A video of under three minutes, shared on Instagram, starts from a claim about Italy’s public debt: we were told we lived beyond our means. The guest economist promises to take it apart with numbers.
They are round numbers: billions in debt, interest, hospitals, doctors. But are those figures right?
To find out, I took the claims one by one and compared them with official sources, in eight steps: from the video to the limits of the numbers.
What does the video say?
The video is taken from a piece of a TV broadcast from 2021, “Notizie Oggi Lineasera” on Canale Italia, with the economist Valerio Malvezzi as a guest. It is titled “La grande truffa del debito pubblico” (“The Great Public Debt Scam”). The claims are these, as they read in the video’s subtitles; the video is an edit made by Positano TV:
- Debt: the public debt accumulated from 1981 to 2020 is “about 2,500 billion” (about €2.5 trillion).
- Interest: the interest paid over the same period equals the entire debt.
- Primary surplus: from 2000 to 2020, “except for one year,” the Italian state always took in more than it spent.
- Households: according to the “sectoral balances” (the accounts of households, businesses, the state and the rest of the world), if the state is in surplus someone else is in deficit, and “for twenty years we have been losing money in households.”
- Health care: “in the last 10 years,” 170 hospitals closed, and 10,000 doctors, 6,000 nurses and 48,000 health-care employees lost. The video does not say which years it means.
- Conclusion: the surplus serves to pay the interest, which in the video goes to the banks, at the expense of doctors, nurses and other services; “it is a political choice.”
Two terms are needed right away. The primary balance is the difference between what the state takes in and what it spends, not counting interest on the debt; if it is positive, it is called a surplus. GDP, gross domestic product, is the value of what Italy produces in a year: it is used to compare figures from different eras.
How much did the debt grow, and how much did interest weigh?
The first number holds up, because “about” says enough. According to the historical series of the Observatory on Italian Public Accounts (Osservatorio sui conti pubblici italiani) of the Università Cattolica, an Italian university, based on Bank of Italy data, the debt grew by 2,460 billion euros (€2.46 trillion) from 1981 to 2020. At the end of 2020 the debt was 154.7% of GDP, according to Eurostat, the statistical office of the European Union. “About 2,500” is a fair approximation.
The second is also essentially true. For the period 1981-2020: the interest paid (2,752 billion) was more than the increase in the debt (2,460). The primary balance, by itself, would have reduced it by 586 billion.
Interest (2,752) minus the primary surplus (586) makes 2,166, but the debt rose by 2,460: about 294 billion are missing. That is what Eurostat calls the “stock-flow adjustment”: the part of the increase in the debt that does not come from the year’s deficit, but from accounting operations, for example when the state holds more cash or lends money to others. The Observatory calculates it precisely as the difference between the increase in the debt and the deficit: 292 billion, and 2,166 plus 292 makes 2,458, against 2,460.
The figure should be read with two caveats:
- Different years: the sum puts together 1981 lire and 2020 euros. Adjusted for inflation the proportion changes, and the high interest costs of the 1980s and 1990s reflected high inflation.
- Where the debt starts from: in the 1980s the state also ran a primary deficit, −134 billion from 1981 to 1991. The debt rises from 56% of GDP in 1980 to 98% in 1991, and the interest on that debt did the rest.
Today, according to Eurostat, at the end of 2025 the debt is 3,097 billion euros, 136.7% of GDP. Interest costs 87.2 billion euros a year, 3.8% of GDP.
Did the state take in more than it spent?
For almost thirty years, yes, but not “except for one year.” The years without a surplus are two, not one: 2009 and 2020. Between 2000 and 2020 the primary balance is positive in 19 years out of 21. The video does not say which year is the one left out.
Put better: from 1992 to 2019 Italy had a primary surplus every year except 2009. The cumulative surplus over those years is 820 billion, and the interest paid is 2,223. In other words, interest was far larger than the surplus.
Then the picture changes. The primary balance is negative from 2020 to 2023, the years of the pandemic and the energy-price crisis, and turns positive again in 2024 (+11.7 billion) and in 2025 (+17.4 billion, about +0.7% of GDP).
What happened to health care?
The video does not say which years: I took 2010-2019, the last ten with complete data in the yearbooks. No figure matches those in the video exactly:
- Hospitals: care institutions (hospitals and clinics, public or private under contract) go from 1,165 in 2010 to 992 in 2019, that is, −173; Quotidiano Sanità, a health-care news site, reports them as “closed.” The count is of inpatient facilities, which in the yearbooks also include the aziende ospedaliere (public hospital organizations): it does not count one hospital at a time. Hospital beds fell by 43,471.
