Living In USA

Fortunately, there is a counter-trend to combat obesity. In the past decade, there has been a rise in the availability of healthier food in the form of organic (grown without pesticides or herbicides) produce and whole foods. Every city has at least one healthfood store, and there are even some supermarket chains (e.g., Freshfields, Wild Oats, Bread and Circus) that specialize in healthier, although costlier, food. Organic food is more widely available than ever before, often found at regular supermarkets as well as at specialty stores. There is also a "slow-food" movement to counter the prevalence of fast food. Begun in Italy in 1986, there about 80,000 members of Slow Food International worldwide (about half of them in Italy), a nonprofit organization designed to preserve and support the pleasures of the table. The international movement was founded in Paris in 1989, and Slow Food boasts more than 70 chapters throughout the United States. Consult www.slowfoodusa.org/ for information on a chapter near you.

The same Men's Fitness survey mentioned above also names the fittest cities in the U.S.: Honolulu, San Francisco, Virginia Beach, Denver, Colorado Springs, Seattle, Boston, Portland (Oregon), and Tucson topped the 2004 list in this category.

Although not yet technically considered a disease in its own right, obesity is nonetheless an epidemic in the United States. According to the American Obesity Association, the rate of obesity in the United States roughly doubled between 1970 and 2000, to over a third of all adults. Even more alarming is the rate of childhood obesity, although these increases are partly due to a 1998 change in the way obesity is calculated. According to the U.S. Bureau of the Census, in 2003 Americans ate an average of twenty-five pounds of candy each! Our love affair with the automobile, along with road construction that is decidedly bicycle/pedestrian-hostile, has made it difficult (and in some cases impossible) in many areas to walk from one place to another. Combined with the plethora of television programming and the rise of video games, the reality is that we get very little simple exercise. Amazingly, some people will go so far as to drive one or two miles to a gym in order to walk on a treadmill!

In addition, many foods are extraordinarily high in fat content, and our portions are quite large by almost any standard. Although some fast-food places have recently discontinued "super-size" from their menus, the "large" size is quite large enough. The fat content of many menu items is increased without noticeably increasing serving size. It is not just hamburgers, however, that should be viewed with caution. During that same period, one chain's small vanilla shake doubled its fat content. Another fast-food chain increased the saturated fat content of its french fries by 60 percent.

Fast-food giants gear their marketing toward children, hoping to develop loyal customers who will prefer the particular taste of their food items. According to Eric Schlosser in his book Fast Food Nation, McDonald's operates more playgrounds than any other private entity and is one of the largest distributors of toys in the United States. It uses a clown (who is depicted in advertisements as a child's one true friend) as its spokesman.

Not all overweight people are obese. In order to be considered obese, a person must exceed a body mass index (BMI) of 30, which is a ratio of body fat to height. This ratio, however, fails to distinguish between fat and muscle, differences in bone density, and other factors when determining whether a person is overwieght. Nonetheless, the social costs of obesity are high — lost productivity, increased healthcare costs, and shorter life spans can all be attributed to obesity. Each year, Men's Fitness magazine publishes an index of the fattest cities in the United States. While Detroit came in first in 2004, five of the top eight — Houston, Dallas, San Antonio, Fort Worth, and Arlington — are in Texas.

Smoking is now prohibited in restaurants in much of the country. No doubt the days of a cigarette between courses or at the end of a meal will someday be gone forever, which you may find refreshing or stifling depending on your feelings about smoking. The original rationale for these bans was health concerns about second-hand smoke, which is supported by some research studies but refuted by others. In reality, public support for these restrictions is high because fewer people smoke, and nonsmokers have become accustomed to (some would say self-righteous about) their right to cleaner air.

In the 1970s, restaurants were required to provide nonsmoking sections, which were typically small rooms or even just a few tables. Gradually, the non-smoking areas became larger and the smokers were banished to smaller tables. In many restaurants, even in locales without legal bans, smoking is not permitted at all on the premises.

The terms used in ordering or buying food can lead to fulfilled expectations or surprises. Use the wrong words and your coffee may turn into liquid candy or your entrée burned beyond recognition.

Meat
If you order steaks, roast beef, hamburgers, prime rib, and so on, the waiter may say, "How would you like it?" meaning whether you want your meat rare, medium, or well done. If you order it rare, the meat will be red inside; if medium, it will be pink; if well done, it will be completely cooked (and sometimes dry).

"Rare" is likely to be cooked just a little; "well done" to be very well cooked. If you prefer, you can indicate something in the middle by saying "medium rare" or "medium well."

