Much has been written about the Italian health care system, and we were about to experience it first hand. Rather, we were about to experience Azienda Sanitaria Locale, a/k/a ASL, the agency that controls the health care system.

Before we moved, I did my research … of course … about insurance in Italy. Several websites extolled its virtues and there were sites that talked about coverage for visitors. Students and clergy people and workers can buy into the system while living la dolce vita … in case vita got amaro (bitter). As Americans, we were stunned at the rate. For about 400 euros a year, a person would have complete coverage. A year. 400 euros. From our POV, that was more than reasonable.

I’m in.

After we moved, we didn’t think immediately about buying insurance. But when David went to apply for his driver’s license, we were told that among the many steps, he had to get a medical certificate from his primary care physician. But we don’t have a primary care physician, we said … a statement that was met with blank stares. Our friend, Sandra, has a brother-in-law who is a doctor in the next town, and he was kind enough to agree to an appointment and the certificate. But he hesitated when we asked if he would be our regular doctor. Talk to the ASL office in your comune to get more information, he recommended.

ASL has offices everywhere … separate ones for separate concerns, including animals. So we found the local office, on the street that has the 25 x 25 painting of a mosquito on a building.

We pulled a number … ah, numbers … and waited. Plastic chairs, all looking in one direction like an auditorium, but facing a blank wall. Within half an hour, our number was called.

The woman was very nice as we explained our situation. It’s true, she said, that since you have American insurance you’re not required to buy Italian coverage. But you can. And when you have that coverage, you pick a local doctor as your primary. You should go talk with the people at the blah-blah office to get more information. Where is the blah-blah office? It’s the building with the fountain, near the hospital. We actually knew that building … so off we drove.

We walked past the fountains, into the building, and up to the front desk. We explained our situation, adding that the ASL office had suggested we talk with them. I don’t know why they sent you here … the people who can help are at the hospital. When you go inside the main entrance, you’ll see the desks.

Off we drove. We went inside, and saw the “desks” … one behind plexiglass, several bank-style stations with numbers suspended above. And at the entrance, of course, was a number dispenser. But not an ordinary number dispenser … one that required you select the type of service you needed. Surgery … specialist … appointments … x-ray. No category was right. And none of the staffers seemed willing look up, acknowledge a slightly raised I-have-a-quick-question hand to tell us which one was appropriate. We wandered past the windows, and through a big set of double doors to arrive at a desk behind venetian blinds. The man behind the curtain was willing to pay attention to us. Unfortunately, he said, the hospital is the place to get information about specialists, not general information we needed. He suggested (you guessed it) to go to the ASL office in our comune. We said we had started there … he shrugged, that knowing this-is-Italy shrug.

So off we drove, back to the ASL office … to find they had already closed for the day. Tuesdays and Thursdays 8.30 to 12.30.

Two days later, we returned. An hour of waiting, and we spoke with the same woman. Of course you can sign up for insurance … here’s the form to fill out. Once you submit it, we’ll tell you the exact cost. Exact cost?, we asked, surprise in our voices. Yes, the premium is based on your income from the last year. At that point, we didn’t understand why she thought the people at the fountain office would help us, when she had all the information we needed … but we kept our confusion to ourselves. It’s part of the charm.

The form was one page, slightly askew photocopied in a font that told me it was the form they had been using for a decade. Or more.

We did the math and estimated the dollar to euro rate of exchange. All nicely handwritten, we took it back to the ASL office.

By now, we were becoming friendly with the woman. Happy to practice her English, she wanted to know what brought Californians to her corner of Italy. Thus began our common response, siamo pazzi … we’re crazy. Ok, I’ll call you when I hear back from headquarters. Probably a week or two. (I already knew that meant two to three weeks.) And here is a list of the primary care physicians … but wait, this one is retiring and these two aren’t accepting new patients.

We decided to stop at one of the offices since it was nearby. On the ground floor of a three-story building, one opens the door directly into the waiting room. Crowded with patients, it seemed to be an ambulatorio … walk in, rather than by appointment. On the left wall were a couple of doors with name plaques next to each, and on the right, a hallway with more doors. At the back was a desk, with a receptionist. There is no number dispenser … so the protocol is to ask, Chi e’ ultimo? (Who’s last?), and then wait.

I looked around at the room filled with deaths’ heads and consumptives. If we weren’t the youngest people there, then these country folk had lived harsh lives indeed.

So … maybe I’d ask if Dr. G was, in fact, accepting new patients, rather than waiting and waiting. I walked over to the receptionist. When she looked up, eventually, I asked my question. Oh, I don’t work for him … and she turned back to her task. I returned to David, and sat down. We heard a nearby person cough or sneeze or wheeze … we exchanged looks and bid our hasty adieu.

Two and a half weeks later … how well I remember that call. We were standing outside the agriturismo of a new friend when my phone rang. I have the numbers for you, she began in Italian. It’s 1,700 euros for each of you. That’s for the calendar year. Scusa, I said … I couldn’t quite hear you, please repeat that. (Actually, I had heard her … my jaw was on the ground, and those were the only Italian words my mouth could form.) It’s 1,700 euros for each of you for a calendar year. Composing myself, I reminded her that it was already mid-September … well, you can sign up next January. Thank you … let me talk with my husband. Of course. the “husband approval” ploy.

We were stunned. $2,000 a year is a good price for annual coverage, especially since it starts at $0 … no deductible. But we already had insurance. David’s pension includes very good coverage, even overseas … we submit all the expenses that we’ve paid out-of-pocket and they reimburse a percentage. And we already realized that we pay the same rates the Italians pay to see a specialist and that visits to primary care physicians are often free. (Now your jaws are dropping.)

We were not enthused about paying 3,400 euros, an optional 3,400 euros.

I’m out.

January came and went … we didn’t buy insurance. We still haven’t bought insurance. We did check again a couple of year ago, thinking that without our Los Angeles salaries on the form, the rate would be lower. Nope. But we can change our minds any January.

We have also learned along the way that the system is not black and white, but 50 shades of grey. We mix and match some free appointments with the specialists, pick and choose how to get referrals and prescriptions … plus we have the luxury of being able to make trips to the United States. Isn’t that a thing? Medical vacations.

And so it goes.


When we had an abundance of cucumbers, I created this creamy, delicious, and refreshing soup.

6 to 7 cucumbers, peeled, seeded, and roughly chopped
Olive oil
1 clove garlic, minced
Bean broth, vegetable stock, or water

- In a large saucepan, with a lid saute garlic in olive oil. As soon as the garlic has a hint of gold, add the cucumber. Stir once or twice.
- Add the broth … you need an amount to just cover the cucumbers.
- Cover pan. Bring to a boil, then reduce heat to a simmer. Cook until the cucumbers are tender … 20 to 30 minutes.
- Let cool, then refrigerate.
- Using a stick blender, buzz the soup to puree the cucumbers.
- Serve cold.


Cucumbers … peeled, seeded, and thinly sliced
Salt and pepper
White wine vinegar

- In a bowl, combine the cucumbers and salt and pepper to taste. Toss.
- With a gentle hand, add vinegar. Toss.
- If you have time, let the mixture sit for an hour.
- Serve cold or cool.