In the great hubbub of voices recently raised to discuss the Law that will introduce Regional Federalism, in particular for the Health System, there is as usual a great conflict on the terms: Federalism, Devolution and Regionalization, but their contents have been entirely lost from sight. We daily witness clashes concerning the need to reform the Health System, as suddenly everyone has forgotten that we are not speaking of a system that has come to a halt at the time of Health Insurance Associations and Public Welfare and Charity Institutions, but of one that has been constantly changing for at least 30 years. There now remain only the ruins of the former system. The old lunatic asylums were the first to be knocked down by the heavy hammer of reforms. Their immense real estate property, which comprised buildings, parks and health structures, immediately became a prey to be divided amongst the vultures who rushed to dismantle the old Psychiatric Institutes to the advantage of the useful and useless institutions that were already perched on the sycamore awaiting the division. Instead the poor lunatics who survived the disaster still wander about the reception wards of hospitals, if they are not in criminal asylums waiting for someone to implement the regulations resulting from the reform. The law that established the National Health Service, which is national only in name as it has long since transferred almost all competences to the Regions and along with the duties also the expenses, now the first item in Regional budgets, dates back to 1978. But worse still, this colossus that is disintegrating is reformed constantly from inside by National and Regional Laws that keep modifying regulations: from calls for tenders to competitive examinations for personnel, from the personnel’s juridical person (employee, freelancer – temporary appointments – permanent contracts – full-time contracts – a tempo unico – with the possibility of freelance work or the prohibition to practice as a freelance) to the juridical person of public bodies (Unified organizations – self-governing bodies – companies), refunds on presentation of expense items, regional financing and refunds on the basis of the famous D.R.Gs (diagnosis related groups) that mean to create uniform hospitalization categories according to the amount of resources spent in the welfare process. But these are not all the reforms: now they do not speak of the sick and of diseases, but of budgets and medical cooperations between doctors specialized in general medicine, between generalists and specialists and between the various types of specializations because nowadays expenses and how to quantify and check them are foremost in reformers’ thoughts. But politics will never come to a halt besides, the health system’s bad organization must be reformed and changed into 20 small and large plants that must grow and develop self-sufficiently. Self-sufficiency has existed for years, that has been written in the numberless laws and by-laws, decrees and regulations, but it was not stated in the Constitution. Hence the need to make a special constitutional law that in practice constitutionally decrees what was already done, till a new reformer appears one day and decides that the system must be unified and, perhaps, must return to the old Health Insurance Associations. Naturally there is an open struggle to decide who was the first to implement this amendment to the Constitution. What is affected by this constant shuffling of regulations is the care given to patients - it must be carried on by a medical category that has lost heart due to the constant changes they undergo and the uncertainty of what tomorrow will bring. Lastly I think that what the Health System needs to solve national, regional and local problems is money. The problem is purely mathematical and not juridical - if we want better health care we must allocate more funds. In particular, we must make sure that they are well spent also by those regions whose only concern is money and possible ways of increasing their income – these have lost sight of the real purpose for which the funds were collected. Translated by interpres sas