Coffee
If you order coffee or tea, the waiter will sometimes ask, "Would you like cream?" If you would not, answer "Just black, please," meaning no cream or sugar. Sugar is generally already on the table, and often milk or cream is also, and the waiter brings the coffee black. Many people now ask for "decaf," meaning decaffeinated coffee. In New York City, "regular" coffee means liberal amounts of both cream and sugar. Elsewhere, it merely refers to coffee that hasn't been decaffeinated.

Coffee is a popular American drink at all hours of the day. It varies enormously in quality; you will just have to experiment to find places that make it the way you like it. Espresso and other specialties are often available, but you have to ask for them. Coffee-house chain stores, such as Starbuck's, Peet's, and Seattle Coffee Roasters, have sprung up in nearly every American city. These offer heartier, darker coffee than traditional American coffee, and a dizzying array of "specialty" coffee drinks as well as pastries and other food. A variety of kinds of tea is also available in these shops.

Tea
Tea is much less popular than coffee in the United States. It is often quite tasteless; perhaps we make it poorly because we don't drink it as much as other nationalities do. In public places tea is usually a shock to the new - comer. A cup of hot water (no longer boiling if it ever was) is brought in with a tea bag in the saucer. You are supposed to put the bag into the water and leave it there until the tea is as strong as you like it. In private homes you will sometimes find it brewed. Herb teas have also become popular in the United States.

Other Drinks
Next after coffee, Americans are likely to drink Coke or other soft drinks, milk, or fruit juices. Iced tea is usually good and is very popular in summer, as is iced coffee. Both can be served either sweetened or unsweetened, although unfortunately not often at the same place. If you want to drink water, you may have to ask for it, except in the more expensive restaurants. Tap water is safe anywhere, but you can request bottled water if you prefer the taste.

Eggs
The waiter at a restaurant will ask you, "How do you want your eggs?" Your answer can include any one of a wide range of possibilities: boiled, fried, scrambled, or poached; with or without ham or bacon or sausage. You also indicate the number of eggs you want. Most Americans consider one or two eggs normal. Boiled eggs are emptied into a cup — rarely, if ever, eaten out of the shell. Fried eggs may be "sunny-side up," meaning fried on one side only (with the yellow face showing);"over," meaning well fried on both sides; or "over easy," meaning fried lightly on both sides.

The addition of one or two slices of bacon, ham, or sausage may be quite expensive. Take a look at the price on the menu before ordering. Usually a listed breakfast is less expensive than ordering side dishes.

French Fries and Coleslaw
French fries are fried potatoes — usually sliced thinly like Belgian fritte, but sometimes they are sliced into wedges more like British "chips." You often get them with a meal whether you order them or not. The same is true of coleslaw — sliced cabbage and mayonnaise. If these are served with the meal, there is no extra charge for them.

Hot Dogs and Hamburgers
Usually hot dogs (frankfurters) are eaten in a long bread roll. The meat can be either beef or pork. You have your choice of adding tomato ketchup (spiced tomato sauce), mustard, pickle, relish, or onion (chopped and raw). Some people put all of these on at once! There is no charge for such condiments.

Hamburgers are one of the few purely American dishes. They are the staple of the fast-food chains (McDonald's, for example) and vary significantly in quality from restaurant to restaurant. They are supposed to be made of pure beef, with varying percentages of fat, though sometimes soybeans are mixed in with the meat. In both restaurants and fast-food places, unless you specify what you don't want, your burger usually comes with lettuce, tomato, onion, pickle, and a mayonnaise-type sauce.

Generally speaking, American food is considered rather bland by those accustomed to hot or spicy cuisines. Salads are very popular and are served all year round. Many people in this country have become weight and calorie conscious and are trying to keep down their weight. This is evident in menus offering low calorie (or in many cases, low carbohydrate) or "weight watchers" meals. Grocery stores now offer a huge array of low-fat, "light," no-fat, or "low-carb" foods, from ice cream to soup to snack foods. "Diet" drinks (meaning without sugar but full of artificial sweeteners) such as ginger ale or cola are also popular. If you do not want low-calorie items, read the labels carefully to avoid disappointing choices.

Waiters in restaurants tend to assume that everyone drinks coffee, especially at breakfast and after dinner, but you do not have to do so! Some people drink coffee (regular or decaffeinated) or tea with their meal; others drink wine or just water. When dining out, you can ask for tea, milk, soda, beer, wine, or water if you prefer these to coffee. Restaurants cannot serve beer, wine, or liquor unless they are licensed to do so. Normally, when eating in a home, it is considered polite to drink whatever is being served and not to ask for something different — unless the host gives you a choice or unless you prefer water.

The main course in American meals is usually meat, fowl, or fish, but rarely is more than one of these served at the same meal (except that sea - food can be used as an appetizer — shrimp cocktail, steamed clams, pickled herring, or smoked oysters, for example).

