The debate over health-care reform has been raging in the United States and it hasn't been pretty. The Democrats were just able to get a bill through Congress with bipartisan support. Well, not all of the Democrats voted for it, and only one Republican did: that counts as bipartisan these days. It headed to the Senate and on its first test managed to garner the 60 votes to prevent filibuster, though almost all the Republicans voted against it, but it still has an uncertain future. Maybe it will fail just as Hillary Clinton's plan for universal health care did.
The proportion of US residents who are not covered by health insurance is large and growing. The most recent data available shows that there were nearly 46 million people without coverage in 2007. This number has increased sharply over time - in 2007, 15.3 per cent of the population was not covered, up from 13.7 per cent in 2000 - and the total figure is certain to rise to roughly 50 million, or one in six people, as the unemployment rate is now 10 per cent, real median household income is falling and poverty is rising.
The availability of health insurance is lower among men than women, lower for minorities than for whites, and especially low for Hispanic Americans, the least educated, the poor, the obese and those living in Texas. Approximately one in three Hispanic Americans has no coverage, compared with one in seven whites.
Moreover, large numbers of the long-term unemployed and their families are at risk of losing their health insurance as their eligibility for a subsidy expires. Under the federal stimulus bill, workers laid off between 1 September 2008 and 31 December 2009 have had to pay only 35 per cent of the cost to stay on their company health-care plans. But the subsidy lasts for just nine months of unemployment and then the laid-off workers are on their own - unless, that is, Congress extends the programme, but it hasn't so far.
The price of malpractice
The debate about providing universal health care has become vitriolic. On the one side are folks who like the health care they have and don't want to lose it or pay for anyone else to get it. This is capitalism and you are on your own, pal. They rage against creeping socialism and tell everyone that the US system is the best in the world, although presumably not for those who don't have access to it. Many of the older people who are against others getting health-care coverage obtain theirs under Medicare, which, ironically, is publicly funded.
Most Americans know little or nothing about the quality of health care outside the US and have never heard of Harley Street, or Barts, or Guy's, even though those two hospitals have been in operation for close to a thousand years. Their local hospital is holding the third annual celebration of its opening next week. Give generously.
On the other side is the Obama administration, which was elected on a mandate to fix health care. Its supporters point out that thousands of people die every year because they can't get treatment. In a recent debate in the House of Representatives, one Democrat insisted on reading out names and numbers of people who had died because they had no health care in each Republican representative's district in turn. Not designed for peace and harmony.
I tell anyone who will listen in the US that the Brits really do love the National Health Service. And they are incredulous that neither of our main political parties is planning on touching it in its election manifesto. They just think we are all mad, but quaint. After all these years they still tell me they love my accent, even though I don't have one and they do.
The cost of health care in the US is driven up by huge malpractice awards, and doctors have to practise defensive medicine, doing endless tests to protect themselves from being sued. Nobody wants to take on the legal lobby.
Most people in the US seem unaware that health outcomes there are not particularly good even though health-care spending per capita is the highest of any country in the world. They spend more than two and a half times per head what the UK spends, and most of their outcomes are worse. The US ranks 25th for life expectancy at birth, and low for maternal mortality. According to the most recent data on infant mortality rates, the country ranks 30th, behind Singapore, Slovenia, the Czech Republic, South Korea and Malta, to name but a few, as well as the UK.
In the emergency room
The US does well, however, on survival rates following various cancer treatments, as it tests so many people. But those without health insurance don't get tested.
In a survey taken in 2008, men aged 40 and over were asked if they had ever been given a PSA test for prostate cancer; 68 per cent of those with coverage said they had, compared to 36 per cent of those without coverage; 4 per cent of those with insurance had been diagnosed at some point in their lives with prostate cancer, compared to 1 per cent of those without coverage, even though they were generally poorer and less healthy. They can show up to the emergency room for treatment when they have symptoms, but by then it's too late, as the cancer has spread. And then they die.
For people from a country with any significant social welfare system, and public toilets, this all seems hard-hearted and callous. And why exactly is it a good idea to let babies and mothers die during childbirth? Presumably Jesus would be voting in favour of health care for the poor and the weak.
Civilisation has been here before. Helping the poor to improve their health enhances the well-being of everyone. The productivity of the workforce would likely rise as it becomes healthier. I guess that, eventually, Americans will work that out.
Sometimes it really feels good to be British. But I still live in America; I have great health-care coverage and it is exciting to live in the home of the brave. As my pal Bill Bryson can attest, the moose- and bear-hunting (yuck!) and snowmobiling are great in New Hampshire, where the state motto is "Live free or die". Or move.
Come visit, but make sure you buy the travel insurance with decent health-care coverage before you leave home.
David Blanchflower is professor of economics at Dartmouth College, New Hampshire, and the University of Stirling
Watch an interview with Prof Blanchflower