The US furore over funding healthcare has exposed American prejudices against the NHS and British preconceptions about the US system. Neither country wants to change, but maybe we both have something to learn.

The extent of the urban myths about each other’s health systems shows that neither nation knows much of the alternatives. We would both benefit by knowing more, but although the argument is over what the Americans call “socialised medicine”, both populations have shown themselves to be immensely conservative – and with good short-term reason.

The key question for most people is not whether the other system might be better but what is the cost of changing.

In both countries health is expensive – the UK spends 8 per cent of GDP on its private system, the Americans twice that. That might look like the British system is more cost-efficient but the Americans argue their system delivers more for the extra money.

But both countries would pay more if they adopt the other’s system, if only because of duplication during the transition. The 10 per cent of UK people who have private health cover (often paid by employers) also pay towards the National Health Service: no-one believes a move to greater private cover would cut the public bill.

The Americans similarly fear they would pay taxes as well as their private insurance, not instead. Further, they would be paying taxes not only to cover their own healthcare but also for those currently without private insurance or who pay low taxes. Those currently with private cover would thus face paying trebly if the US moves to publicly-funded healthcare.

A National Health Service may seem a good safety net for America but UK history showed it to be the thin end of the wedge: before long the safety net was the universal provider.

The cost of changing for both countries is thus too great. But the merits of the two systems deserve consideration, if only because they consume so much of peoples’ income. Britain’s NHS costs £100bn and the 1.56m workforce is exceeded only by Wal-Mart, the US supermarket group, and the People’s Liberation Army in China.

And the UK’s common supplier of health services means there is no competition by which to measure it domestically. Americans can choose which hospitals they use, just as they can choose to shop at Wal-Mart. Nor is there any exercise of demand and supply rules in the UK: free health cover creates high demand that is countered by rationing or waiting lists (the “death panels” cited by US critics).

A UK system that allowed choice of provider and a choice of how much cover to pay for is not on the agenda of the main political parties or most people however. Even die-hard capitalists are conditioned to defending the NHS, partly because we know no alternative and partly because suggesting dismantling it rather than enhancing it is regarded as subversive.

But having made British people provide their own housing requirements and their own pensions, suggesting they finance their own healthcare ought not to be beyond the pale. There can be safety nets, but if we had to spend the money ourselves we might spend it better.

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