- Doctors: the salaried doctors of Italy’s National Health Service (Servizio sanitario nazionale) go from 107,448 to 102,316, that is, −5,132. With the contracted doctors, meaning family doctors, pediatricians and out-of-hours doctors, the drop is 9,484, about 10,000.
- Nurses: from 263,803 to 256,429, that is, −7,374.
- Employees: the salaried staff of Italy’s National Health Service falls by 42,380 (−6.5%); the drop is over 46,000 counting the contracted doctors. The order of magnitude is the video’s; the number is not.
The period matters. With 2020 included, the staffing figures change a lot: nurses go from −7,374 to +883, because of the hiring in the first year of the pandemic, and salaried doctors to −4,356. The video also speaks of “twenty years” of cuts to hospitals: a comparison over twenty years would need the 2000 yearbook.
After 2019 the facilities are stable and nurses come back above the 2019 level (268,013 in 2022).
The video talks about cuts, and cuts are a matter of spending. According to Eurostat, public spending on health care between 2010 and 2019:
- In euros: from 119.1 to 121.1 billion, almost flat.
- Adjusted for inflation: 8% lower.
- As a share of GDP: from 7.4% to 6.7%.
In 2020, with the pandemic, it rises to 130.3 billion, 7.8% of GDP.
How far are the video’s figures from the data?
The gaps go in both directions: the video understates nurses, hospitals and the years without a surplus, and overstates doctors and employees. Here is the comparison, using only the 2010-2019 period for health care:
| What | Video | Data | Video’s gap |
|---|---|---|---|
| Debt 1981-2020 | about 2,500 billion | increase 2,460; at the end of 2020, 2,578 | +2% on the increase; −3% on the debt at the end of 2020 |
| Years without a primary surplus, 2000-2020 | 1 | 2 (2009 and 2020) | −1 year |
| Hospitals (care institutions) | 170 fewer | 173 fewer | −2% |
| Doctors | 10,000 fewer | 9,484 fewer (with contracted doctors); 5,132 (salaried only) | +5% (+95% on salaried only) |
| Nurses | 6,000 fewer | 7,374 fewer | −19% |
| Health-care employees | 48,000 fewer | 42,380 fewer (46,732 with contracted doctors) | +13% (+3% with contracted doctors) |
The gaps are the difference between the video’s figure and the data, divided by the data, and are rounded.
What are sectoral balances, and what do they say about households?
The economy can be divided into four parts: households, businesses, the state (“general government” in the charts) and the rest of the world. Each one’s financial balance is the difference between what it takes in and what it spends. Added together, the four balances come to zero every year. It is an accounting identity, that is, an equation that always balances, by the way it is built; according to AMECO data, the European Commission’s economic database, it holds from 1995 to 2025 with no discrepancies.
The video, on this point, is right: if one part is in surplus, another is in deficit.
But what enters the identity is the total balance of the state, interest included, not the primary balance. The primary balance says the state took in more than it spent; the total balance is negative every year: overall, the state spent more than it took in. They are two different measures.
| Balance, % of GDP | 2000 | 2019 | 2020 | 2025 |
|---|---|---|---|---|
| State (general government), interest included | −2.4 | −1.5 | −9.4 | −3.1 |
| Households, with nonprofit institutions | +3.7 | +2.0 | +7.9 | +1.9 |
So if the state overall spends more than it takes in, someone else must be in surplus, and households are, every year: their financial balance, which is what the identity measures, is positive every year from 1995 to 2025. It was +10.3% of GDP in 1995. Other things, such as incomes or purchasing power, the financial balance does not measure.
Do the numbers show that the surplus was used to pay interest at the expense of health care?
The data show four true things in the same years:
- Primary surplus: from 1992 to 2019, almost every year.
- Interest: higher than the surplus, so the debt rises.
- Facilities and staff: in 2010-2019, fewer facilities, fewer hospital beds and fewer staff in health care.
- Health spending: almost flat in euros, down adjusted for inflation and as a share of GDP.
That the reduction in facilities and staff was decided in order to pay the interest, however, is a political claim. The numbers do not prove it, and do not rule it out: they say that things happened in the same years, not that one caused the other.
