Health Care Analysis 8: 341–354, 2000. © 2000 Kluwer Academic Publishers. Printed in the Netherlands. Solidarity and the Role of the State in Italian Health Care NICOLA PASINI 1 and MASSIMO REICHLIN 2 1 Centro di Analisi sulle Politiche Pubbliche, Dipartimento per gli studi Sociali e Politici, Facolta di Scienze Politiche, Università degli Studi di Milano Via Conservatorio, 7, 20122 Milano, Italia, E-mail: Nicola.pasini@unimi.it; 2 Unità di Filosofia, Facoltà di Psicologia, Università Vita-Salute San Raffaele via Olgeitina 58, 20132, Milano, Italia, E-mail: reichlin.massimo@hsr.it Abstract. The article deals with the issue of solidarity in health care, with particular reference to the Italian context. It presents the difficulties of the Italian NHS and assesses the current proposal to counter the crisis of the Welfare State by giving up institutional arrangements, in order to favour the so-called ‘social private’. Moreover, it addresses the question of priori- tisation and targeting in the context of health care, arguing for the insufficiency of the standard approach of neutral liberalism, and showing how the concept of solidarity might help to develop a different account. Lastly, it discusses the case of organ transplantion in Italy, as an example of solidarity-inspired health care policy. Key words: health care, Italy, national health system, organ transplantation, solidarity, Welfare State Solidarity and the Peculiarities of the Italian Health Care System The idea of solidarity is at the heart of the Italian conception of the Welfare State. The Republican Constitution acknowledges every person’s equal dignity and freedom and grants everyone the same rights of citizenship; it requests the accomplishment of unbreakable duties of political, economic and social solidarity and aims at the removal of the economic and social hindrances to the citizens’ freedom and equality in view of the full devel- opment of the human person. With reference to health care, it states that “the Republic protects health as a fundamental right of the individual and an interest of the collectivity, and guarantees free care to the needy” (art. 32). However, the model of Welfare State implemented in the last 50 years is largely inconsistent with these inspiring principles. It can be described as a distortion of the “particularistic-meritocratic” model of Welfare State, characteristic of Continental European countries (Ferrera, 1984); this distor- tion can be attributed to the peculiarities of the Italian social system. Two