Universal healthcare is one of Europe’s greatest achievements, yet we often take it for granted because we assume it will always be there. It is not.

The concept originated in the UK and was first implemented in the aftermath of World War II. A population exhausted by the conflict, impoverished, and starving had an enormous need for healthcare. Therefore, in 1948, the British National Health Service was established based on the significant role of the state and universality of the right to health. The model was successful and emulated by many countries in Europe and other continents.

Italy’s Health Service

In Italy, the National Health Service (SSN) was established in 1978 with the support of many political forces, parliamentary majorities exceeding 80%, and the crucial impetus provided by Health Minister Tina Anselmi, who made the SSN a central focus of her political career.

The SSN is Italy’s publicly funded universal healthcare system, financed largely through general taxation and based on the principles of universal access, solidarity, and equity.

We soon began to enjoy the benefits of the system and, at the same time, took them for granted. Its founding principle is rooted in the Enlightenment Idea. It reflects and even expands on Article 32 of the Italian Constitution, which states that “the Republic safeguards health as a fundamental right of the individual and an interest of the community, and guarantees free care to those in need.”

Significantly, the Constitution refers to individuals, not citizens. The right to health belongs to everyone because it addresses fundamental human needs. It is like water. Today, the SSN provides access to healthcare services across Italy, with eligibility determined by residence and other legal criteria. Emergency and essential care is also available to individuals who are not legally residents in the country under specific provisions. If someone’s life is in danger, the first thing to do is not ask for documents.

Rights and Duties

All of this comes at a cost, which is borne by the state and ultimately by us as taxpayers. In 2024, healthcare spending was €138.3 billion. This figure is usually compared with the gross domestic product (GDP), which accounts for 6.3% of the GDP in 2024. We know that this percentage places Italy behind most European countries. I believe a more meaningful comparison, although one that is cited far less often, is with total public spending, which amounted to €1108.4 billion in 2024. Healthcare spending accounted for 12.47% of the total public spending. Does this seem like a lot? However, if we think about it in terms of a family budget, who would not spend 12.5% of their available resources to ensure the health of their family and themselves? It is hardly surprising that universal healthcare enjoys staunch support among populations fortunate enough to be experience it first.

Most funding for the SSN comes from general taxation, that is, taxes. This means that wealthier individuals partly pay for the care of those who are less well-off. This model is known as income redistribution, which is another constitutional principle. Some prefer to call this solidarity.

From Rights to Care

There is no such thing as a “right to health,” as is often claimed. Such a right can only be guaranteed within the limits of medical knowledge and available technology. The SSN, on the other hand, protects health, meaning that it commits to doing everything possible to preserve and restore it.

But it does much more. It provides security: The security of not suddenly finding yourself facing an illness without the financial means to deal with it and not being pushed into poverty in the process. It safeguards people’s dignity even when they are ill. It promises equality in the face of unavoidable events in life. It is founded on solidarity among individuals, even when solidarity is required by law and often goes unrecognized. In other words, it is an immense, precious safeguard of civilization.

We should be proud to belong to a country with a universal healthcare system, even if it is inevitably imperfect. We must all commit to defending it against the many threats it faces: Rising costs, pressure from economic interests, and parochial self-interest.

A System to Protect

However, for many years, public and universal healthcare systems have been challenged by a different view of the state’s role. According to an extreme view, everyone should be responsible for their own healthcare, using their own savings, or purchasing private insurance. However, if you are born with a serious illness, this may not be possible. If you come from a poor family, statistics show that you are highly likely to remain poor and, in turn, have children who are poor. Under these circumstances, taking care of oneself and the people you love can become impossible.

We should not assume that these circumstances always happen to someone else. Even those who enjoy a comfortable lifestyle can lose their jobs, suffer serious accidents, fall ill, or see the security they have built over their lifetime crumble. They can suddenly find themselves in need of help from others. None of us are immune to adversity.

This insight was articulated with particular clarity by philosopher John Rawls, who argued that society’s institutions should be designed by individuals placed behind a “veil of ignorance”: individuals who do not know what position they will occupy in society. They do not know whether they will be rich or poor, healthy or sick, marginalized or privileged, employed or unemployed, or men or women. It is likely that individuals in this situation would design fairer institutions and be more inclined to protect less fortunate members of society because they themselves might be among them. It is likely that they would strongly favor universal healthcare.

Marco Crescenzi, MD, PhD, is a physician and former research director at the Italian National Institute of Health in Rome. During his career, he conducted extensive research at Washington University in St. Louis, the National Institutes of Health in Bethesda, Sapienza University of Rome, and the Regina Elena National Cancer Institute in Rome. He has conducted pioneering studies on cell proliferation and differentiation in regenerative medicine and is a passionate educator and scientific communicator. 

This story was translated from Univadis Italy, part of the Medscape Professional Network.