It's not mandatory to purchase travel insurance to visit Italy. Most leisure and business travelers choose to purchase insurance in order to cover unexpected medical costs and protect their trip investment against unexpected cancellations.
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If your trip doesn't involve any nonrefundable reservations, you may not need travel insurance. For instance, if you've booked only airplane tickets and a hotel stay for your vacation, and they're both governed by flexible cancellation policies, the trip cancellation benefit may not be necessary.
Healthcare in Italy is not free, but the fees are usually quite reasonable and Emergency Medical Assistance is provided to anyone in need, regardless of their nationality, without asking for upfront payment. Healthcare in Italy is provided to anyone with a mixed Public and Private system.
Important: While travel insurance policies may be more comprehensive than credit card protections, there are limitations. They typically won't cover non-essential medical expenses, high-risk sports or activities, or pre-existing conditions — at least without paying for add-on coverage.
In general, Italians respect Americans and always welcome them as friends. They adore the curiosity of American tourists in regard to experiencing Italian culture, and they love the way that Americans enjoy their food.