Sunday, September 24, 2017

A Mystery Headline In My Inbasket Last Week

“No extenuating circumstances for those who throw mud on the dental profession.”
            - Rome Medical Society Newsletter
Huh? Who was throwing what mud on whom how? I couldn’t resist clicking through. The mudslingers turned out to be . . . real dentists who dishonor the profession by covering for phony ones. This is an old story. Most dentistry in Italy is done privately, not on the National Health Service, which has spawned a whole army of dental imposters – 15,000 or so strong, said to fill a quarter of all the country’s cavities. Usually the pretender is a technician, trained to work on crowns and bridges but dabbling in live teeth on the side, in cahoots with an authentic doc who for a price allows his name to grace the receipts, the prescription forms, and the bronze plaque on the office door. One of my closest friends had a dental technician uncle so she never went to a licensed dentist until she moved to another city at age 35.
The figure of prestanome or name-lender is as deeply rooted in Italian society as that of the Mafia consigliere. Years ago my secretary was inveigled by her first boss into being the official CEO of a shady import-export company, whose shenanigans eventually got her hauled into court. The judge took one look at her neckline and jeans and spat out in disgust, “She’s obviously just a prestanome.”
While name-lender dentists never used to risk more than a slap-on-the-wrist fine, lately the Medical Societies have started upping the ante. Last week’s headline was celebrating the very first time the Rome Medical Society had publically stripped a dentist of his licence, after the courts had found him guilty. This particularly bad actor, charitably left unnamed in the article, had abandoned hand-in-mouth dentistry years earlier in favor of skimming the profits off a chain of quack offices.
But, then, when I was studying medicine in New York it was whispered that patients at my Mount Sinai Hospital had been operated on for years by a neurosurgeon who didn’t have a medical license. As the Italians say, tutto il mondo รจ paese, everywhere in the world it’s the same village.

Tuesday, September 5, 2017

Scorecard: Money and Longevity

                                                                   United States      Italy
Gross Domestic Product per capita                $57,467          $30,527
Health spending per capita                             $9,892            $3,391
Life expectancy at birth                                  78.8 years      82.6 years
What’s Their Secret?

The main reason Italians get more bang for their health care buck is that they have a single-payer National Health Service, financed out of taxes. Everyone can see their own primary care doctor and be cared for in the hospital without paying a penny, while medications, testing, and specialist exams require at worst a tiny co-pay. Add in low income inequality and a famously healthy lifestyle, and Italy has more than enough on the plus side to compensate for its medical system’s many flaws.