By Maggie Astor

What do Canada, Costa Rica, France, Japan, and Sweden have in common? They all have universal health care — along with a slew of other nations.

With the recent passage of a sweeping overhaul of the American health care system, the U.S. moves one step closer to joining the long list of countries that guarantee health care to all their citizens. But for all of the conservative furor surrounding the bill, it does not actually provide universal healthcare — according to the Congressional Budget Office (PDF), it will newly cover 32 million Americans, but will leave up to 23 million uninsured.

Of the 195 countries recognized by the United Nations, 16 (8.2 percent) have single-payer health care systems, meaning citizens’ medical costs are paid for out of a single (usually government-run) pool to which a variety of public and private sources may contribute. A further 51 countries (26.2 percent) provide universal coverage through other means. The United States is the only industrialized country that does not guarantee adequate health care to all its citizens.

This is not to say that other countries’ systems can easily translate to the United States; every country has different demographics and different needs, and a successful national health care system should be individualized accordingly. But it is fallacious to say that because Sweden’s system won’t work in the U.S., no universal health care system will. What follows is an examination of universal health care programs in several countries of various sizes and political backgrounds.

CANADA

Population: 33 million (compared to U.S., 307 million)
Health spending: 10 percent of GDP (compared to U.S., 15.3 percent)
Life expectancy: 78 men / 83 women (compared to U.S., 75 / 80)
(STATISTICS ARE FROM THE WORLD HEALTH ORGANIZATION, c. 2006)

All Canadian citizens receive health insurance through a federal program called Medicare, but hospitals and physicians are not publicly controlled; only the funding is nationalized. Each of the country’s 10 provinces runs its own nonprofit insurance plan, and citizens are charged neither deductibles nor copays. The tradeoff is that doctors are paid less and there is a smaller supply of expensive equipment like MRI machines, which necessitates waitlists. The provincial governments have an incentive to keep costs down because the more successfully they do so, the more public funding they receive. Doctors are paid on a standardized scale, and hospitals operate under standardized budgets.

When Canada established universal health care in the 1960s, the political, social, and economic considerations were very much similar to those the U.S. faces today. The New York Times concluded that its success “demonstrates that it is possible to have public health insurance that largely fulfills the explicit purposes set out in the Canada Health Act of 1984: universal insurance, comprehensive hospital and physician benefits (without hidden insurance policy constraints), portable coverage across the nation, clear accountability through the political process and no significant financial barriers to care.”

COSTA RICA

Population: 4.5 million
Health spending: 7 percent of GDP
Life expectancy: 76 / 80

Costa Rica offers universal but non-mandatory health insurance to all its citizens. The program — Caja Costarricense de Seguro Social, commonly known as Caja — costs between 10 and 11.5 percent of income and entitles members to treatment at any of 10 major public hospitals or smaller local clinics. A mandatory pension payment is included in Caja costs and is paid out after age 65. Private insurance through a government-run monopoly, INS, is also available for between $50 and $100 per month per person, but it does not cover preexisting conditions or annual physicals.

The Costa Rican system differs significantly from the plan passed by Congress in that it is true socialized medicine, with both the means of funding (insurance) and the means of care (the hospitals and clinics themselves) being government-controlled. It operates, however, in a very different climate: Costa Rica is less than 1/68 the size of the U.S. in terms of population, so a fully government-run system is far easier to coordinate and maintain.

FRANCE

Population: 62 million
Health spending: 11 percent of GDP
Life expectancy: 77 / 84

The French system operates much like Canada’s in that it is government-financed but not government-operated. In other words, all citizens receive comprehensive health insurance from the government — funded mainly by payroll taxes, just like Medicare and Social Security in the U.S. — but doctors themselves remain private. And, like under the plan just passed by Congress, French citizens cannot be denied coverage based on pre-existing conditions or have their coverage terminated past a certain cap.

In most instances, this public insurance plan covers 70 percent of any medical visit, and the patient is responsible for the remaining 30 percent, though this copayment is waived for patients with chronic conditions whose out-of-pocket medical costs would add up to over $100 per month. Citizens may purchase optional supplemental coverage from private insurers. According to the New York Times, over 99 percent of the legal French population is insured through this system, and the very small remainder can get emergency room visits covered.

While France’s small size in relation to the U.S. must be taken into account, the success of its system dispels many of the criticisms levied against the new plan here. As Victor G. Rodwin, a health policy and management professor at the Wagner School of Public Service at New York University, told the New York Times, “The French health system demonstrates that it is possible to achieve universal coverage without a government-run system that regulates how doctors practice medicine.…The French system also demonstrates that in contrast to some single-payer systems, universal coverage does not preclude the existence of private insurers.” ()

JAPAN

Population: 127.7 million
Health spending: 8 percent of GDP
Life expectancy: 79 / 86

Japan has one of the most complex of the universal health care formats, but it is also arguably the most efficient: Japanese citizens have the longest healthy life expectancy of any nationality, yet spend only half as much on health care as Americans do.

The country is home to thousands of insurance providers, but they do not compete; every citizen is enrolled in one based on where they work or live, and the premiums are based on income. Once insured, patients can choose their own provider, and doctors have full control over treatment. Insurers reimburse doctors at standardized rates, which are negotiated biyearly.  Insurance is provided within several categories: for instance, employees at businesses with between five and 300 employees receive a plan from one source, those at businesses with over 300 employees are insured from a second source, government employees from another, the unemployed from another. The benefits in all of these plans, however, are the same; only the source of the funds is different.

Like France, Japan has a multi-payer system that mimics a single-payer system in practice: there are multiple insurers, but stringent government regulations to ensure that each insurer provides the same level of coverage for the same price. This is an effective alternative to fully “socialized” health care. Just as under the new American plan, all Japanese citizens are required to obtain insurance either through their employers or on the market, and the government provides subsidies for those who cannot afford it. As NPR notes, “It’s a model of social insurance that is used in many wealthy countries. But it’s definitely not ‘socialized medicine.’ Eighty percent of Japan’s hospitals are privately owned — more than in the United States — and almost every doctor’s office is a private business.”  Japan’s population is also more comparable to that of the U.S. than the populations of countries like Canada and France, and a strong argument can be made that a system modeled on Japan’s would also work on this side of the Pacific.

SWEDEN

Population: 9 million
Health spending: 8.9 percent of GDP
Life expectancy: 79 / 83

Sweden — along with its Scandinavian neighbors Norway and Denmark — has a single-payer health care system in which medical providers remain mostly private, but all citizens are fully insured through a single government-run pool. The maximum amount any individual will be required to pay for medical costs (other than prescriptions) in a year is $108, and the maximum they will have to pay in prescription costs is $156 per year.

While many factors — population, economic strength, political opinions — influence the type of health care system that would work best for a particular country, there is no reason to say that the United States cannot follow in the footsteps of these and other countries and guarantee decent health care to all of its citizens. These serve as concrete evidence that it is possible to balance the moral imperative to insure citizens with the capitalist desire to keep the government small and health care an unregulated commodity on the free market. Universal health care does not have to be “socialized medicine.”

But, what if it is? The establishment of true universal health care in the U.S. would be an acknowledgment that certain things are basic human needs. The government provides paved roads and snow-plowing services because it realizes the ability to travel expediently and safely from Point A to Point B is a necessity. Similarly, a system modeled on some of those above would acknowledge that the ability to go to the hospital for a heart attack and not be saddled with debt for five years is a basic human need.

Maggie Astor is a journalist/student at Barnard College.