What happens to public healthcare when lobbying interests prevail?

There was a time in Italian history when everything seemed possible. It lasted less than people tend to believe — from 1947 to 1964 — yet it was enough to be remembered as a true economic miracle, one that transformed Italy into one of the leading Western economies.

Without underestimating the postwar drive for recovery, economist Nicola Rossi, in Un miracolo non fa il santo, identified two main factors behind that brief season of growth: a liberal economic policy aimed at fostering bottom-up innovation, shaped by the Schumpeterian idea of creative destruction; and the emergence of the modern welfare state. It is no coincidence that during those years the foundations of the Italian National Health Service were laid — officially established in 1978 — replacing the previous mutual aid system and guaranteeing the right to health as both a fundamental individual right and a collective interest.

Then, over the decades that followed — much as it had during the first eighty years after unification — Italy returned to protecting rather than creating businesses and prosperity. We became a country of privileges at the expense of the common good. And the consequences are increasingly visible, both in the numbers of economic growth, which remain sluggish even beyond the global slowdown, and in the shrinking access to opportunities, now reserved for fewer and fewer people.

The latest Oxfam Report confirms this dramatically. Between December 2010 and June 2025, Italy’s net national wealth increased by more than €2 trillion in nominal terms, yet 91% of that increase was concentrated in the hands of the richest 5% of households, while the poorest half of the population received just 2.7% of the overall increase. Alongside this polarization, wealth accumulation has increasingly been driven by inheritance, whose weight within total national wealth continues to grow, while inequality in net income distribution has worsened, placing Italy twentieth out of twenty-seven EU countries in terms of fairness. According to Oxfam, the recovery of purchasing power remains distant, and wage stagnation continues to go hand in hand with growing income inequality and in-work poverty.

Suffice it to say that between 1990 and 2018, the share of low-paid workers in the private sector rose from 26.7% to 31.1%. The counterpart to this trend has been the slow but relentless expansion of both absolute and relative poverty. In 2024, more than 2.2 million households — equal to 5.7 million people — were living with insufficient monthly resources to afford basic goods and essential services. Healthcare is one of the clearest examples of a decline rooted in the triumph of privileged interests over the collective good.

Codice Rosso. Come la Sanità pubblica è diventata un affare privato by Milena Gabanelli and Simona Ravizza reconstructs the story of how we stripped family doctors first, and hospital doctors later, of their dignity and purpose, creating a perverse system that is dismantling the National Health Service in favor of private healthcare. In open contradiction to Article 32 of the Italian Constitution. “Public-private collusion is built on converging interests: you bring me votes, and I grant you accreditation. Then you can do whatever you want. I appoint the most loyal directors in my local health authorities, not necessarily the most competent ones. Then I bury hospitals in bureaucracy […]. On the side of accredited private providers, the goal is profit, and doctors are paid according to revenue. […] Waiting lists, meanwhile, are better left unresolved, so that more patients will choose to pay out of pocket.”

The consequences are at least threefold. First: access to healthcare becomes a privilege reserved for those who can afford private facilities or have insurance coverage. According to data from ISTAT and the latest BES Report, the share of people forced to forgo essential healthcare reached 7.6% of the population in 2023, up from 7.0% the previous year. Second: recruitment and career advancement are no longer based on competence, but on personal connections and loyalty — not only for healthcare professionals, but also for those responsible for training future family doctors. Third: because of these dynamics and converging interests, positions of power increasingly belong to those who facilitate profit accumulation rather than patient care. Not to mention the longstanding overlap of incompatible positions, tolerated for decades under a veil of general opacity.

This is what happens when the subculture of privilege prevails over the culture of merit, profiting from the suffering of citizens and from the future of the country.