Thoughts on Health Insurance

This summer we were in the US, and one night I saw a TV add in which a bunch of Canadian Senior Citizens who looked rather lost were shown taking a bus into the US for medial treatment, the message being that the Canadian national health insurance system didn't work and people were better off with the US pay-for-service/private-health-insurance system. To be frank, it made my skin crawl. Why? Couple of reasons.

When we were in a store in the US in 1995, Riccardo (aged 2 at the time) went one way while Betty went the other; the result was a yank that popped his elbow out of joint. Turns out that this dislocation is common enough to be known as nursemaid's elbow, and is also easy to fix: one straightens and then flexes the arm, and the joint goes back into place. Though Betty is an MD she had never done the maneuver, so we went to the Bryn Mawr hospital (in Bryn Mawr PA). The first response at our arrival wasn't "let's see the child." Rather, they asked if I had health insurance, and then how I'd pay for the treatment. Then the receptionist started making waiting-room type noises, though putting the joint back is a very quick thing. Fortunately, in getting Riccardo out of the car Betty jogged his arm and it went back into place by itself. How do I know the fix is quick? Because when he popped his elbow again in Italy, we drove him over to the hospital and the doctor fixed it. No fuss, no questions about paying, and we were out of the ER with R sucking a lollipop in less than 5 minutes. The Italian health program is completely free for all children under 6, and comprehensive, taking care of day-to-day things as well as illnesses. For example, we were notified every time he was due for a check up or vaccination, and had we missed an appointment they'd have called us to find out what was wrong.

Riccardo's elbow was relatively minor. Very different situation with my mother, who lost a long battle with cancer in 1998. During the last 6 months she had 6 major operations, and ended up paying thousands of dollars in fees of one sort or another and deductibles that weren't covered by her health plan (Blue Cross Blue Shield). What's more, there were billing errors she had to iron out, and all sorts of other things; the papers made for a 6-inch stack and I was still getting bills from various health providers 9 months after her death.

Compare this with what happened to my mother-in-law: She had a congenital cerebral aneurysm rupture on August 3, and the event triggered a severe vasoconstriction -- the circulatory system greatly reduced circulation to the brain in its attempt to halt the bleeding -- that produced results very similar to a stroke. Since the treatment for the one exacerbates the other, the doctors had to wait a week for the vasoconstriction to subside, and then operated on her to repair the aneurysm. 6 hours in surgery, followed by more complications; in all she spent a month in intensive care, and is now in rehabilitation. We've been told she should eventually recover almost completely, but we've still got a long road ahead of us. The paperwork and the cost for all this? Not sure about the paperwork, but no expenses at all, because she's over 65.

For people in-between, like me? I pay into the state system based on my income, and I'm covered. Some things do require one pay a deductible, and some elective procedures aren't covered, but most major things are, from broken bones, to transplants, to expensive drugs for things like AIDS. There are of course problems with the Italian system. Corruption, inefficiency, some diseases aren't that should be aren't included in the free category, and patients' families often end up helping with the nursing care if the patients are in regular (as opposed to intensive care) wards. Moreover, hospital patients are generally put in rooms with a number of beds (one can get a single by paying out of pocket), and there are waiting periods for elective procedures. On the other hand, doctors make house calls.

More importantly, one doesn't have to worry about finding a job that provides health insurance, or worry about loosing coverage for one reason or another (something a number of friends in the US are very worried about). Moreover, since the system isn't profit-driven, there's none of the pressure to keep costs down through denial of care or shortening of hospital stays that one often reads about in the US press. These things may seem minor when one is well, but if illness strikes close to home they become very important, and are a good argument in favor of a national plan. A second argument is purely pragmatic: National plans know they will end up paying for people's illnesses, and therefore have considerable incentive to catch things early by practicing preventive medicine, beginning with expectant mothers. As a result, the general population is healthier, and consequently more productive.

To those who would object to the cost of a national plan in the US, I'd reply that if one's company provides it one is already paying for it, because it's certainly not free. If one is paying for it privately, one would just pay a different organization, and if things are structured correctly -- as they are in Europe -- those who cannot now afford coverage will get it. In the long run, all will benefit.

Pan Fried Artichokes

Stepping off of the soapbox, artichoke season is rapidly approaching, and Aggie just posted this to the forum:

I just saw your post re "baby artichokes" and have a great recipe for you from my mother and aunt. We buy them at Sutton Place here in MD, and sometimes McGruders. They are sold by the pound (about $2.99 lb) and I usually get two pounds. First, cut the stems off, scrape away the outsides, and cut them in pieces. Then snap back the outer leaves, discarding just the hard parts. Then trim the stem ends of the artichokes, quarter them, rinse them, and boil everything in water that has some lemon juice in it. When they're half done, drain them well, wrap them in paper towels and squeeze them. In a bowl, put some breadcrumbs, Parmesan cheese, minced garlic, chopped parsley and ground pepper. (No salt is necessary, for the cheese does it all). Put some olive oil in a frying pan and set it over very low heat. Add a layer of artichoke, a layer of the breadcrumb/cheese mixture, and continue alternating layers, ending with the crumb mixture. Drizzle some olive oil over top, but not too much. Cover and slowly sauté on this very low heat. Do not let it brown or it will get hard. Add a little water if need be to keep moist. No need to turn it or stir it. When it's done you'll know. Delicious!

