Review and discussion of 1993 meeting between the United States President Bill Clinton and Italian Prime Minister Carlo Ciampi to discuss US-Italian cooperation on a variety of domestic and international affairs.

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“Our two nations share a wealth of cultural, historical and personal ties.  From the voyage of Columbus to the contributions that millions of Italian-Americans make today to our Nation, those ties form a foundation of a common understanding of common objectives.”

  •  - President Bill Clinton

September 17, 1993

American-Italian Summit

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On September 17, 1993, United States President Bill Clinton and Italian Prime Minister Carlo Ciampi met to discuss US-Italian cooperation on a variety of domestic and international affairs (Clinton). The topics covered included Health Care Reform, which at the time, both countries struggled in legislating meaningful and effective improvements.  Historically, measures to institute working systems of health care in both Italy and the United States undoubtedly failed – America lacks a substantial national health care system, and Italians complain of a disorganized and corrupt system.  Experts cite a variety of unique economic and social explanations for the shortcomings in each country yet fail to realize an obvious similarity between the two welfare states that curtails any health care reform: their similar political institutional structure.   Fearing a resurrection of authoritative rule, the constitutional framers of both the American and Italian states designed and structured governments that diluted political power to a vast number of individuals with particular interests, making meaningful health care initiatives impossible to legislate because nationalized health care is a complex issue to compromise on because of the difficulties in coordinating, both administratively and financially, such a massive welfare program.


  1. The Inexplicable: Flawed Theories in Explaining the Failure of Both Systems

Despite all their differences, both America and Italy suffer from public discontent towards their health care systems; therefore, one causal factor must connect the two frustrated nations and, thus, be the source of such woes.  Scholarly explanations for the failure of each system, however, lose validity in a comparative analysis of both health care systems because proposed causes of one nation’s system malfunction cannot be found in the other system’s development.  

Gosta Esping-Andersen categorized welfare states by their ability to “de-commodify,” or the extent that an individual can remain outside the market and maintain a certain minimum living standard (Esping-Andersen 37).  He divided welfare states into three different categories according to their level of de-commodification: Liberal, Conservative/Corporatist and Social Democratic.  Under Esping-Andersen’s welfare state typology, Liberal welfare states, such as the United States, minimize de-commodification because of their emphasis on capitalism and premium on market solutions to social problems, while Social Democratic nations effect the highest level of de-commodification (Esping-Andersen 43).  If, due to its emphasis on markets, a Liberal welfare state is incapable of creating a working health care system like in the United States, then a Social Democratic or Conservative/Corporatist state would be able to structure an efficient national health service.  This, however, remains untrue as illustrated by Italy’s, a Conservative/Corporatist welfare state, inability to successfully manage its health care system.   The type of welfare state, thus, has no influence over the success of its health care system.  

American analysts, for example, argue that America’s relentless individualistic philosophy fails to place a premium on a national health care (Steimon 332).  Following this logic Italy’s Catholic tradition focusing on universalism, communal support, and boasting an effective communication network ought to have yielded an immense, well-organized health care system with a vast assortment of benefits for all, but such is not the case.  Clearly, the levels of individualism or communalism minimally impact the effectiveness of a national health care system.  

Italian critics blame financial hindrance for the failure of their system, but the world’s wealthiest nation, the United States, fell short in producing any system that could be coined a national health care system (Ferrera 235).  If financial resources yielded effective and extensive health care systems, then the United States would likely be extending medical care to Canadians, so obviously financial resources cannot be attributed to the inefficient health care systems.

Italians also cite that international pressure stemming from the Masstricht Treaty in 1992 led to poorly planned and rapidly implemented reform that backfired (Ferrera 240).  The international community, however, never pressured the United States to speedily extend health care to its citizens and it still cannot devise a plausible plan that would be ratified and executed properly.   International pressure, although a motivation for reform, cannot be blamed for Italian health care failure.

Finally, leftists Americans cite a lack of leftist ideologies in the political process for the deficit in effective national health care, but during the 1970s the Italian Communist Party (PCI) was allowed to return to government and still failed to produce a viable and efficient health care plan (Osbourne 9, Di Scala 299).  As a matter of fact, the PCI played a key role in the creation of health care institutions that now plague modern reform of the ineffective Italian system.  Leftist politics contribute in popularizing the need for national health care but do not yield working health care systems.  

As analyst and theorist bicker about the roots of Italian and American health care failure, citizens grow weary of their nation’s inability to provide proper treatment.  As this discontent brews and swells, faith in governments and political institutions wanes, damaging state legitimacy.  Historically, Americans look to expand their health care system while Italians desire shrinkage and consolidation, but the end remains the same: both citizens overwhelmingly call for reform, yet why have both these democracies been unable to meet this popular demand?  The answer lays in their Constitutions, which established institutions inappropriate for ratifying, implementing and administering such complex, national systems such as health care.  


  1. The Bureaucratic Bombshell: A Look at Italian Health Care

Founded in 1978 and subsequently reformed in 1993, the Italian National Health Service, or Servizio Sanitario Nazionale (SSN) falls victim to a highly bureaucratic logistical nightmare and a financing crisis.  Modeled after the British National Health Service, the Italian system boasts a mixed method of financing.  General taxation, in combination with social insurance, finance health care, while service provisions, such as pharmaceuticals, specialized consultations and other rehabilitative services, are mostly funded by the government but partially by the individual.  This method of payment however proved ineffective.  Prior to its reform in late 1992, the Italian health service amassed a 45,000 billion lire debt in 1991 but the reorganization proved largely ineffective (Del Favero 168; Ferrera 242). Within twenty-five years of its existence, the SSN requires financial reform despite the government’s attempts to regulate the system and avoid such deficits.

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In an effort to prevent such financial entropy, the government established a decentralized, three-tier system of administration for the Italian health care structure.  At the top, the national government enjoys the ability of regulation by instituting minimum service levels for each region – approved by Parliament - and specifies the conditions under which the private sector can provide service to individuals.  The National Health Council, a convoluted organization composed of officials from each region, central administration, industry professionals and social unions, advises Parliament as to creation of such standards.  The duties of implementation, planning, financing and monitoring of the health ...

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