 Though all of these health care systems assure universal access to all citizens, their benefit packages vary. Sometimes, the variations occur at the level of specific treatments. For example, one system might decide a particular drug for Alzheimer’s is not cost-worthy, whereas other systems might provide it. Sometimes the differences involve whole categories of service. For example, the Canadian national law requires coverage only for inpatient drugs, not outpatient ones; different provinces provide different levels of coverage for what is omitted from the national schemes. Similarly, long-term care is not part of the national Canadian system, though some Canadian provinces, but not all, provide long-term care. The U.S. Medicare system provides nearly universal coverage to the American elderly, but until 2006, when the 2003 Medicare Modernization Act became effective, it excluded drugs from its benefit package (Medicare 2003). All universal coverage systems exclude certain categories of service, such as cosmetic surgery (as opposed to reconstructive plastic surgery). In general, then, where systems provide universal access, it is access for all to a specific set of benefits that varies from country to country, not to every service people may need or want.