Most Americans eat quickly during the day — that is, breakfast and lunch — unless it is a social, business, or family occasion. Racing through daytime meals is part of the fast pace described earlier. Lunch breaks at work are limited to a half hour or an hour. There is also another reason for eating fast — others in public eating places are waiting for you to finish so they too can be served and get back to work on time. Each one hurries to make room for the next person. The evening meal, however, is usually leisurely and a family time — unless, of course, there are children (especially teenagers) involved in sports or other late-afternoon activities.

There is a real difference in leisure and timing here between a meal that is "social," meaning shared and enjoyed, and one that is "just a meal."

It is possible to be served a meal at any hour — including all night — in most large cities and many small ones, though you may have to look around a bit.

Some places offer Sunday "brunch"(or you might be invited to a brunch at someone's home). This is a combination of breakfast and lunch, served about 11:30 or noon for late Sunday sleepers. If you are outside a major city, it may be difficult to find a place that is open after 8:30 or 9:00 p.m., though lunch counters, diners, and fast-food shops usually stay open late.

In people's homes there is considerable variety as to eating times. The main meal is usually served in the evening, except perhaps on Sundays or holidays, when it may be eaten in the afternoon. In cities people often eat dinner about 7:00 or 7:30 p.m. Outside the cities most people dine earlier, at 6:00 or 6:30 p.m., or sometimes even earlier. The hour for cocktail parties is usually 5:00 or 5:30 p.m.

Some American bars are loud, smoky (in some cities, smoking is now prohibited in bars as well as restaurants — see below), and crowded; others are rather dark and meant for quiet conversation. Some bars are now a common meeting place for singles and can be quite lively, with a dance floor and loud music. Some bars cater particularly to gays and lesbians.

Unless you name the brand of alcohol you want, you are likely to get a less expensive "house" brand, which for most people is perfectly acceptable. We don't usually order beer by the pint or half pint, as you would in some countries. Ask for a glass of draft (usually ten to twelve fluid ounces, or one-third of a liter) or a bottle. There are many varieties of American beer, and it is served very cold. Imported beers, ales, and dark beer, are gaining popularity. Japanese, Chinese, and Mexican beer is often available in good restaurants and bars as well.

U.S. whiskey tends to be sweeter, more full-bodied, and cheaper than the whiskeys of Scotland or Ireland. Canadian whiskey is light. The main U.S. whiskeys are bourbon (made from corn) or a blend of several grains, known as "blended whiskey" and often incorrectly called "rye." If you want real rye whiskey, be sure the bartender understands. He or she will generally serve the blended type unless you make your desire clear.

If you like your drink at room temperature, be sure to say "No ice, please." Americans like most of their drinks ice cold.

An increasingly popular type of pub is a "brew house" or microbrewery. These feature a variety of beer and ale styles, some usually made on the premises. There are usually very good restaurants on site as well.

Fast-food chains, coffee shops, delicatessens (delis), lunch counters, and diners offer quick and inexpensive meals. The food and handling are inspected regularly by government officials, so you can usually feel safe about the food, although you are advised to choose a clean-looking place nonetheless. These places are crowded with people at normal mealtimes, particularly over the lunch hour, but if you eat a little early or a little late, you can usually get a seat without waiting too long. They can be found everywhere, are open long hours, and are useful in keeping your food budget down.

Diners are often found on the outskirts of towns. They vary from clean and shiny to rather old and run down. Truck drivers often stop at them because they are likely to have good parking facilities and serve large portions of good food at low prices. Furthermore, there is often an interesting cross section of people in them, especially in the early morning hours when long-distance truck drivers are eating breakfast. Some diners, built from the earliest prefabricated buildings, are remnants of another era. These have fan clubs with elaborate photographic books devoted to them. You do not generally tip at delis, where you serve yourself, or at fast-food restaurants, but you do leave a minimum tip at lunch counters and diners, say 10 to 15 percent.

Fast-food places (where a limited menu is precooked and ready for rapid dispensing and quick consumption) have become very widespread and popular in the United States. Such chains as McDonald's, Kentucky Fried Chicken (KFC), Burger King, Subway, Jack-in-the-Box, Carl's Jr., Taco Bell, and Wendy's cater to millions of people who want quick service and fairly good food in clean, simple surroundings. There is no tipping, though in many cases you are expected to clear your own table and discard your trash in the containers provided. Fast-food shops are especially appealing to children and young people. By and large, these are not places to take a date!

Although not technically fast food, some restaurants provide full service quickly. Chains include Friendly's, Cracker Barrel, International House of Pancakes (called "I-HOP"), Shoney's, Perkins, Bob Evans, and many others. These emphasize breakfast foods, but offer other items as well.