Lower spending is compatible with the video’s claim, but also with other explanations: regional deficit-reduction plans (the plans under which regions with deficits in their health-care accounts must put them back in order), the European rules on the deficit, or the reorganization of the hospital network. They remain associations, not proof. In the video it is the guest economist’s claim.
What can’t the numbers say?
Three limits, each tied to the data. Debt, interest and balances are in nominal euros, not adjusted for inflation, so adding up different decades is an approximation: the charts use the percentage of GDP. For health care, the 2010 and 2019 figures come from a secondary source, a news site that compares the yearbooks, and the counts of institutions are of inpatient facilities, not of hospitals one by one. The 2025 data are not yet final.
The rest is not a question of numbers. The video also says that it is the banks that collect the interest: the data in this check do not say who holds the debt. And whether the reduction in facilities and staff was a right or wrong choice, and whether it could have been avoided, is a political judgment: the numbers inform it but do not settle it.
All that remains is to see, in the years ahead, whether the primary surplus of 2024 and 2025 becomes a habit again.
Frequently asked questions
Has Italy’s public debt really grown by about 2,500 billion euros between 1981 and 2020?
Essentially, yes. According to the Observatory on Italian Public Accounts, based on Bank of Italy data, the increase is 2,460 billion euros, from 116.7 to 2,576.6; according to Eurostat the debt at the end of 2020 was 2,578 billion, 154.7% of GDP. At the end of 2025 it is 3,097 billion, 136.7%.
Is the interest paid equal to the entire debt?
Yes, and in fact it was more. From 1981 to 2020 the interest paid was 2,752 billion, against an increase in the debt of 2,460. The sum, however, puts together 1981 lire and 2020 euros: adjusted for inflation the proportion is different.
Did Italy have a primary surplus every year from 2000 to 2020, except one?
No, the negative years are two, 2009 and 2020. The primary surplus is there every year from 1992 to 2019, except 2009. After four negative years, from 2020 to 2023, it turns positive in 2024 and 2025. The video does not say which year is the one left out.
How many hospitals, doctors and nurses were lost in ten years, and how much did spending fall?
The video’s figures are close but not equal, and the video does not say which years it means. Between 2010 and 2019, according to the yearbooks of the Ministry of Health, care institutions fall by 173, salaried doctors by 5,132, nurses by 7,374 and salaried staff by 42,380. Public spending on health care goes from 119.1 to 121.1 billion, 8% lower adjusted for inflation.
Have Italian households been losing money for twenty years?
The households’ financial balance is positive every year from 1995 to 2025. According to AMECO data, they set aside more than they borrow. The state, interest included, has always been in deficit. The financial balance counts only what is lent and what is borrowed: it does not measure income or purchasing power.
More number checks
Other articles on this blog that check numbers against official sources:
- “Italy’s budget and energy: where the MASE’s €14 billion comes from”
- “But Why Do We Italians Pay So Much for Energy?”
Download the data and the code
I put the data and the code with which I redid the calculations into a zip file, so that anyone who wants to can repeat the analyses. Inside are the data from Eurostat (debt, deficit and interest since 1995; public health spending), from AMECO (sectoral balances) and from the health-care yearbooks, in CSV files, that is, plain-text tables; the scripts that download the sources, redo the calculations and draw the two charts, written in R, a language for data analysis; and a file of instructions. The historical series of the Observatory on Italian Public Accounts, which covers the decades 1980-2025, is not in the file: the script downloads it from the Observatory’s website. Download the data and code for the analysis (zip): 16 KB (16,050 bytes), file dated November 2, 2026, SHA-256 b4817facb34417c9af22b250338a1ed936236cb2519c557baf2471c43b1db20d. The data come from the sources listed below.
Method note (for those who want to check the math)
Debt, interest and the primary balance come from the Serie storiche di finanza pubblica (historical series of public finance) of the Observatory on Italian Public Accounts (Università Cattolica), March 2026 file: the data are from the Bank of Italy for 1980-1994 and from Istat, Italy’s national statistics office, from 1995. At the end of 1980 the debt was 116.7 billion euros and at the end of 2020 2,576.6 (Observatory); Eurostat gives 2,578 billion at the end of 2020. Eurostat (table gov_10dd_edpt1, notification of October 21, 2026) gives 2020 and 2025 and a check: for 2019, 2020 and 2024 the difference with the Observatory is under 2 billion. AMECO, the European Commission’s database, gives the sectoral balances. Health spending is the “Health” item of the classification of the functions of government (COFOG 07) of Eurostat; adjusted for inflation means at 2010 prices, with the GDP deflator.
