One of my biggest gripes about the United States was the broken medical system. When I was last living there I was perhaps straddling the poverty line too hard, and I found myself entirely without medical insurance. As always, it is exactly when you don’t have a safety net that you realize just how sharp the fall is. I found myself with a cavalcade of problems and pains, and nothing I can do about it. I wrecked my shoulder, perhaps permanently, and there was nothing I could about it.

The moral of this blog post will be that there is not such thing as perfect, only trade offs. That’s a good lesson to learn in life, and I feel like most people miss it.

I don’t actually think the American medical system is definitively bad. It’s mostly just inaccessible. If you are drinking from the fountain of paid American healthcare, it is fantastic. But the problem is that as the economy gets worse, more and more Americans find themself without access to healthcare, and a profit motivation incentivizes providers of healthcare to crop people from the pool of eligibility. There are other problems involved, but the point of this post isn’t really to moan about the American system. I could just as easily nominate some of the virtues of the American system, such as how much money it is able to funnel back into the very research that makes advanced medicine possible, a point not enough people actually bother to consider. There is also a line blurring virtue to medical care as a service. If you have a series of benign moles on your body, am American doctor has no problems simply saying ‘yea, let’s get those off’ even though there is no medical reason to do so.

That’s exactly where I found myself recently. Everyone in my family wonders why I still have a bunch of unsightly moles. I couldn’t afford to get them removed in the US, and here in Italy the doctor took a look at them and simply said “Yup. They are benign. Have a nice day.”

It’s medicine. It isn’t a service.

So now that I am back in Europe, one would think that things are awesome. They aren’t. Europe has its own healthcare issues. I have a hypochondriac in the family, and so I am sensitive to wasting people’s time. When I have a problem, I am convinced it is a real problem. About a decade ago when I was living in Rome I thought I had a real problem, only to be seen by a nurse fresh out of fucks to give, who mocked my legitimate misunderstanding of what the problem was. She was overworked, I was stupid and wrong, and mockery seemed to her like a good response. I now won’t go to a doctor save for anything short of a gunshot wound, and frankly this is how a person ignores cancer until it is too late.

Nor is everything here affordable. What is considered essential is, and everything else doesn’t matter. Europeans mock Americans for the quality of their teeth, all of which have an almost unreal look and color to them. It might be jealousy. Most of us Europeans can’t afford healthcare. I pieced a bit of this together this past winter, when I would engage in the apex of medical tourism by driving to Croatia from Italy to go to an affordable dentist. The economics of this works. Everything you can do there starts at 1/3 of the price of what you would pay in Italy. It is more affordable to drive two hours there and two hours back, crossing two borders and leaving the EU, and you may get an interesting meal out of it. Not bad, really. At least it is right now, when I am still kind of self employed and live kind of close to the border. What happens when it becomes a 5 hours journey, there and back, and it needs a day off of work? I guess I can go without taking care of my teeth. Or wait till I was going on vacation anyway.

Does that make sense? When I was in DC me and my poor friends joked that if have a medical emergency we would call an uber before we called an ambulance. Does it really make much more sense that if I have a dental emergency I have to plan a trip across an international border? Here is a concluding anecdote: About a decade ago I was with my father in Sicily. He was having one of his stubborn moments, and didn’t want to throw away some very old bread. He chomps down on it and breaks several of his teeth. He had always had bad teeth, so it wasn’t that much of a shock. But his US insurance doesn’t cover medical abroad. And the cost of a local dentist to fix his teeth was far too steep. So he decided to wait until he got back to the US, where the cost would be covered. His broken teeth, however, where extremely jagged and cutting the inside of his mouth, so he had me get a nail file and file down the points.

And I’m still not over it.