Because the United States is home to so many different nationalities, you will be able to find almost any kind of restaurant in the large cities. Listings in the Yellow Pages may be by national cuisine or by area of the city or both. Restaurants range widely in price. Many post their menus in the window so you can get an idea of prices before you enter. If not, you may want to ask to see a menu before you are seated, or else just ask about the price range. Appearances from the outside can be deceptive — what looks small and inconspicuous may turn out to be very expensive, or a nicely decorated place may be quite moderate. It works both ways. You can get a good meal for about five to eight dollars in cafeterias or fast-food chains, but in a medium-priced city restaurant you should expect to pay fifteen dollars and up per person — with wine or drinks extra. Prices in big cities go up fast! Beware of state no-smoking laws in all establishments serving food. In most states patrons in restaurants are no longer permitted to smoke — and you will be unpleasantly surprised if you light up (see "Smoking" below).

If you are going to a middle - or upper-level restaurant to dine, telephone ahead for a reservation — the earlier the better. Keep to the time of your reservation or else phone to say you will be late. Good restaurants will not hold reservations for more than a short time. If you are turned away or asked to wait because you have not reserved ahead, don't take it personally. The management has no choice. Fire laws are extremely strict about the number of occupants, and unannounced fire inspections are frequent. No restaurant owner dares overcrowd his or her establishment.

Many mid-level restaurants will not accept reservations and operate on a first-come, first-served basis. The only way to find out if a restaurant takes reservations is to call.

Along with finding a place to stay, finding something to eat is likely to be foremost on your mind when you arrive. Food is very closely linked to culture, and while most Americans might deny it, there is a dominant style of food that is common here. This chapter explores types of restaurants, styles of food, our food habits, and food customs.

Most cities feature inexpensive paperback books, usually available in bookstores, covering their eating places, or you can check local magazines and newspapers for advertisements. Your colleagues at school or work, or hotel personnel, will be glad to offer suggestions, too.

Hotels
Most people start their visit to the United States by staying in a hotel. You will find that hotel restaurants, grills, and lounges are nearly always more expensive than neighborhood restaurants. It is worth wandering up and down the nearby streets to see if you can find something less expensive and more enjoyable. The hotel employees might also suggest nearby restaurants. Coffee shops in a hotel are sometimes less expensive than restaurants.

You might think this subject need not concern you. Unfortunately, there is a growing need for everyone to carry liability insurance as well as health insurance, because an increasing number of people are claiming high damages after even the simplest and most ordinary of accidents. If someone trips on your front step, or your dog knocks over a child, or your cleaning woman gets burned on your stove, he or she could — and a growing number do — enter a lawsuit against you and claim damages out of all proportion to the accident. Courts assume that everyone is covered by insurance, so they often award far more in damages than would seem reasonable to most of us. If you do not carry insurance for such a situation, you could be in serious financial trouble.

The term to use when inquiring is comprehensive liability, which is included in a homeowner's policy. An insurance agent will advise you about the proper level of coverage for your income, the size of your family, and so on. Be sure to consult a responsible agent who will not sell you more insurance than you need. Find an agent through your firm, someone you know in a bank, a friend, or a lawyer. When you get the agent's advice, it is a good idea to discuss what has been recommended with a colleague or friend before actually signing any contract. The more the agent tries to rush you, the more cautious you should be.

You should also seek advice on other kinds of insurance according to the value of your possessions and property. If you did not bring any jewelry, fine paintings, or furniture, you may not need to carry such property insurance as fire or theft, but you should discuss this carefully with a knowledgeable person. Generally speaking, you need cover only a few selected, expensive, and irreplaceable possessions (such as jewels, furs, or cameras, for example) for theft. If you are renting an apartment, you can buy an inexpensive renters' insurance policy. If you buy a home, a homeowner's policy is mandatory, and it is probably worth an upgrade of both the liability and the personal property portions. You will need adequate health and accident insurance because medical costs are so high here, and you need auto insurance if you plan to drive.

There are some simple precautions that will help prevent fires. Do not burn trash on your own. Most populated areas of the country have laws that forbid trash burning by individuals. Trash is placed in cans or strong plastic bags for pickup by the garbage collectors. In apartment houses, follow the trash instructions for the building.

Most house fires are caused by burning fat, by defective electrical wiring, or by cigarettes. Never leave your home — even for a minute — while anything is cooking. All homes should have a small foam fire extinguisher near the stove; these are good for either fat or electrical fires. You can buy small portable ones at most hardware stores. Be sure to check the date before you buy — they deteriorate with age. Also, keep a box or two of baking soda handy. It quickly smothers grease or oil flames. Smoke alarms are required by law in most places. They are inexpensive, are easily installed, and are good warnings, especially at night. They are also available in most hardware stores.

