Italian Healthcare Vs American Healthcare

Italian healthcare wins, hands down, in my opinion.

And, on multiple fronts. I’ve been in Italy for almost eight years now, and as I look back across the Atlantic, especially during this pandemic, I’m especially grateful for the assurance of complete medical care without fear of losing everything I have in the wake of a catastrophic illness.

An important note:

This post is focused on the healthcare systems, not a comparison of the quality of doctors and caregivers in each country. Both Italy and the U.S. have brilliant medical minds and selfless doctors and nurses who give their all.

I’m here to offer a view from afar.

That is, as it pertains to the American healthcare system and how it stacks up against Italy’s. Why do I believe this topic is relevant and important, especially now? Because many American right-wing conservatives are using “socialism” as a catch-all fear-the-loss-of-all-your-rights threat. Such fear tactics ignore that socialism is not an all-or-nothing system. Those tactics ignore socialistic type programs like Italy’s healthcare system. But, go figure, there are some Americans who vilify socialism in a wholesale fashion, yet gladly come to Italy, take up residence, and eagerly sign up as beneficiaries of its “socialist” healthcare system. GRRRRRRR!!!

Let me start with a recent, harsh reality (for me, at least).

I cannot return to the U.S. to see friends or family ANY time in the foreseeable future.

Technically, I could, since I am a U.S. citizen. Realistically, I can’t because finding any type of travel medical insurance policy that covers COVID in the U.S. is next to impossible. PLUS, why the heck would I take the risk, even following rigid protocol, to be in a country where behaviors are all over the map. Even a five to ten percent risk of catching COVID and being sidelined in the U.S. and away from my Italian family is a risk just not worth taking. And for me, this exemplifies for me why Italian healthcare is far superior.

Healthcare is afforded as an equal right to all Italian residents (not just citizens).

I’m gladly onboard with aspects of socialism that focus on the common good of ALL people, and not just those people who have access of gold-standard insurance policies and consequently, the top-level medical care. (Remember, members of U.S. congress have comprehensive, gold-standard care for life.)

Here’s a great overview link of how the Italian healthcare system works.

“As stated in the Italian Constitution (Art. 32), the national government is responsible for granting that all residents, in every region of Italy, have access to this benefit package for all essential levels of care.”

I, like most Americans, had secure healthcare coverage while I was employed. Thankfully, I had a job that I loved.  But if, God-forbid, you lose your job or want to leave your job because you are so miserable, you start swimming in dangerous waters—not just of finding adequate coverage, but of potential financial ruin. I have friends who are late in their working years and have left their jobs and now paying exorbitant fees for basic coverage and ginormous deductibles. No wonder people run to jobs in the U.S., almost any job, just to sleep at night knowing they have coverage that will help keep them from the precipice of financial ruin.

Not just Italians, but most Europeans, are horrified and fearful of the American healthcare system.

I can’t tell you how many questions I’ve fielded from disbelieving Italians in regard to American healthcare. “How can a country not be set-up to protect the health of each and every citizen?” they ask. My answer? It’s simple. The Italian healthcare system is not built on a foundation of massive profit-taking from hospitals, insurance companies, and drug manufacturers.

That’s right, the Italian news isn’t littered with stories about Insurance company executives raking in yearly bonuses in the millions of dollars. Hospitals aren’t big money-making machines. Doctors aren’t paid huge salaries, yet they are some of the best trained and most giving in the world.

Italian healthcare services have consistently been rated as being among the best in the world.

“As far as healthcare is concerned, Italy ranks among the World Health Organization’s top 10 countries for quality health services.” – Read the full article here.

Yes, there IS the reality that regions of Italy aren’t so robust in their healthcare service. The northern regions as a whole kick butt on the services in the south, something a wannabe ex-pat might want to consider very carefully before making a decision where to land and live. And, for those who live on the yearly permesso di soggiorno, the ability to be part of Italy’s national healthcare plan comes with a fee. Some regions, like Veneto, charge a yearly fee of something in the neighborhood of 400 euro, while others charge on a sliding scale based on a person’s annual earned income. Still, such fees to participate are a fraction of what you’d pay in the U.S. And, pre-existing conditions aren’t part of the equation. Imagine that.

For non-urgent health matters in Italy that require more specialized care, you’ll most likely be put in a queue. You’ll have to wait longer than you’d like. BUT, you always have the option to go private and book a specialist independently to be seen more expeditiously. The cost? Usually around 150 euro. Not bad.

