One of the lessons to be drawn from this column is how at odds with each other the British and the American healthcare systems are in terms both of their mechanisms and the philosophies underpinning them: on the one hand, the universal, solidaristic, public, taxpayer-funded NHS; on the other the individualized, market-oriented, predominantly private American system (with the exception of Medicare and Medicaid,  of course). And these differences emphasize the gap between both societies’ historical conceptions of the place of health in their respective social policies, i.e., between a society (Britain) that conceived healthcare reform as the cornerstone, if not the be all end all of its Welfare State – disease being the greatest of the five ‘giant evils’  William Beveridge had targeted in his 1942 report (along with idleness, ignorance, squalor and want) and the 1946 National Health Service Act (which created the NHS and effectively nationalised medicine in the country) being by far the most important social reform passed by the Attlee government after the war, together with the 1946 National Insurance Act (which enforced social security), and another society (the US) in which healthcare coverage never proved to be a priority, even to some of its most liberal leaders:

– during the New Deal, no significant program was launched by the Roosevelt administration, at least none that might compare to the New Deal’s momentous social reforms regarding employment, labour relations, social security, pensions, welfare, or even education.

– LBJ’s administration did enact Medicaid and Medicare, but though many of its advocates expected the latter program to cover more and more Americans if not all of them, and though a majority of Americans have consistently favoured expanding it to people between the ages of 55 and 64 to cover more of the uninsured, it never happened…

– under her husband’s presidency, Hillary Rodham Clinton herself was forced to give up on her ambitious plans to reform healthcare and broaden federal programs (in 1992-1994)

– even President Obama had to abandon the idea of a public option to have the Affordable Care Act enacted…

Finally, the concluding remark by Iain McClements, the last interviewee in the text, that “there is no safety net” in the US, is an overstatement to say the least, if only in light of the protection guaranteed by Medicare and Medicaid, not to mention numerous other welfare programs. But it is true that, when it comes to healthcare and other areas of social policy, the U.S.’s safety net is more limited than the British one. And the fierce opposition that has been made to President Obama’s ACA tends to suggest that, somewhat paradoxically, a good many Americans actually wished Mr McClements’s diagnosis were entirely true, and would be happy to do away with what little safety net the US still has.