European v. U.S. Medical Care—a Case Study

by Robert Chan

In the year 2 B.C. (before COVID-19), while on vacation in Florence, I tripped on the way back from the bathroom and cracked my head open on the corner of a desk. It being 2 A.M. and not wanting to disturb my wife, Amy, I wrapped a towel around my forehead and returned to bed. At daybreak, unsettled by my dilated, different-sized pupils and the blood soaked towel, sheets, and pillows; my wife insisted that I seek medical attention. I declined; it would heal on its own, I didn’t want to miss the Pitti Palace, didn’t speak Italian, and wasn’t comfortable with becoming ensnared in a foreign system of medical care.

The hotel concierge told us that the Servizio Sanitario Nazionale would treat me free of charge, but it being early on the Sunday before Christmas, I’d receive more attentive treatment at a nearby private clinic—from which he would undoubtedly be receiving a kickback. I opted for the SSN. After giving my choice her usual consideration, Amy accompanied me to the private clinic.

On seeing the Palladian mansion surrounded by a lush garden, my eyes rolled back replaced by dollar, or rather Euro, signs.

Not having mastered the American technique of keeping patients waiting until they lose their patience, a doctor appeared in a few minutes. After examining me, he recommended a CAT scan and plastic surgery. A troupe of €s danced Busby-Berkeley-like before my eyes. Also, I didn’t want to lose a day or two of my vacation. So, I told him that, since the bleeding had stopped, a Band-Aid and a Tylenol would be sufficient. He responded like a judge after hearing Giuliani present a case of voter fraud, and Amy denied my appeal.

While the doctor roused a plastic surgeon from his Sunday morning repose, a technician administered the CAT scan that confirmed I was as hardheaded as I was hardhearted. Shortly thereafter, the surgeon arrived, perhaps lured by the scent of money. After explaining in clear English that, if I wanted to avoid a disfiguring Tony-Montana-like facial scar, I’d need an astronomical number of tiny stiches. With the Euro-meter spinning at warp speed, I felt like a foreigner getting into a cab on 59th Street and being taken to Grand Central by way of Pennsylvania. In any event, he preceded with such competence that my scar is barely visible.

Blessedly, what would have taken a couple days in the good ole U.S. of A had been expertly performed in three hours from beginning to end, but that only reduced the time until I’d have to confront the bill. What was the limit on my American Express Card? Did Italy have debtors’ prisons?

Knowing that our medical insurance wouldn’t cover foreign treatments, Amy had gotten us limited coverage via travel insurance. She’d already contacted them and been told that they would only cover what they deemed reasonable and necessary, insurance-speak for they’d pay bupkis.

As I approached the business office, I felt my heart beating quick and shallow at the base of my throat. Perhaps they’d have the courtesy to offer me a blindfold and a cigarette.

They presented me with the bill.

I looked.

I gasped in disbelief. My concussion must have been worse than I thought. I blinked several times and looked again, but number didn’t change. Then it hit me like a grand piano falling from a billionaire’s penthouse—it must be an Italian custom to leave out the final two zeros.

“Is this correct?” My voice trilled up like a high school nerd asking out the girl of his dreams.

“Si signore.”

“But 356 Euros, that’s like 425 dollars.”

“Si, I think so.”

A few weeks later I received, from Fly-By-Night Insurance Co. Inc., a check for $998. Accustomed to U.S. medicine, their computer program couldn’t pay less than that for a CAT scan and plastic surgery without decomposing into a puff of smoke and a mass of undifferentiated 0s and 1s.

The moral: We don’t know how bad we have it.

Robert N. Chan is a semi-retired litigator (Just when I thought I was out, they pull me back in) and author of 10 published novels–see This piece was written for the IRP Writers’ Workshop expertly coordinated by Charles Troob and Leslie Bedford.