Commentary. With public investment below warning levels and services reduced to the bare minimum, Italians may soon have to face a choice not between public or private health care, but between getting treated or not.

Italians are angry about wages and healthcare, and Meloni knows it

The fact that the Turin students’ protest was met with police batons shows just how nervous is the atmosphere surrounding Giorgia Meloni these days – especially now that she has to deal with the thorny issue of healthcare. The day is approaching when the budget law will have to be sent to Parliament and Brussels, and Meloni is putting her hands up already, saying that “priorities are many and resources few.” When it comes to the revitalization of the National Health Service, the draft budget probably won’t even include those €4 billion requested, without much conviction, by Health Minister Orazio Schillaci.

Meloni knows that on wages and healthcare – issues that aren’t relevant only to opposition voters – her support is in danger of imploding. Even Transportation Minister Matteo Salvini has understood that this is a delicate moment. On Tuesday, as he boisterously hailed the new battery- and hydrogen-powered trains, he put on the proverbial hard hat – in this case, the stationmaster’s cap – and urged his own supporters to “not disturb the driver” for the next five years, “just like the sign says on buses.”

Nonetheless, the right-wing narrative is being dismantled by the friendly fire of the Economic and Financial Document Update Note (NADEF) drafted by Economy Minister Giancarlo Giorgetti, which predicts that, in the absence of radical interventions in the next budget, the share of GDP allocated to healthcare in 2024 will drop to 6.2 percent (while it remains above 10 percent in France and Germany).

Even more, according to the note, the decline is set to continue in the following years until public health spending returns to 2003 levels: turning the clock back by 20 years.

Meanwhile, the average age of the population has risen from 42 to 48, and the pandemic and environmental crises have brought out new health needs. So far, Italians have been meeting these needs out of their own pockets, bringing spending on private healthcare to over 40 billion euros. The NADEF numbers – which the markets have judged to be downright optimistic – thus show that the paltry four billion fruitlessly requested by Schillaci wouldn’t even be enough to make up for inflation, and would amount to a de facto cut in healthcare spending. And, if Giorgetti’s ministry is right, not even that amount will be found to begin with.

In Turin, speaking before the regional presidents, Meloni asked them “not to focus only on resources, but also reflect on how they’re being spent.” While this was a move aimed at distracting public opinion, it’s also a not entirely unfounded admonition to administrators of public funds: for more than two decades, health care has been organized on a regional basis, and plenty of waste and inefficiency originates in local government.

However, since coming to government, the right has fully indulged in this drift. This is evidenced by them dropping the idea of bringing territorial healthcare into the fold of the public service with NRRP funds, maintaining the regional spending ceilings that curb the hiring of health care workers in the public service, the subsidies to private pharmacies, the announced amnesty for medical device companies, and the refusal to abolish the limits on the numbers of medical school students, despite the fact that there aren’t enough recent graduates to fill the available places in specialization schools.

Even worse: speaking to the same “governors,” the Prime Minister reiterated her goal of differentiated autonomy, which would allow regions to expand their use of different kinds of health insurance schemes: another gift to private health care, reserved for those who can afford it.

With public investment below warning levels and services reduced to the bare minimum, Italians may soon have to face a choice not between public or private health care, but between getting treated or not. In 2022, according to ISTAT, four million Italians were already forced to forego care in the public system because of costs and waiting lists.

An intelligent opposition would have an opportunity to put the government on the ropes on the healthcare issue, whose importance is understood by everyone. Of course, this would require the humility to acknowledge that the national and local center-left has also often favored the privatization of medical services.

The opportunity to set out a path in a different direction will come on October 7, with a national demonstration that will unite NGOs and unions, as well as regular citizens, against the politics of the asocial right and in defense of the rights enshrined in the Italian Constitution. The right to healthcare is protected in Article 32 of the Constitution, and it’s number one in the order of importance right now.

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