The cumulative primary balance 1981-2020 is +586 billion; the cumulative interest 1981-2020 is 2,752 billion; the stock-flow adjustment is +292.4 billion (item L of the Observatory). According to Eurostat it includes the cash held by the Treasury, loans, equity holdings (net of privatizations), exchange rates and statistical discrepancies; the Observatory calculates it as the difference between the increase in the debt and the deficit (item L = change in debt plus net borrowing): it does not measure the individual items. The calculation, 2,752 minus 586 plus 292, makes about 2,458 against an increase of 2,460, and the remainder, 1.4 billion, is due to the rounding of the series as a percentage of GDP. For 1981-2025 interest is 3,147 billion, against an increase in the debt of 2,980.
For health care, the 2010 and 2019 figures come from the comparison of the statistical yearbooks of the Ministry of Health (the annual collections of data) published by Quotidiano Sanità; those for 2020 and 2022 from the yearbooks themselves. For nurses, in the yearbooks (2010, 2019, 2020 and 2022) the drop between 2010 and 2019 is 7,374, and with 2020 it disappears. After 2019: inpatient facilities stable between 2016 and 2022; salaried doctors 101,827 and employees 625,282 in 2022. The Conto annuale (annual accounts) of the State General Accounting Office, which shows the data only through an interactive application, is left out of this comparison.
The video’s quotations are read from the subtitles burned into the edit, one frame per second: the audio was not transcribed. Quotations from Italian-language sources are my translations.
Sources
Accessed November 2, 2026. I mark the type of each source: primary (whoever produces the data), derived (calculated from primary data), secondary. Titles of Italian sources are in the original, with an English translation in brackets.
- Osservatorio sui conti pubblici italiani (Università Cattolica), Serie storiche di finanza pubblica [“Historical series of public finance”], March 2026 file (debt, interest, primary balance, stock-flow adjustment; Bank of Italy and Istat data). Primary; derived from primary data. https://osservatoriocpi.unicatt.it/content/dam/siti-web/ricerca/osservatorio_cpi/risorse/ocpi-OCPI%20-%20Serie%20Storiche%20marzo%202026.xlsx (page: https://osservatoriocpi.unicatt.it/risorse/serie-storiche.html)
- Eurostat, government debt, deficit and interest (gov_10dd_edpt1), notification of October 21, 2026 (2020, 2025 and check). Primary. https://ec.europa.eu/eurostat/databrowser/view/gov_10dd_edpt1/default/table
- European Commission, AMECO, sectoral balances (households, businesses, general government, rest of the world), 2026 (2025 data provisional). Primary. https://ec.europa.eu/economy_finance/db_indicators/ameco/documents/ameco16.zip (page: https://economy-finance.ec.europa.eu/economic-research-and-databases/economic-databases/ameco-database_en)
- Ministero della Salute, Annuario statistico del Servizio sanitario nazionale [“Statistical yearbook of the National Health Service”], 2020 and 2022 editions. Primary. https://www.quotidianosanita.it/allegati/allegato1658825757.pdf (2020) and https://www.quotidianosanita.it/allegati/allegato1712573646.pdf (2022)
- Quotidiano Sanità, comparison of the 2010 and 2019 yearbooks (care institutions, doctors, nurses, staff). Secondary. https://www.quotidianosanita.it/studi-e-analisi/in-anni-chiusi-ospedali-personale-ridotto-di-mila-unit-scarsi-progressi-sull-assistenza-territoriale-e-sempre-pi-spazio-al-privato-ecco-com-arrivato-il-ssn-di-fronte-al-covid/
- Eurostat, general government expenditure by function (gov_10a_exp, COFOG 07 “Health”), updated October 21, 2026. Primary. https://ec.europa.eu/eurostat/databrowser/view/gov_10a_exp/default/table
- Eurostat, Stock-flow adjustment note, October 2018. Primary. https://ec.europa.eu/eurostat/documents/4187653/9329991/STOCK-FLOW-2018-OCT.pdf/618b019d-c80a-43dc-a4d6-a58103d402ca
- Positano TV, reel “La grande truffa del debito pubblico” (“The Great Public Debt Scam”), an edit of a piece of “Notizie Oggi Lineasera,” Canale Italia, 2021, with the economist Valerio Malvezzi. Subject of the check. https://www.instagram.com/reel/DfO5H2mteBg/
