Many people in America cry out for universal health care, pointing to the other countries that do it well.  We point out that the  % of GDP here is much higher than in other places, and that we spend well over twice what the next country (Canada*) spends, on average, per citizen on health costs.  We hear from foreigners living here and Americans who have lived abroad that it is better.  The United States is one of the only countries in the "free world" that doesn't have national health care.  But understanding what we want means understanding the terms, and also how they apply to the big picture. 

Universal health care is not entirely synonymous with national health care.  We think it will mean every person will have access to the most standardized, highest quality medical care anywhere we live or set foot, without paying for it.  National health care is a system of "single payer".  It is not free, by far.  Countries with national health care have significantly higher taxes- both on goods and services, as well as property and income- than anywhere in the United States.  There is no opting in or out.  Those who have more money still frequently buy private health insurance, and go to private hospitals and get the care they want, faster, or of higher quality, than they can get in the national health system.  For the poor, they are getting good, average care.  For the rich, they can go to another country or private.  That is true anywhere in the world.  

Universal access is a different story.  We have, for the most part, universal access in the United States.  If you live out in the country, there is less choice.  Someone has to pay for those doctors and those buildings and those techs and those machines to be there, and that is always based on money.  Otherwise, any of us can get health care and will not be denied it for emergency and lifesaving medicine.   Who picks up the tab is another story altogether.  The libertarians would have us believe we should only pay for what we use.  But the doctor must be educated for years before they get to us, the buildings bought and filled out, standing on ready.  You can't have an expensive medicine on hand if it hadn't already spent years in development and research and manufacturing.  Medicines go bad.  All of those things must be there, paid for, at the time you need them, whether you need them now or in ten years.  

National health care is always part of a greater national welfare system. Depending on the country,  the integration of the community makes it easier or harder to apply these services.  Scandinavian countries were once aristocratic and had social revolutions that put in place social democracies.  There is no institutional inequality anymore, and this is very important.  The attitude of those growing up in those countries is towards equality of each other, between men and women, and respect for old and young alike.  They have an understanding of personal freedom and rights that I have personally found lacking in most Americans.  There is a huge difference between rights, liberties and privileges.  Everyone is raised with a strong sense of responsibility towards each other.  People don't have guns, and violence is very low.   Contraception and abortion are also universally available, and are an expected part of health care.  Because, once a child is conceived and the mother decides to carry it, that child and mother will be cared for the rest of their existence. 

Other countries, like England, still have a hugely entrenched class system that makes retrograde socialization very hard to budge.  They also have a completely different history of colonialization and immigration than Scandinavia, and Germany, and a completely different history of occupation by Nazis and Soviets.   If you think that doesn't matter, you would be wrong.  Living through the aftermath of two world wars, in the ruins of society, among the buildings, in the fields, in a relatively small land mass (Europe), with a very dense population of very diverse cultures, is entirely different than 400 years of post English colonialism, two pre-industrial wars fought on our land, and a long history of institutionalized inequality and racism.   The worst war we experienced on our land was the Civil War, and I understand the South still hasn't fully recovered.  

Why this is important is that the places with the most successful integration of social welfare- medicine, education, housing, transportation- have an attitude in common.  That is for the communal respect of each other, and the care and investment and responsibility in each person in that society towards each other. Social democracy is a "cradle to grave" institution, and works better in places where most people have the same religions, cultures, and values.  Within Denmark, you can talk about the difference between the rudeness of those from Copenhagen, the mildness of those from Fyn, and the bucholic daftness of those from Jutland, and compare notes on their accents and relative intelligence.  Of course, until you live there long enough and understand the accents, most people would find Danes relatively the same.  Underneath all the colloquialisms, we find a country of people who know that if they were to move to any other part of the country, they are "in the system" and have the same rights to education, welfare, medicine, and same expectation of quality, as anywhere else.  The kommune** system keeps track of their members, but is transferrable.  

We see this falling apart in Scandinavia, as well as all over Europe, now.  Aside from the weakness in the Euro (caused by the Greeks***, of course!, with their different values and different history and different culture), the Europeans have major clashes of class, religion, culture and immigration that are very serious.  This has been going on for over 20 years (I witnessed anti muslim attacks while studying in Spain in 1992, and they weren't uncommon), and indicates cracks in the system that idealists and philosophers dont' address.  In order to have a good attitude towards commonwealth (in the socialist sense), you must have a good attitude towards those you share the common wealth with.  Americans don't have this attitude any better, and we are more vocal about it.  We justify our history of institutionalized racism and slavery, and still pursue it through our nationalist means (immigration laws).  We justify our right to pursue our own happiness at the neglect of others.  We justify our right to let others fend for themselves, after all, we killed thousands of Native Americans in order to turn this wild continent into a country less than 200 years ago.  We don't have a long history of shared neighbor space and invasion with our neighbors.  We have a short history of colonialism and manifest destiny, thievery, robber barons, tycoons and occupation.  Of course, now, we have run out of space to take over.   