Markedly different attitudes availability of care.

I encourage you to read a blog post I wrote a few years ago about how my sister became ill when she came to visit. The short story is that she was seen quickly at a Rome hospital, and NOT charged anything by the staff. Would this EVER happen in the U.S.?

So, if you’re quick to enumerate the evils of socialism…

Consider the Italian healthcare system and how the country enshrines the right and affordability of healthcare to citizens and residents of every socioeconomic class.

By |2020-09-15T16:46:28+02:00September 15th, 2020|Healthcare in Italy|17 Comments

About the Author:

I’m an American expat living in Italy!


  1. Mark September 18, 2020 at 8:18 am - Reply

    Well Jed another great article, first let me say you were instrumental with your blog as a guide for when i did my Permesso Di Soggiorno a few years back and I am always thankful for that. I understand Thomas and his frustrations pertaining to his situation he is correct about the taxation levels and the IVAFE as well as the sales and services tax as well as income tax in the long run it can make him poorer. Those levels of taxation disincentives people from wanting to grow and expand there wealth for the more they earn the more they have taken away!! I lived in Sicily and believe me the south is in dire financial needs we all know about the half empty towns and homes for a dollar, there is a reason why that happened and continues to happen. To me the problem is HIGH taxation notice how All governments never talk about cutting massive expenditures and massive government waste and extremely bloated PUBLIC pensions. it is always just about raising taxes on the wealthy. The problem is not whether which health care system is better but rather WHO has to pay for it or who does not!!
    It is not as cut and dry as Socialistic health care vs Capitalistic or American health care there are so many other factors to consider, I have lived now in 3 different continents and 4 different countries I believe this is certainly not a one shoe fits all sizes issue. It is always inspiring that people of different points of views can at least share those views on a blog, something that today around the world people seem not to be able to do face to face without some form of confrontation so Jed for this your blog is well received.
    For me I was outside of Italy when covid hit and my Permesso expired before the borders were re-opened which is not a problem I can go back if i want under an Igresso visa under the circumstances but is has afforded me the time to really contemplate and look at the bigger picture for we all have different situations and different financial circumstances.
    to Jed thank you again for a spirited article, bless you all and to all have a blessed day!

    • Jed September 18, 2020 at 11:49 am - Reply

      Hi Mark, Thanks for sharing a very important perspective, one that I hope other people will read in order to get a 360 degree picture. I understand that high taxation is an issue here and the problem of overspending by governments isn’t unique to Italy. I’m not sure you’re aware of this, but Sunday is an important election which will decide if the parliamentary houses of Italy will be reduced significantly in its numbers. This is a prime opportunity to cut government overhead. So, we’ll see.
      I only wanted to take on Italian healthcare as one thing that seems to work and benefit everyone here. Believe me, I know much else is a big, hot mess!

  2. Christie Hardwick September 16, 2020 at 10:25 pm - Reply

    My wife and I look forward to returning to our home in Umbria. We have appreciated the healthcare system over the 15 years we’ve been visiting. It is so civilized and it is equitable and compassionate. Thank you for this blog!

    • Jed September 17, 2020 at 9:04 am - Reply

      I so agree! Thanks, Christie!

  3. angela September 16, 2020 at 7:26 pm - Reply

    Buongiorno o Buonasera, Jed. I’ve benefited from the Italian Healthcare Program on two occasions. I offered to pay and was told “certo no! The care was professional, thoughtful — really amazing. I so very much appreciated the care. Great post. Stay well.

    • Jed September 17, 2020 at 9:04 am - Reply

      This has been my experience as well, though I’ve remained remarkably healthy, other than seasonal allergies and mild asthma, and haven’t had to depend on it too much. But, I know it’s there and that I don’t have to navigate through a maze of what is covered and what isn’t. And, a special shoutout to the people who work the pharmacies (often with a doctor on-site)—they’re another important level of support and advice. We love the folks at our pharmacy just down the street. They always go above and beyond, and they never rush!

  4. Nicole Victor September 16, 2020 at 5:58 pm - Reply

    I’ve always had an individual insurance policy and never relied on employer insurance as I never believed or wanted to be tied to employer insurance. Of course as I’ve gotten older it has become more expensive but I won’t give it up. Our system is so messed up – we are seeing it in the roll out of Covid testing, etc. Not sure if we will ever get to a ‘unified equitable health system’ as we can’t even unify our country. The evil ‘S’ word will always divide people who don’t take the time to really understand what it means. Thanks for great article Jed!