As mentioned earlier, in most communities in the United States, the telephone number to call in case of an emergency is 9-1-1. This was mandated by federal law to be completed by late 2003, but in a few communities regular telephone numbers (for fire, police, and ambulance services) are still used and will be listed in a prominent place in the local phone directory (such as the inside front cover). If this is the case, be sure to write the number down and post it on or near the phone. You should use the emergency number for fire, the police, and medical emergencies. You can also dial "0" to get an operator who will connect you to the emergency number. Keep in mind, however, that if you dial an operator (or if you call 9-1-1 on a cell phone), you will not immediately alert officials to your location. The most important thing is to remain calm enough to relay the essential information quickly. Sadly, the nation's 9-1-1 system is not fully funded, resulting in long waits in large urban areas. Furthering the problem is the widespread inappropriate use of the number, tying up the lines with complaints of noisy neighbors and requests for directions. Remember that 9-1-1 is for emergencies, not for general help.

As humorist Garrison Keillor once observed, there are still small towns in the U.S. where some people not only refuse to lock their doors, they forget where they put their keys years ago! Nevertheless, locks only work if you use them. Never leave the door to your house, hotel, or apartment unlocked; be careful not to leave a key in the door by mistake, even for a short time. Also, don't leave your door open, ajar, or unlocked, even if you are just going out to empty the trash or talk with a neighbor. It is a good precaution to use the inside chain on the door, especially at night. Most hotels, apartments, and homes are now equipped with dead-bolt locks in addition to the regular locks on the doorknobs.

Most city apartments have peepholes through which you can see who is at your door before you open it. Others have TV systems in the front lobby or some voice identification arrangement. Use whatever system is provided; it is there for your protection. If you live on the ground floor or face a fire escape and are worried about your windows, talk to the superintendent about window locks or security screens. Don't open a door unless you know who is there. Don't admit a salesperson, repairman, or delivery person unless you know or are expecting the person. Many service people carry an identification card issued to them by their companies. Ask to see it.

None of this is meant to frighten you, but it is common sense. If you use the various safeguards that exist, then you can feel secure, relaxed, and protected. If you do not, you are taking a chance almost anywhere nowadays.

If you lock yourself out of your apartment by mistake, the superintendent can let you in again with a master key kept for such emergencies. Some people also leave a spare key with a trusted neighbor for just such moments of need. In most large cities there are locksmiths available on 24hour duty. Look under "Locksmiths" in the Yellow Pages. They can be lifesavers if, for example, you break off the key in your car lock by mistake.

Women who are alone are far more free here than in many parts of the world; one sees unescorted women almost anywhere. Unfortunately, however, crime is widespread here and certain precautions are necessary.

A woman can feel safe in planes, buses, and trains (day or night). It is safe for a woman to drive long distances alone. Service station attendants and hotel and motel personnel will give friendly help; if there is trouble with the car along the way, a single woman will nearly always get help from passersby (although here, too, caution should be exercised) or the highway patrol. If your car does break down, you should try to pull as far off the road on the right side as possible. Turn on the emergency flashers and raise the hood, then wait with the car for help to arrive. In most locations, even on deserted stretches of road, a highway patrol car will arrive before too long. But if a woman (or a man, for that matter) is driving alone in a city, it is wise to keep the car doors locked and valuables out of sight. These two simple habits can prevent someone from jumping quickly into the car at a stoplight or grabbing something through an open window.

Cities become less safe after dark. Stay on well-populated and well-lit streets; take taxis after about 9:00 p.m. Hold your purse carefully, don't let shoulder bags hang loosely, and don't wear valuable jewelry until you reach your destination. With the high price of gold and gems, jewelry is a hot item among thieves.

It is best to ask locally which streets (and areas) are safe and which are not, although the responses often reveal as much information about your informant's prejudices as about the safety realities. Remember that looks can be deceiving; some dark areas can be safe; well-lit ones may be dangerous at quiet times (such as Wall Street after the business world goes home). Visitors to the United States should be particularly careful about safety. Until you have been here for a while, you won't know how to judge whether a situation, a person, or a place is dangerous because you won't know how to "read" the clues.

Everyone knows that cities around the world are full of problems and are sometimes dangerous; however, you need not miss the many advantages cities offer if you take precautions and use common sense. Then the chances of having a misfortune — while not totally removed — are very much diminished.

Safety on the Streets
When you walk after dark, keep to the more heavily traveled and well-lit streets. If you have to go through dangerous areas, go by bus or taxi. Try to board your bus in a populated area rather than at a bus stop in a deserted locality.

