Budget Law

Manoeuvre, no measure eases the tax burden for public healthcare

The government forces have pledged to introduce legislation that favours categories of taxpayers or introduces burdens on economic groups, but there is no IRAP relief

by Roberto Caselli

6 November 2025

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4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

Some light and many shadows in the text approved by the Council of Ministers on 17 October and which, after being stamped by the State General Accounting Office, has been sent to the Senate for a first reading.

SNS companies 'ignored'

None of the tax measures touch the National Health Service companies. The various government forces have pledged to introduce measures in the measure that favour certain categories of taxpayers or in some cases to introduce burdens on economic groups (agreeing on the size and modalities), but none have bothered to propose an easing of the unsustainable tax burden, especially IRAP, that weighs down this sector. This is an absurd roundabout game that no government has thought of abolishing.

The burden of Irap

It should be noted that the Government's main concern was to keep the accounts balanced, limiting the increase in the 2006 deficit, and this aim seems to have succeeded. It is true that new resources will be invested in the public health sector: 2,400 million for 2026 and 2,650 million for 2027, but unfortunately no account has been taken of the actual increase in the costs of personnel, drugs and services that have burdened the sector in recent years, in an increasing manner. What continues to amaze is that a considerable share of the cost of healthcare is made up, according to reliable estimates, by IRAP, i.e. the tax used to finance healthcare itself, to the tune of about 3%. In 2024, the total cost of public healthcare was approximately EUR 137.9 billion, corresponding to 6.3 per cent of GDP, which is still falling compared to the past. Let us remember that the tax affects, at 8.5% (a measure that has never decreased since its introduction in 1998), salaries, wages and remuneration for external collaborations, which is not the case in the private sector.

Since the limitation of resources for public health depends on insufficient tax revenues to meet growing needs, including military needs, it may be appropriate to analyse the measures that favour one section of the population and whether or not they are compatible with constitutional principles.

Constitution partly disregarded

Let us recall that our Constitution begins, in Article 1, with the affirmation that 'Italy is a democratic Republic founded on labour' and that Article 53 provides that 'everyone is obliged to contribute to public expenses according to his or her ability to contribute and that the tax system is informed by criteria of progressiveness.'

It is clear that the path being taken is moving further and further away from these fundamental principles, and that only those with a fixed income from employment or pensions are taxed according to the criterion of progressivity, albeit at a maximum rate (43%) far removed from that in force under the 1974 reform (72%), which benefits the taxpayers with the highest contributory capacity.

Reducing discrimination

If there were to be a significant increase in revenue for the Treasury, so as to be able to finance public health care again in accordance with actual needs, starting with an increase in the number of doctors and nurses, action would have to be taken to eliminate or mitigate the most obvious discriminations, in particular those in favour of financial income earners and real estate income earners, but also of many categories of self-employed workers, who can opt for flat taxation, i.e. a single tax rate independent of the amount of income, the so-called 'flat tax', which might perhaps be acceptable for limited periods and in exceptional cases, while it is becoming an increasingly widespread tool. Rates vary from 10% to 26%.

There has also been much discussion in recent days about the possible increase from 21% to 26% of the flat rate for short rentals, an increase that will probably not be voted on because it is considered too high; and there is talk of a measure that has favoured the proliferation of a type of contract that has taken rental housing off the market for those who work in historic city centres and who are forced to look for housing in the increasingly distant suburbs.

In the area of labour relations, this manoeuvre increases the cases of flat taxation, from as low as 1 per cent up to a maximum of 15 per cent, even in public health, in favour of limited groups of workers.

Progressiveness as a compass

One cannot but agree with the increases in salaries and wages, which have lost so much purchasing power in recent years due to inflation and the non-indexation of tax brackets (the fiscal drag), as well as of fringe benefits in overtime and night work, in both the public and private sectors, but the flat tax in fact, does not benefit the recipients, but mainly the state or private employers, who, in order to pay their employees net sums commensurate with their efforts and merits, incur lower costs because certain salary increases or recognition of fringe benefits are taxed at a flat rate, albeit within certain limits. In essence, salary awards are welcome, but the Constitution would require that they be taxed according to the principle of progressivity. It is not right, in the writer's opinion, that the principle of progressivity should be departed from, even if it is declared to be done to favour weaker categories.