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Austerity and the Americanization of health care was Italy’s problem

April 24, 2020

Topics: Quote of the Day

The Americanization of Italian health care plays a part in the country’s disastrous coronavirus outbreak.

By Vale Disamistade
The Nation, April 14, 2020

Democratic and Republican pundits have no shortage of bogus talking points to discredit calls for Medicare for All.

A memorable recent incarnation of this effort came when Democratic nominee Joe Biden weaponized the Italian health care system—which has been besieged by one of the world’s most lethal outbreaks of Covid-19—against universal health care during the March 15 Democratic presidential debate. “With all due respect to Medicare for All,” he said, “you have a single-payer system in Italy. It doesn’t work there.”

There’s really nothing a European like me enjoys more than listening to US politicians rant about the mythic “endless lines” and inadequate levels of care we face in our single-payer systems.

Before moving to the United States, I had never once worried about accessing the health care I needed. As for our waiting lines, nothing compares to the struggle to find an American doctor that will simultaneously take new patients and accept my insurance, or the endless process of disputing inflated bills and going back and forth with the web of insurance companies and private-sector middlemen that are somehow involved at every stage of even a simple procedure.

Here’s what Biden’s comments completely elide: When Covid-19 reached Italian shores, it found a country in the midst of a private-sector transformation that has been turning the country’s single-payer health care system into an Italian version of Biden’s beloved “public option”—and putting millions of people at risk in the process.

The callous slashing of public funding undertaken by all Italian administrations since the 1990s and the parallel proliferation of private clinics have left the country with fewer health care personnel and hospital beds, and longer wait times.

To be sure, Italian authorities’ mistakes were legion. But these failures have very little to do with the public nature of the health care system, and very much to do with the fatal ingredient in the cocktail of tardy responsiveness and at-risk demographics: a decade of austerity policies. Since the turn of the century, and more aggressively after the global recession of 2008, the Servizio Sanitario Nazionale (SSN), Italy’s universal health care system, has undergone continuous spending cuts and rounds of privatization.

The “Americanization” of the SSN has been ongoing since the 1990s, when Italy joined the European Union. But the 2008 global financial crisis acted as an accelerator, and when the recession really hit the country in 2011.

The Piani di rientro, policies aimed at containing health care expenditure across the country, became the fundamental instrument through which the then-decentralized network of regional health care services could be re-centralized under the unifying agenda of austerity. These financial recovery plans put regions with high deficits under the scrutiny of the Ministry of Health and, for the first time, the Ministry of Finance—turning the delivery of health care into an issue of financial stability.

In concrete figures, these plans have amounted to the cutting of €37 billion from the SNN since 2010. Between 2008 and 2017, a hiring freeze led to a decrease of 42,800 health care personnel—particularly doctors and nurses.

A study published as recently as last month shows how between 2004 and 2014 these policies worked really well at reducing costs. They also had the “inadvertent” consequence of increasing the rate of “avoidable deaths” by 3 percent.

If there is anything to blame for this catastrophe other than the virus itself, ask an Italian. Many of us have been saying it all along: Austerity kills.



By Don McCanne, M.D.

Italy’s lesson? Austerity kills.

Joe Biden says that Italy shows us that Medicare for All won’t work, yet freeing up a half trillion dollars in administrative waste by enacting and implementing single payer Medicare for All would go a very long way toward forestalling austerity in our health care system. Medicare for All will work.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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