Avoid parks after dark; if you are passing one, walk on the opposite side of the street. People with bad intent often loiter in dark places. They like the edges of parks because they can make a quick escape. They also like doorways and alleys. If you feel apprehensive, walk on the curb side of the sidewalk.

If you have to wait in a train or bus terminal at night, do so in the main waiting room, where it is light and people are passing, or else choose a place in sight of a guard or police officer. Avoid subway travel in the late evening when stations are likely to be fairly deserted.

Most — but not all — crime in the United States takes place in dark, rather predictable places where there are few people about. Reasonable precautions such as the above will markedly reduce your chance of trouble. Find out about neighborhoods or areas of the city to avoid after dark (or at any time).

Because medical costs are high, insurance is necessary. There are many excellent free public facilities for the poor, but they are so crowded and the waiting time so long that most people who can afford to use private doctors do so. More important, as a non-American (that is, until you have obtained permanent residence), you are not permitted to take advantage of publicly funded medical care. You will not be turned away, but there may be consequences later with your immigration status. As of yet, there is no national system of health care coverage (except for Medicare, which covers persons sixty-five years of age and over), but the issue is hotly debated.

At the present time, the great majority of American people subscribe to private insurance programs, which help to pay for hospital and doctor bills. You should join such a program also. If you work for an American company, there is quite likely a group insurance plan to which you and your family will automatically belong, but you should find out about this in detail. Payments for such plans are usually partially paid by the employer; your contribution is made through automatic payroll deductions. Find out exactly what the coverage includes, because this varies from one plan to another. Also, check the deductible (the amount you must pay before the insurance covers the cost). Many insurance programs require a "copay," which is a fixed amount you pay for each medical treatment. While these are usually modest, they can add up to a significant amount for those who have chronic conditions requiring frequent visits to a doctor.

If you are working for an organization that does not have group insurance, you should purchase private health insurance for yourself and your family. One bad accident or serious illness could cost you a great deal of money. Most insurance plans are open to international personnel after they have lived in the United States for six months; some will cover them earlier than that. Ask at your company about a good insurance adviser or ask your doctor. This should be done immediately after arrival in this country.

Foreign students enrolled in U.S. colleges and universities are usually required, either by their institution or by the state it is located in, to have medical insurance (by federal regulation, J-1 students and scholars must have insurance). They also pay their college infirmary fee, which entitles them to receive full infirmary care whenever they need it. They can also purchase additional low-cost accident insurance, which is recommended and often required. The university or college catalogue will give details, and the foreign student adviser will inform new students about the insurance plan recommended by the school. Dependent family members are often not eligible for infirmary care and should be covered with outside health insurance.

Medical insurance almost never covers all expenses. Read the policy carefully and have someone explain it to you in detail. Coverage varies widely from one policy to another. Some policies include medications and basic dental care, but few cover eyeglasses. You can have these specialties added, but the cost rises sharply with each one. Be sure to think over carefully exactly what you need, balancing the cost of the policy against those services you can afford. Eyeglasses generally cost between 50 and 200 dollars, more if you do not have your written prescription from an eye doctor.

Before selecting a health insurance agent, it is a good idea to obtain advice from a colleague or friend. Most agents are reliable, but some are not; you will need help in selecting a reputable firm.

Be prepared to present your insurance card before receiving services at a hospital. If you have no insurance, be prepared to arrange for payment of all hospital bills before taking the patient home. Your corporation or your insurance may cover such matters for you; otherwise, the hospital may demand full payment — even if this requires your taking out a loan to cover it. It is advisable to talk to your employer, your doctor, or your insurance agent about this so you will know your own situation before an emergency arises. Occasionally, hospitals will agree to have payments spread over a period of time.

In most of the country the emergency number for ambulance, police, or fire is 9-1-1, but it is wise to check this locally, especially if you are far from large cities. If you do not know the emergency number, just dial "0" for the operator and tell him or her about your situation, but do not forget to give your address and telephone number. If you hang up without giving this critical information, you will have wasted precious moments while the operator tries to trace the call. If you can, go directly to the emergency room of the nearest hospital. Emergency rooms are set up to deal with serious accidents and acute illnesses (such as a heart attack). It is a good idea to find out where this facility is located before you need it. They are equipped to respond quickly to life-threatening situations. However, calling 9-1-1 and requesting an ambulance may be the most prudent course.

Urgent Care
If you have an urgent medical concern that does not qualify as an emergency, the first step is to call your doctor. If you do not have a doctor — or if he or she is unavailable — go to the emergency room of the nearest hospital. Less serious illnesses and accidents, although they may occur without warning, are treated by family physicians and in walk-in clinics. Some hospitals also have an "express care" or "urgent care" service, separate from their emergency services. There are even urgent care or walk-in clinics, separate from hospitals, that may provide quicker treatment of many serious (but not life-threatening) medical conditions such as broken limbs or fevers. These tend to be less expensive than the emergency room and you will not likely have to wait too long, unlike an emergency room where more serious injuries are treated before minor ones.

