Keeping Italy's Enviable National Health System Healthy

ROME - I met pretty, ever smiling Flavia in a ward at a big teaching hospital in Rome, where we were both recovering from surgery not long ago. In her early thirties, she is married with two children in elementary school. The family live in Calabria, where her husband earns under $1,000 monthly. She suffers from Crohn's disease, and her entire intestine had to be surgically removed. The Roman team is well known, and so she was sent here for the operation.

Mario Monti  

Renato Balduzzi  

Attending her during almost two weeks of care were her husband and mother, who stayed with nuns in a hospice while her father took care of the children back home. Despite a situation which can only be described as difficult in every way, Flavia enjoyed the best of care and has a bright future.

Obviously there are darker patches, but, whenever I have the chance, I boast to my fellow Americans about the advantages of Italy's nationalized universal health care system. There is care for expectant mothers and for infants, down to and including inoculations against polio. There is care for the elderly. And care for those in real need, like Flavia - care that does not require their selling their home to pay the hospital bills.  This is thanks to a law that created a national public health service in 1978 with the support of  85% of Parliament. The result in the past three decades as been quite an achievement, with the World Health Organization citing Italy as second in the world for "capacity and quality of care." As Livia Turco, Health Minister during the Romano Prodi government, has remarked, "Perhaps we Italians take it for granted, but in reality very few countries in the world guarantee health care of this type for all citizens, with no discrimination whatsoever."

At the same time, we know that many of the Italian health service doctors suffer from patient overload, and simply lack the time to reflect at due length upon an individual's aches and pains. Instead of thoughtful care, the numerous elderly men and women who crowd into the waiting rooms tend to leave with a handful of prescriptions - more, I suspect, than a more careful examination of their conditions would justify. In this way the doctors trying not to waste their time waste prescription money.

This national health service is one of the areas under attack by the bean-counters of the present emergency government headed by Premier Mario Monti. Under relentless pressure fto cut costs, Health Minister Renato Balduzzi, 57, who is a professor of constitutional law at the Catholic University of the Sacred Heart in Milan, is expected to slash health service expenses, down to and including janitorial and laundry services, by around $1.3 billion before the year is out. About one-third of the cuts will come from a reduction in expenditures for pharmaceutical products, from medicines to gauzes and syringes. The government has prepared a suggested list of prices for acquiring medical products, in effect suggesting that in the past some prices were inflated.

"I'll go with saving on syringes," Pier Luigi Bersani, 62, head of the left-leaning Partito Democratico, commented gruffly Tuesday, "but won't tolerate jobs being cut." Was this flat statement realism or rhetoric? For an example of cost cutting, one way in which US hospitals - and who more spendthrift than they? - are reducing expenditures is by having centralized expert reading of X-rays sent from small local hospitals (those same local hospitals Italy is trying to cut out instead of improve). After the patient has an X-ray in the local hospital, the results are sent via the Internet for reading by experts. Some jobs are cut, but patients benefit from top quality analysis. The same occurs in Italy, but less routinely.

The point is that the national health service is a national treasure and should be preserved, even at the price of reducing employees.

Cutting the costs of hospital care is only one of the goals of Premier Monti's almost complete spending review, of course. On other fronts the government intends to reduce the number of public employees by offering retirement two years ahead of schedule, with 80% of the salary over a two-year period. In practice, this may mean that pension payments will amount to about half the pay received at retirement age. Some 280 local courts and other judiciary offices risk closure. Among the cuts expected in the Defense Ministry, rents being paid for office space will be cancelled and a 5-10% reduction in personnel is expected, but weapons acquisitions will remain untouched. Elsewhere in the bureaucracy a reduction of some 10,000 to 100,000 employees is under consideration.

However harsh all this seems, Monti, still proud of his recent showing at a meeting in Brussels at the EU summit in Germany, continues to ride high in the saddle and was speaking of his government seeing the crisis through until time to vote next Spring. Before the Brussels summit La Repubblica commented that vultures were circling over Palazzo Chigi (the Premier's office). After Brussels all that seemed changed, and on Wednesday afternoon Monti was meeting with Chancellor Angela Merkel in Rome. As the German magazine Der Spiegel commented this week, "For now Monti appears to be safe, and Berlusconi will have to go back to his sulking... Monti [is] a serious actor on the European stage, who must be taken seriously. For the foreseeable future, the European Union will no longer be dominated by Germany ad France."