Rising rates of chronic diseases, aging populations, and mounting medical costs threaten the financial solvency of the health care systems of the United States and Costa Rica. Despite ranking 1st in health expenditures, the United States achieves the same health outcomes as Costa Rica, a country that ranks 50th in expenditures. As a result, the United States is transitioning to Costa Rica’s model of government-sponsored care in an effort to reduce costs just as Costa Rica begins shifting away from centralization of medical care in an effort to improve quality. However, many of the fiscal and quality problems that Costa Rica experienced over long-term implementation of its public system will likely also confront the United States. The forecasted increases in U.S. health care spending will necessitate strict cost-cutting measures, similar to those enacted in Costa Rica, that risk deterioration in care quality.