    • Jed September 17, 2020 at 9:00 am - Reply

      You nail “it” on the head, Nicole, taking time to understand what it means, separating potential benefit from potential dangers, is a worthy use of one’s time.

  5. Mallory Olson September 16, 2020 at 3:38 pm - Reply

    Thanks for your well written comments. As a Canadian, (and semi recently a USA citizen) and as a nurse who has worked in both Canadian and American hospitals for 35 years, I appreciate your comments.
    There are so many problems here in USA that if we didn’t have kids here we would be trying move to your beautiful house in Umbria. We love Umbria and have visited and stayed, and now have good friends in spello. Trieste is also beautiful. But we live the Umbrian countryside
    Once elections are done in November we will know whether we need to pull up and move back to Canada or elsewhere or hang in at work a few more years
    Again, your blogs are spot on, thanks

    • Jed September 16, 2020 at 4:52 pm - Reply

      Thanks Mallory, I hope everything works out for you and that we all soon will see light at the end of the tunnel in this dark and challenging time.

  6. Tony Cranfield September 16, 2020 at 3:21 pm - Reply

    Great post!! Perfectly explains the differences between a health care system that supports the people vs a system that only wants to profit from its citizens.

    • Jed September 16, 2020 at 4:51 pm - Reply

      One thing that I neglected to mention in my post is that doctors here actually spend time with you and don’t rush through appointments while looking at their watches, trying to maintain a defined quota!

  7. Danielle Howard September 16, 2020 at 3:20 pm - Reply

    This is a brilliant post!! Truly shows just how detrimental the US healthcare system can be. Being business focused, with money making the priority instead of the care of its people.

    • Jed September 16, 2020 at 4:49 pm - Reply

      Thanks Danielle. As pointed out by Thomas, many people can feel stymied by a doctor being assigned to you by the ASL office, but there are ways to seek out and have a different doctor assigned if so desired. It just takes a little work. And, the cost for seeing a different doctor or specialist is a fraction of what you’d pay in the U.S.

  8. Thomas September 16, 2020 at 2:51 pm - Reply

    We were legal residents of Italy by Permesso Di Soggiorno. Italy’s “free” health care system was funded by our taxes. Our income tax rate ,with No deductions permitted under the tax code , exceeded 40%,add the sale/ services tax of 10%to 22%, a wealth tax on investments and bank account balances .Wow, “free ” health care! Now, add the lines and the fact that we had a one doctor choice. No thanks, we are no longer living full time in Italy . We now spend less than 180 days annually to avoid the confiscatory tax rate. We have a health insurance plan that covers us in Italy.

    • Jed September 16, 2020 at 4:46 pm - Reply

      Thanks for sharing your perspective and your experience, Thomas. Yes, healthcare is funded by taxes, but a resident who is out of a job and isn’t receiving income still receives the same standard of care——an important perspective for people who are nowhere near retirement or not in a position of financial comfort or security. I can’t speak to your tax situation since I’m not a commercialista and don’t understand your income level or filing options or restrictions. But, yes, for people receiving healthier incomes, the tax rates easily can head north. As for the wealth tax, I assume you’re speaking of the IVAFE annual foreign held asset tax of .2% on property/assets held outside of Italy. Coming from California were EVERYTHING is taxed to the hilt, I got past my ire at paying the IVAFE tax when I considered that I was no longer paying state income to CA northwards of 9%. As for IVA/sales tax, I wince when I have to pay that on services, but for things at Ikea, and at stores, it’s baked in the price (no surprises at checkout) and don’t seem unreasonable to me. I’ve found property taxes here much lower than in the U.S. So, there are pros and cons, but for me, much evens out in the wash. Having comprehensive healthcare is a big benefit to me. And, when I was on the annual permesso di soggiorno, I actually found a doctor I liked (and paid a small fee for a consultation, around 30 euro) and asked if she would take me on as a patient. When the ASL went to assign me a different doctor, I told them about this doctor, and they called her to get a verbal okay that I could be added to her clientele in the system. So, there ARE ways to work with the system.

  9. Susan September 16, 2020 at 2:28 pm - Reply

    Such a great article Jed. It also mirrors our experience. It is really hard to justify the American health care system to the rest of the world. Thank you for writing this and differentiating the paths that socialism can take.

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