Although health care is expensive in the United States, it is good and in most cases very thorough. People are referred to hospitals more often here than in many other countries. If this happens to you, be sure you understand from the doctor exactly what the reason is before you become worried. It often means only that the doctor wants to make use of special facilities for tests, X-rays, or treatment procedures, or wants to have you observed at frequent intervals over a period of days by a trained staff. It does not necessarily mean that the doctor thinks you are seriously ill.

For general medical care, most people's primary doctor is a family practice specialist — someone who will provide routine care for all members of the family and who can refer you to other kinds of specialists when necessary. There are two kinds of specialists who are often contacted immediately — a pediatrician if there is a young child in the family and a gynecologist for adolescent girls and women. Many general practitioners, however, are qualified and experienced in treating children and gynecological matters.

There are numerous medical groups that give patients access to a number of doctors rather than one. They emphasize family practice — taking care of all the medical needs of family members in one place and providing service at all times with one or another of the group members available on call. Many of these groups are referred to as health maintenance organizations, or HMOs. Some are attached to hospitals, but most are independent, and the physicians have privileges at local hospitals. Most HMOs have listings of doctors in your area who are members, and a few HMOs combine health insurance and health care into one organization.

How do you go about finding a reliable doctor? Physicians are listed in the classified telephone directory (often called the Yellow Pages), and many even advertise their services, but people usually find doctors by asking friends and acquaintances about their experiences with medical care. There are a variety of ways to search. Your company may advise you. Often there is a company doctor or an arrangement with a medical group, which is a great help. Perhaps you can ask your neighbors, or the person from whom you rent your apartment, or the head of your child's school. The officer at the bank or someone at your church, mosque, or synagogue may also give you advice. Your own consulate may have a list of doctors who speak your language.

Don't necessarily accept the first physician suggested. People have different needs. Most physicians are very well trained in the United States, so you rarely have to worry about technical competence. Probably the most important consideration, and one you can judge easily, is personality. You will want to find someone who is easy to talk with and in whom you have confidence. You may also want to inquire about costs if that is important to you.

If it is difficult to obtain a personal recommendation from someone you know, call the County Medical Society or the Physician Referral Service in your area. These offices can either provide a list of physicians or tell you where you can get this information. You can also call the administrator's office at the nearest hospital and ask for the names and office addresses of doctors with privileges at their hospital. This way you will find well-trained doctors with nearby hospital affiliations. Neither the hospital nor the County Medical Society will recommend one doctor; they will always provide several names. When you have been given the names and telephone numbers of several doctors, make an appointment with one of them. Take your family's health records and ask about fees, hospital connections, and anything else you want to know. If the doctor's experience, medical training, and personality seem right to you, you will probably want to become a regular patient and return whenever necessary. If not, you may want to look for another doctor.

Many doctors have so many regular patients that they will not accept new ones. Simply keep trying until you find one who is able to accommodate you as a patient. Don't feel shy about discussing fees when you first make these contacts. They can vary, and it is better to know in advance the approximate fees any given physician is likely to charge. Medical care is extremely expensive in the United States, and it is important to know what costs to expect.

When people move to a new, unfamiliar country, they are often quite concerned about what might happen if they get sick. This is an understandable fear because medical practices and the customs that surround illness differ, sometimes dramatically, from culture to culture. Even if the medical care you receive is excellent, as it usually is in this country, there is still discomfort because it is not what you are accustomed to, and because you may be far from people who would normally assist and comfort you. The information below is intended to help you understand the practice of medicine in the United States so that you can obtain care with as little apprehension as possible.

Before You Leave Home
The first step in obtaining medical care in a new country is to bring your family's health records with you, if possible. This provides your new physician with a complete history of past medical experience and may help you save on expensive tests or background studies. Also, have all necessary dental work done before you leave home; costs for dental care in the States are nearly as high as those for medical care, and insurance rarely covers all procedures.

If you wear eyeglasses or contact lenses, have an extra pair with you and be sure to bring a copy of your prescription. If you are on regular medication, it is a good idea to bring a copy of the prescription and information from your physician at home about the condition for which the medication is required.

Some people from other countries — and also some in the United States — are opposed to tipping, considering it undemocratic and demeaning. Furthermore, it is illogical — waiters, porters, and hairdressers are tipped, while airline attendants, store clerks, and insurance agents are not. Many feel that people should receive an adequate salary rather than tips.

