara’ veramente libero.

And a second one

When we feel the need for a hug, we must run the risk of asking for it.
Quando sentamo il bisogno di un abraccio, dobbiamo correre il rischio di chiederlo.
Emily Dickinson

P.S. I always appreciate comments ( and new subscribers)

The wedding (il matrimonio)

Saturday, October 10th, 2020

On Friday we took a taxi to the comune (city hall) of Bologna. The two witnesses and the two guests were already there but could not enter without us – the pandemic has caused a number of restrictions. We had to wait for a bit and the witnesses and guests need to show identification but strangely enough Laura and I did not.

The wedding ceremony is pretty different. Here in Italy almost all written formal communications cites one or more references to laws either for the country, the region or even for the European Union. So I guess the officiant (one of the members of the city council) is required to read a couple of rules as the first order of business). Of course I understood almost nothing and frankly could care less. I suspect this is true of the entire population.

So then I had expected wedding vows during the ceremony and had translated what seems to be more or less the standard format in the U.S. and the translation into Italian. It seemed like a nice touch. First in Italian and then in English.

“Io, Joseph, ti prendo, Laura, per essere mia moglie sposata, per averti e tenerti da questo giorno in poi, nel bene, nel male, in ricchezza e in povertà, in salute e in malattia, di amarti e onorarti, finché morte non ci separi.”

“I, Joseph, take you, Laura, to be my wedded wife, to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, until death do us part.

Then Laura did the same in both languages.

The the officiant, rather than wedding vows simply asked “Do you want to marry this person” to each of us and we responded “Yes (si’) and then he simply said “OK, you’re married” – well he didn’t really say “OK” but it was very brief – short and sweet.

Laura read a poem that she had written and that I clumsily translated into Italian. It is really hard to translate poetry! I have tried to find a way to change the font size for poetry without success so I’m just going to live with it.

Molte volte ho sognato di stringere
una mano che mi corrispondesse
tenera complice e immaginato occhi sinceri da potermici fidare.
Un desiderio poco probabile ad avverarsi,temevo.
Poi, quando non ci credevo più, ti ho visto
e ho capito che eri tu. Perché
il tuo sguardo è un abbraccio che dà forza,
un sorriso che si apre su tutto il viso;
la tua mano nel prendere la mia
m'ha accolto benvenuto come a casa.

Many times I have dreamed of holding
a hand that matched mine
a tender partner and I imagined sincere eyes that I could trust.
A wish that is unlikely to come true, I feared. Then, when I no longer believed, I saw you and realized it was you. Because
your gaze is a hug that gives strength,
a smile that opens up all over your face;
your hand in taking mine, welcomed me home.

And of course there are photos that friends made.

We each read the vows in both languages (above) and then Laura read her poem.

Exchanging rings.

Both Laura and I and the two witnesses (Monica and Gianluca) signed a document of some sort. They didn’t give us a copy but I’m sure it’s filed away somewhere in the comune.

Then since there is a little balcony overlooking the fountain of Neptune and Piazza Maggiore we had our photos taken there as it seems all newlyweds do.

Also with our testimoni (witnesses) kind of equivalent of best man and maid of honor. Both good friends of mine and in this case Monica was my “best man” and Gianluca was the “maid of honor”. There must be two witnesses and they kind of assume the roles as I mentioned above.

And the last photo taken when we returned to our house.

By the way you may have noticed that I’m using a cane. I did some sort of damage to myself when I moved from my old apartment to the new house. I thought it was a pulled groin muscle but it has been pretty persistent and I’m having it checked out. More adventures with the health system here which I will write a post about before long.

And I almost forgot (again) to add a quote from un Bacio (the chocolate)

“Un amico e’ qualcuno che ti conosce molto bene e continua a frequentarti”

“A fiend is someone that knows you well and continues to spend time with you.”

Oscar Wilde

Of course I love to get comments.

Big News

Monday, September 28th, 2020

Yes, a major news flash! Laura and I are getting married on October 9th.

We had talked about this since late winter and since I needed to go to the consulate in Firenze (Florence) in late April to have some documents notarized for the sale of my house in Oakland I decided to complete the document (“dichiarazione giurata” – sworn statement) that must be notarized at the consulate and had that done too. At the consulate they told me that there is a time limit of the validity of said document (from one to two months, depending on the city) and I decided to take the chance and paid the $50 to have it notarized. As it turned out it was still valid when we went to the marriage office just about 2 weeks ago. I still had to have it “legalized” at the Prefettura which translates to Prefecture and I have no idea what that is. Then I need an “atto notorio” (affidavit) in the presence of a “notario”, a kind of lawyer here (with fees to match) in which two people who know me swear that they know me and there is no obstacle to the marriage. So after all of this bureaucratic nonsense – some of which is because I’m not an Italian citizen, finally we went to the marriage bureau at the ” Comune” (city hall) and presented the documents for review. They approved the documents along with the usual signatures and seals and like many bureaucratic stuff a “marca da bollo” (tax stamp) of 16 euros. They then publish a wedding announcement on a bulletin board near the office so that if anyone has reason to object they can – I think that it stays there for 8 days or something like that and for all I know it is published somewhere else. So shortly thereafter they notified us that the date for the wedding is on October 9th in the “Sala Rossa” (red room) in the Comune where weddings are held. In Italy a civil ceremony is required to be legal and some people opt to have a duplicate ceremony in a church which is purely symbolic.

A previous wedding in the Sala Rossa

The wedding is officiated by someone from the city council or possibly even the mayor and in this period the attendees are limited to 16 including us, the officiant and the required two witnesses – in this case my, and by now our, friends Monica and Gianluca. I’ve also invited 3 others so that will be 8 total in the room.

The time is noon and there is no cost and they offer live streaming of the event. So we opted for that but I have yet to figure out exactly how to get the streaming to work. It requires Javascript and Adobe Flash Player and I’ll continue to work on it. Hopefully Laura’s daughters will be able to view it as well as her friends in Torino and perhaps other friends here and even in the U.S.

If you are interested leave a comment and I can give you some further details.