One of the reasons I left Denmark and returned to living in the United States was environment.  Despite Denmark leading the world in green technology, recycling (they've done it for 50 years), and environmental awareness and organic food, I need sunshine more than alcohol to combat the SAD I experienced there and growing up in New England.  I needed more visual space, as well, for the claustrophobia I get in urban settings and along the densely populated and heavily treelined, winding roads and thick with buildings streets of Europe and New York.  I had already lived in rural Colorado and New Mexico (urban Santa Fe) and had a hard time pressing my mind into tight, dark, rainy space.  

When the environment forces you to contend with dark, wet, tight space day after day, you learn to get along with your neighbors a little better, but there is only so much room for it.  I was seen as an eternal optimist, pollyanna to my russian counterparts at school there.  I mystified the Serbians fleeing the war in Kosovo.  My friends from language school, from all over the world, moving to Denmark loved the neatness, the tidyness, the politeness, the schedules, the kommune.  Yet, all observed the coldness beneath the politeness, the reliance on sarcasm, smoking and heavy drinking, to get through it all.  And we didn't even have cold winters.

 If you are not a Dane, you are an outsider no matter how long you have lived there.  I am half Danish, and learned to speak the language quite well, and still found it very very hard to make friends with anyone but English, Russian, Chinese, Canadian, Spanish.... If you are not a Dane, you are taking up the social welfare resources, one way or another, more than you are putting into them.  This is what people are thinking, and will say if they think you are white enough to hear it.  A cousin of mine worked for the UN and was top tier in the Foreign Ministry, so I got to hear this from the perspective of one who gets behind those closed doors on national policy and diplomatic relations.  People flock there to get those social benefits, and there is a huge backlash.  With the falling of the euro, there are many cuts into the social safety net.  Immigration laws have tightened, citizenship rights are changing, again, and deportations are stepping up.  Sound familiar?

Americans are too different from one another and too disrespectful of other cultures, religions, races and ideals to have a successful social welfare system.  The parts of the country, like New England, where socialism is more realized, are much smaller and less diverse.  Our system is not built on the same foundation, historically or culturally as Europe, or Japan, or England.  We could change our attitude about a national health care system, but it would still mean a lot of money out of our pockets, and not necessarily improve the service.  Some things would be better, like cheaper and more efficient, some things would get worse, like longer waiting times and less innovation.   Cuba has a great national health care system and most Cubans live in abject poverty.  They aren't getting top of the line medical care, they are getting the generic, knock off versions of what we have developed in this country.  

The cost of our healthcare, outside of the administrative and profit margins of insurers, is also the reality we lead the world in innovation.  Socialized countries take our medicines, our technology, and use them- but they rarely develop them.  I'd be happy to end up in a Danish hospital for many things, but I also know that if I was 70 and got lung cancer, I wouldn't be given all the lifesaving care necessary until the end.  If I needed a new hip at 40 it would happen, but much later if I was retired.  I was glad to see more acupuncture available when I was there last, and will check things out when I visit this summer, but there is a very narrow range of what medicine is paid for.  That means less choice, less freedom, and less hope.   

The other reason I left.  I am too American, I am used to having another option, and a positive outlook.   

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* This was from the last stats I read, maybe outdated by now. 

** If you don't know the modern history of Europe, or the difference between Nazis, fascism, socialism, and communism, as well as theoretical versus how it really happened, please sort this out yourself.  Kommune is a word for commonwealth, in the way we use county to refer to public welfare.  It is not remotely synonymous with what we refer to as communes here in the states.

***  Currently, the Greeks are to blame.  The "blame" for failure of unity is always between the highly industrious north/protestant countries, and the more lassez faire and corrupt south/mediterranean/catholic countries.  Thankfully, the phenomenon was pointed out to me by my european history teacher when I was in undergrad in Madrid.   How much does religion have to do with shaping attitudes towards fate, poverty, personal destiny, family vs clan vs strangers?  Well, historically, a lot.