“With all due respect for Medicare for All, you have a single-payer system in Italy — it doesn’t work there.” Such was Joe Biden’s reply to Bernie Sanders when the Vermont senator suggested that a universal public health care system is the protection America needs against the coronavirus epidemic. But for Italians closed up in their homes — in a country gripping on to its Servizio Sanitario Nazionale (SSN, National Health Care Service) as a last bastion of protection in these difficult times — Biden’s claims were simply unreal.
Yes, the advent of coronavirus is a tough test for Italian society — and one imposing hard sacrifices on all of us. For the last week, we’ve been living in near-total isolation, able to go out only for food shopping, for other urgent reasons, or — for those forced to do so — to go to work. Even the Italian cities normally considered most chaotic are now surreally deserted and silent; the economy is giving off troubling signs. There’s a tug-of-war between trade unions, businesses, and the government over the possibility of shutting down production to keep workers safe and the social policies needed to soften the crisis’s effects.
Yet even in such a trying situation, no one would dream of raising question marks over the SSN. Not even the most right-wing forces — not even the Italian equivalents of Donald Trump — are currently prepared to say anything about public health care other than to offer praise and support. Universal public health care is doubtless the reason why Italy hasn’t collapsed, explaining why the difficulties we face haven’t yet turned into mass tragedy.
This virus is lethal for the elderly, the immunosuppressed, and people with prior medical conditions — and also has grave consequences for many young people. In this troubling scenario, the only basis for confidence in the future, the only thing that can lessen our worries, is our ability to count on a constitutional guarantee that every sick person will be treated as best as possible, regardless of their personal finances. Today more than ever, something that Italians take for a fundamental individual right — a freedom from want, worth far more than many formal liberties that only the richest can truly enjoy — appears for what it really is, i.e., a public good. Faced with a pandemic, even the health of the wealthiest depends on everyone being promptly treated.
This is the reason why Italy — which today has the second most cases of contagion in any country — is still standing. Because every day, citizens can see the number of dead, but also the number who have recovered. And, as of this point, we are winning: 2,335 people hospitalized with grave symptoms have recovered, compared to 1,809 who have died. And none of the 124,899 Italians tested for COVID-19 has been charged a single euro. Among the many economic worries we might have in this period — the reason why Jacobin Italia is fighting for guaranteed income for workers and collective solidarity — one fear we don’t have is that we’ll lose our health coverage. Come what may, if we get ill, we will be aided and treated by well-prepared, expert medical personnel.
Privatization Is Hurting Here, Too
Does this mean the Italian health care system is perfect? Of course not. It’s still a battlefield for the Left, something that needs improving. The problem isn’t that this system is public and universal, but that it should be more so. Sadly, over time we have allowed the various Italian equivalents of Donald Trump and Joe Biden to make it a bit more like the American system.
The system’s origins date back to December 1978, when health minister Tina Anselmi (a former anti-fascist partisan, an MP for the Christian Democrats, and the first woman to become a minister) signed Law 833, which established the Servizio Sanitario Nazionale. The law’s first article proclaimed that “through the national health care service, the Republic protects health as a fundamental individual right and collective interest.”
This finally realized the principles proclaimed in article 32 of the Constitution, itself a product of the anti-fascist Resistance of 1943–1945. There was no longer to be a system of insurance schemes linked to people’s work, but a universal and public system on the model of Britain’s NHS (National Health Service), in which health is a right for each human being and the collective takes charge of guaranteeing it. Even at the outset, this was not a perfect system — there were some conservative choices, such as not counting dental treatment among the free care provided.
But this was a gigantic, civilizing step forward. Thanks to this guaranteed health care, among other things, while Italy has a GDP per capita at barely half the US level, Italians’ life expectancy is around four years higher. The average Italian lives to over eighty-three years of age — the fifth highest life expectancy in the world, while the United States languishes in thirty-fifth place.
Italy is a notoriously divided country — some commentators steeped in a patronizing Orientalism even consider it a nation “unable to follow the rules.” But today — even more than may have been expected — Italy is showing a capacity for social togetherness and collective solidarity while protecting the health care rights of the most vulnerable. It does so on the basis of the essential, committed work of doctors, nurses, cleaning staff, and all those working for our national health care service.
There are some worries over health care in Italy today — and they owe precisely to the fact that the system has been chipped away over the last twenty-five years — indeed, “Americanized.” In the early 1990s, off the back of Clintonism and the “Third Way,” various legislative measures introduced quasi-market elements into our public health service, greatly weakening its effectiveness while also regionalizing control over it. This had the effect that only the richest regions (although, fortunately enough now, the ones where this epidemic has hit hardest first) could keep guaranteeing the same standards we had all become used to.
This legacy of privatization is weakening our response to coronavirus today. According to the World Health Organization, between 1997 and 2015, the number of intensive care beds in Italy more than halved, from 575 per 100,000 people to 275. Faced with such cuts, the private sector has contributed very little — given the difficulties making money off these particular services. From 2009 to 2017, austerity measures taken as a supposed response to the economic crisis meant that Italy lost 8,000 doctors and 13,000 nurses.
The worrying thing, from an Italian perspective, is that the nurse who would have tested us for coronavirus has retired without being replaced or is herself elderly and thus now put at greater risk. And this pressure owes to the policies implemented by the Italian Trumps and Bidens — those who claim we don’t really need public health care. The criminal nature of such claims becomes clearer each day, with the war dispatches reporting the fresh numbers of casualties.
Faced with this emergency, no one in Italy is prepared to take such a dismissive stance. There is no party, politician, or commentator who doesn’t pay tribute — however hypocritically — to our universal health care system. Liberal economists are starting to doubt whether the market is able to provide the masks and respirators we need. The technocrats who once pushed austerity are now calling for European bonds to finance public health care. The government has suddenly started investing and hiring — putting the dogmas of “balanced budgets” into doubt — and questioning whether it’s fair that you get less health provision just because you happen to have been born in poorer Southern regions (the Italian equivalent of the idea dear to many Americans that you have to “earn” the right to health through work and income).
Italy is still standing because, despite the cuts, the system is still functioning. We could invest more money in health care —hopefully, all that we need. But the reason we can even think of doing this is because there is an organized health care system capable of putting these funds to good use — however under pressure it is now.
In last night’s debate, Biden compared the coronavirus emergency to a war. We don’t much like the metaphor, but we’re happy that we’re fighting it with an “army” that has been prepared over time, rather than rushing to hire private mercenaries when the enemy is already upon us. If we are worried, it is because for too long we have allowed our own Trumps and Bidens to cut staff numbers, facilities, and equipment, bringing us to where we are now. We hope our American friends can learn our lesson — and not make the same mistake.