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Squid ink, and a tasty risotto

A couple of days ago I had risotto nero alle seppie, black risotto with cuttlefish, in Livorno's Ristorante Gennarino (Via S. Fortunata 11, Tel 0568 888 093, closed Wednesdays). It's called black because it's made with the animal's ink, which made it look very much like gravelly tar. However, it's extremely delicate, with much of the delicacy coming from the ink, which imparts an evenness to the cuttlefish flavor of the risotto that would have been absent otherwise.

Never had risotto nero alle seppie? Here's Pellegrino Artusi's recipe, from my translation of his book (The Art of Eating Well, Random House). It's about the only instance I'm aware of in Italian in which the word Fiorentina is associated with spinach:

Risotto Nero Colle Seppie alla Fiorentina -- Black Risotto with Cuttlefish, Florentine style

This invertebrate (Sepia officinalis), which belongs to the order of mollusks and the family of the cephalopods, is called calamaio [inkwell] in Florence, perhaps because nature has given it a sack containing a black liquid that can be used as ink with which to defend itself (in Tuscan, words are often formed through similes -- see below).

Tuscans, and in particular Florentines, whose love of vegetables is such that they’d willingly stuff them into everything, put beet greens into this dish, where they seem to me to go as well as baked bread goes with the creed [in other words, not at all]. This excessive use of greens is no doubt one of the reasons, and certainly not the least, behind the flaccid constitutions of some groups of people who bear up poorly under the stress of illness, and fall as thick as the leaves in late autumn.

Skin and open the cuttlefish to remove the unnecessary parts, i. e. the bone, mouth, eyes, and stomach; set aside the ink sacks. Wash the cuttlefish well and dice them. [Cleaned, they should weigh about 1 1/2 pounds.]

Finely mince two small onions, or better yet one onion and a clove of garlic, and sauté this mixture in a pot, in a quarter cup of good olive oil. When it's lightly browned, add the cuttlefish and wait till they begin to color before adding about a pound and a half of well washed, ribbed, and coarsely chopped beat greens. Mix well, and let the mixture simmer for about a half-hour, then add 3 cups of rice (the weight of the cuttlefish) and the ink. As soon as the rice absorbs the color from the ink, add boiling water and finish cooking the risotto [stir in water, a ladle at a time, until the rice reaches the al dente stage]. The rice should not be overcooked, and when we say dry we mean it should form a mound on the serving platter. You should, generally, accompany rice with grated Parmigiano, though you should forego the cheese when the rice is cooked with hard to digest ingredients like these, if you’ve got a delicate stomach.

Now I’ll give you another method, leaving the choice of which you prefer up to you. No beet greens, no ink, and when the cuttlefish begin to color, as above, add the rice and cook with boiling water and a half cup of tomato sauce or two tablespoons of tomato paste. A dollop of butter added will give the risotto grace, and when it’s almost done stir in some grated Parmigiano.

If you want an even better risotto, add, when the rice is half done, stir in 3/4 of a cup of freshly shelled peas.

(1) Artusi means the Tuscan language here. Modern Italian derives from Tuscan, and more specifically the variety of Tuscan spoken between Florence and Siena. When Alessandro Manzoni was working on "I Promessi Sposi" (The Betrothed), considered one of the great novels of all time, he announced he was going to "rinse his clothes in the Arno", and spent several months in Florence, listening to the way people talked. As a result, his Milanese characters speak using Florentine speech patterns. Back up.

Another idea for cuttlefish ink is Seppie Nere alla Veneziana, cuttlefish stewed in wine and broth with their ink and a little tomato. Venetians traditionally serve it with polenta, and it's very nice, especially when it's nippy out.

Not sure where to find the ink? If you live near a seaport, visit a market that has freshly caught fish and ask for an uncleaned squid or cuttlefish. When you get home, carefully cut around the beak, then pull out the mouthparts, which will have everything else attached to them including the ink sack. Be careful not to puncture it until you need it. If you're not near a seaport, I recently got an email from Sharon Allen at Moon River Seafood in Southern California (sharonsseafood@prodigy.net; Tel. 562-868-2765; Fax 562-864-3908) She sells ink in retail packages (not sure how big one is, but she'll email you a picture) or jars.

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Finally, a couple of announcements.

First, If you plan to be in northern Italy at the end of October and like to eat, visit Slow Food's Salone del Gusto in Torino, which is scheduled from October 25-29. There will be 500 plus espositiori -- producers of the finest artisanal foods of Italy and the world -- with their wares on display (and one is expected to taste), dozens of guided tasting sessions to help people discover new foods and the minutiae of those they thought they already knew (for example, a comparison of Spanish and Italian raw hams, Puglian cheeses, or American microbrewery beers), lectures, and restaurant meals planned for the occasion in Piemonte's finest restaurants, which are very fine indeed. I'm planning to diet before I set out for the thing. For further information, including a complete program listing, see http://www.salonedelgusto.com.

Second, I recently met Natalia de Reggi, who is launching Le Baccanti, a company that offers elegant and unusual wine tours in Tuscany. They're just starting out, but the tours look like they could be quite fun; see http://www.lebaccanti.com. Something to think of for next summer!

A presto,
Kyle Phillips
Webweaver, About Italian Cuisine

PS -- Send a card from the Italian Cuisine Post Office!

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