However you feel about this, the fact is that in the United States many people do depend to a large extent on tips for their livelihood. In some fields of work, wages are simply not adequate. The theory is that by compensating people through tips rather than on a straight salary, you encourage good service. Although that is debatable, the system prevails.

You do not have to tip. If you are dissatisfied with service, you can show it by reducing or withholding a tip. But generally speaking, tipping is expected in the United States. It is a way of saying thank you to people who provide services for you. One exception to this is in a restaurant when your party is a large one. Very often a flat 15 percent gratuity is added to your bill. Check carefully in order to avoid tipping twice.

People You Tip in the United States
Waiters, taxi drivers, porters, doormen, hat-and-coat-check attendants, and delivery people should all be tipped. You also tip for personal services from barbers, shoe shiners, hair stylists (or beauticians), and so on. Parking lot attendants should be tipped only if they have parked your car or brought it for you.

Unfortunately, many employers of these workers underpay, considering tips to be part of the wages. If you do not tip, therefore, you are depriving the worker of needed income.

People You do Not Tip
Customs officials or other government employees, such as police officers or firefighters. This is considered bribery.

Postal employees and other commercial delivery people. Although mail deliverers are not tipped, people often give them a gift around the winter holidays of five to ten dollars. The same goes for package delivery service drivers (such as United Parcel Service and Federal Express if you receive regular packages from them), as well as newspaper deliverers.

Airline flight attendants or ticket agents.

Room clerks or people at hotel desks (unlike the European concierge system).

Bus drivers. If, however, they also serve as guides on guided tours, then give them a few dollars and thank them as you leave.

Store clerks.

Gas station attendants.

Elevator operators, receptionists, or telephone operators.

Employees in private clubs.

Theater or movie ushers.

Normal Tips
Tipping customs and amounts vary considerably from one part of the United States to another, as well as from small towns to large cities. When you are settled in your area, you should ask about this locally.

To put newcomers at ease during their initial few days, the following guidelines are offered.

Porters. A dollar or two per bag is customary. Some people tip more if the bags are heavy and difficult to handle.

Taxi drivers. The driver will expect 15 to 20 percent. If there are several of you, or if you have a lot of luggage, give at least 20 percent. In some cities there is an extra charge for each passenger. Such variations are posted in the cab.

Waiters. Give at least 15 to 20 percent to the waiter. A service charge is generally not included in the bill. Give the waiter more if you are particularly satisfied with the service, have asked for extras, had a large group, or requested help in understanding the menu or in serving young children; in other words, if you have received more than normal service. If you are part of a group of six or more, a 15 percent gratuity is generally added to your bill. As in other countries, tips are naturally higher in finer restaurants. In such a place your tip for the waiter should not be less than 20 percent. If you order wine, the wine steward may expect a tip as well as the waiter. In a low-priced diner or cafe, the tip is about 10 percent, or at least a dollar per person or a quarter under your plate for just a cup of coffee or tea. If you order room service in a hotel, 15 to 20 percent of the bill is proper.

Doormen. For normal daily services, you do not tip except when they call a taxi for you. Then give them a couple of dollars. If they help with a great deal of luggage at any time, give them three to five dollars, depending on the amount of trouble taken. Most people give the doormen of their apartment houses occasional tips — ranging from one to five dollars — for any extra services they may perform, for special occasions, or for a good many small services done over a considerable length of time (that have gone untipped). This is not required, but it helps to keep service friendly and helpful.

Personal services. It is hard to give a rule of thumb as to how much to tip barbers, hairdressers, delivery people, parking lot attendants, the maid who looks after your hotel room, and other people who serve you. Rates vary, depending on the part of the country, how much service they have given, and other factors. The best advice is to ask locally, though if you ask four or five people in your office, at a party, or in your neighborhood about tipping, you will undoubtedly receive varied answers. If you cannot find anyone to ask easily, you can say directly to the person involved, "I would like to give you something extra for your service but I am a stranger here. What is the normal tip?" Almost surely you will get a big smile and an honest answer.

The holidays. The winter holidays are special — and expensive. Here are some suggestions. If you live in an apartment house where there are doormen, give each one of them a gift of ten dollars or more during the holidays. The amount will vary, depending on how long you have been living there, the size of your family, and how many other tips you have given throughout the year. Also, the superintendent of your apartment house should receive a gift of twenty dollars or more. If there are other service people such as trash collectors, porters, or telephone operators, you may also want to give them five dollars or so. Holiday tips are also sometimes given to the tradespeople one sees regularly — the laundry attendant, newspaper deliverer, parking lot attendant, hairdresser, or barber. These tips are flexible, depending on how often they have served you and on your financial situation. But if you feel friendly toward them, three to five dollars in a holiday card would be much appreciated by any of these people who have worked for you throughout the year.