How come Canada and Japan have lower government expenditures relative to GDP than the US despite seemingly having more social services?

It seems to me that Italy and France are outliers in terms of having a very large share of the national economy (the GDP) being government expenditure, but how Japan, Australia, Canada and Switzerland are able to provide universal healthcare despite having lower government expenditure than the US has me a bit stumped.

I get that the US has medicare and medicaid and that those two programs actually are quite expensive to run, it just still doesn't quite add up to me.

https://ourworldindata.org/grapher/total-gov-expenditure-gdp-wdi?tab=line&time=2008..latest&country=USA~DNK~FRA~ITA~JPN~CAN~SWE~NOR~CHE&mapSelect=USA~DNK~FRA~ITA~MEX~JPN