“Free healthcare”, doesn’t that sound great? Many, of course, agree that healthcare should be a right, not a luxury, and no one should have to choose between getting treatment and staying afloat financially. Italy prides itself on having a universal healthcare system, one that is supposed to take care of all citizens equally, but if you look closer, the reality is far messier and a lot less fair.
The Italian medical system is riddled with absurdities of heavy-handed regulation. Italy is the only place in Europe where it is mandated by law that joining a gym or participating in amateur sports requires a medical certificate from a doctor, which must be renewed annually. “Certificato medico sportivo non agonistico” is part of a public health policy aimed at preventing health emergencies during physical activity. All the while, Italy faces severe doctor shortages, amidst a wave of retirements and low intake of new medical graduates.
What is more, a recent study by G. Citoni, D. De Matteis, and M. Giannoni looked closely at how Italy’s healthcare system is funded and revealed that it significantly diverges from the fair healthcare system it is supposed to be. On paper, it promises vertical equity, but in practice, hidden taxes and uniform fees end up weighing more heavily on the poor, while many wealthy Italians quietly sidestep the system altogether. This is not just unfair, it is a warning sign that a government-controlled monopoly can never truly deliver justice or freedom.
Italian healthcare is managed regionally, and on paper, this decentralized system helps with efficiency and forwardness, since the regions can choose what is best for them. In reality, where you live matters a lot: some regions in the north, like Lombardy or Emilia-Romagna, have well-funded hospitals and quicker services; in the south, in places like Calabria or Campania, you often face long waits, understaffed clinics, and poor facilities. To try and even things out, money is transferred from richer regions to poorer ones, but this often just keeps inefficient systems running, rather than improving care; this leads to Northern taxpayers ending up frustrated, feeling like they are just bailing out problems that never get fixed, meanwhile, southern residents continue to wait, using the money of the north.
There is no doubt that income taxes and social security contributions are more progressive, as the wealthier do pay more here; but overall, the combination of all these taxes and fees means the system ends up being unfair in practice, even if that is not the intention.
Many wealthier Italians do not rely on public healthcare at all. They pay out of pocket for private care to avoid the headaches of the public system: long lines, slow service, and bureaucratic red tape; and so, despite the claim of universal care, in reality, the rich and poor live in two very different healthcare worlds, and one pays for the other, without getting anything in return. The government controls the entire system, and people have no real choice about how their money is spent or where they get care. They are stuck with a monopoly.
For anyone who believes in freedom, this is a problem: freedom means having options, being able to decide for yourself how to spend your money and where to get help when you are sick. It means having competition that drives everyone to deliver better quality and lower costs. It means personal responsibility, not being forced into a one-size-fits-all system.
Switzerland might be the perfect example. Everyone must have health insurance, but people can choose their provider: insurers compete, pushing services to improve, and people get more control over their care. It is not perfect, but it is a system built on choice, not coercion.
Italy does not need to copy Switzerland exactly, but it does need to move away from a state monopoly. The current system punishes the poor, rewards inefficiency, and limits freedom. Real reform would give people control over their healthcare spending, open the door to private alternatives, and break down the bureaucratic walls.
A healthcare system that forces everyone into the same mold cannot be truly fair. People are different in needs, in budgets and in preferences. Treating everyone the same often means treating the poor worse, just because they cannot choose. We can’t fix Italy’s healthcare by just adjusting taxes or fees here and there: we need a fresh approach, one that puts power back in the hands of individuals and families.
The aforementioned article highlights something crucial. True vertical equity in healthcare financing remains an elusive goal in Italy; instead, hidden taxes like VAT and mandatory co-pays place a heavier burden on everyone. Meanwhile, government control keeps the system rigid, inefficient, and unresponsive to individual needs. If we truly care about fairness and freedom, we must acknowledge that universal healthcare, as it stands, often fails both: it forces everyone into the same mold, disregarding personal responsibility and choice.
Imagine a healthcare landscape where people decide how to spend their own money, where private and public providers compete, and where innovation and efficiency flourish because they have to, not because the state demands it. Only by returning control to individuals and families can we achieve a healthcare system that is truly just.
Until then, the myth of “free” healthcare remains just that: a myth. Italy deserves better than a system that takes more from those with less while allowing the wealthy to opt out. It is time to embrace freedom, choice, and real equity in healthcare financing because true justice begins when people are free to make their own decisions.
