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The United States should follow Europe's lead in recognizing that health care is a right, said Romano Prodi, professor-at-large and former prime minister of Italy, who spoke to a full Joukowsky Forum Thursday along with his wife.

Prodi and his wife, Flavia Franzoni, a professor of politics at the University of Bologna, compared the differences between the health care systems of the United States and European nations.

Prodi said the disproportionate amount of money spent on care in the United States is largely due to the high salaries of American physicians relative to those in Europe. But he also observed that the high cost of health care in America may be tied to the relatively high prevalence of malpractice suits, which forces physicians to spend more on insurance.

This process "increases costs and makes life unhappy," Prodi said. "Don't underestimate litigation. This to me is one of the dangers of democracy."

Prodi and Franzoni said the major ideological difference between American and European thinking is that Europeans consider health care a right, whereas Americans do not.

Franzoni said the health care system in Europe, where coverage is thought of as a right, is not only considered a way to control costs, but also "an instrument of government."

They agreed that providing universal health care should be a priority of governments.
"In their moment of weakness, the citizen must be protected," Prodi said. "I think this is civilization."

Though coverage models differ in Europe from country to country, Franzoni said the universal right to health care is usually a major tenet.

In some models, she said, care is funded through contributions from employers and employees, whereas in others, the coverage is paid for by the government to better facilitate care for the unemployed.

At the base of the Italian system, Franzoni explained, is a family's general practitioner. Visits to these family doctors are free to patients, and the National Health Center compensates the doctors based on the number of patients they see.

Family doctors are compensated more for certain patients who tend statistically to need more treatment, such as the elderly, and doctors cannot refuse patients, she said. Every family chooses its own medical doctor and can switch at any time.

Aside from providing general care and prescribing drugs for patients — usually with co-payments for all but the poor — family doctors have the sole authority to refer patients to hospitals for no-cost procedures or to specialists for diagnostic exams — also usually with co-payments.

One problem of the referral system, Prodi pointed out, is the disparity between regional administrations of the system. Because patients can choose which hospitals and specialists to see, patients from the South often flock to hospitals in the more economically developed North for procedures, placing a burden on those local hospitals.

"It's an enormous problem," Prodi said. But it's "legitimate to look for a hospital that's better."

Another point of contention in Italy is the coverage of illegal immigrants, which Prodi called "the great problem of today." He said illegal immigrants can obtain emergency care, but in most cases, the physician must report them to the police afterward, thus discouraging most illegal immigrants from seeking care.

Despite the problems with Italy's current system, Prodi said he hoped the event would "de-demonize people's perception" of European health-care models.

Asked by an audience member whether he thought a European-influenced model of health care could gain approval in the U.S., Prodi said he was skeptical of radical change, but was confident that the European models would have some influence.

"There's much opposition in America to anything managed by the government," he said.
By being flexible with the specifics of a health-care plan, President Obama has been able to raise support for reform, Prodi said. "But the majority of the American public is still suspicious about change."

In his introduction of the speakers, Vice President for International Affairs Matthew Gutmann noted that the Italian health-care system ranked second in a World Health Organization report on 191 member countries, and the United States ranked 37th, the lowest of all industrialized nations. But the most disturbing part, he said, was that the United States spends more than 16 percent of its gross domestic product on health care, compared to an average 8.6 percent in European countries.

"The United States can learn much by examining health-care systems like those found in Europe and elsewhere," Gutmann said.


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