I WAS SORRY to read about the accident a member of our community had recently while traveling with a church group in Italy. I was also sorry to read that the medical care was unsatisfactory. I hope the writer is fully recovered by now. It is true that Italy has a government financed health care delivery system that the writer refers to as “socialized medicine.” I was surprised to learn that Italy’s system is ranked No. 2 in the world by the World Health Organization. Nonetheless, the writer’s experience was not satisfactory.

Socialized medicine is typically a pejorative term used by those who oppose health care reform and hope to stigmatize supporters as socialists. The fact is there are several ways universal health care coverage (covering all citizens) is handled in different countries (and in the U.S. for certain subpopulations). Some countries have public financing and private delivery. Medicare is partially publicly financed along with private patient premiums, but privately provided by doctors who do not work for the government. Other plans have public financing and public delivery. Examples would be the U.S. Veterans Administration, the U.S. Military Health Service and the British National Health Service where health care providers and doctors work for the government. Canada’s health service is publicly funded for the most part, but privately provided. We do not often hear the Veterans Administration or the Military Health Service attacked as being socialized medicine.

Although the United States provides universal health care coverage for certain subpopulations as alluded to above, we remain the only modern industrialized country in the world that has not established a universal health care system that covers the entire population. Currently about 43 million citizens do not have health care coverage that they need to stay healthy and look after their families. The current U.S. health care plan passed in 2009, The Affordable Care Act (ACA), seeks to be universal by covering the rest of the population not covered by military health care, Medicare, and Medicaid. It is publicly funded only for those who can’t afford insurance premiums, insurance is provided by private companies and care is provided by private health care facilities and private physicians. It is a health insurance plan, not a health care plan. Further, the Congressional Budget Office, the independent body that both parties rely on to calculate the cost of bills, has said it actually reduces costs — $100 billion in the first decade. It does this by cutting waste in the system and putting an emphasis on preventative care to keep people healthy. It also keeps sick people who do not have an emergency out of expensive health care settings like the emergency room — care which taxpayers wind up covering.

The most controversial part of the ACA and the part that the Supreme Court will soon rule on is the individual mandate, which requires everyone to buy health insurance. Most health policy experts and insurance companies agree that insurance risks must be spread over the entire population to make health insurance affordable and to prevent free riders from buying insurance only when they get sick. That is what Republican presidential nominee Mitt Romney must have concluded too as he supported an individual mandate in the Massachusetts health care plan that was the model for the ACA. In fact, the individual mandate was originally a Republican idea. It started with some economists at the conservative Heritage Foundation to counter Democrat single-payer proposals similar to Medicare. The idea was later supported by other Republicans including Bob Dole, Orrin Hatch, Richard Lugar, Alan Simpson, Arlen Specter and Newt Gingrich.

So, the ideas in the ACA, once acceptable to Republicans, bear no resemblance to “socialized medicine.” It is a plan to extend private medical insurance to all of our citizens in a cost effective way.