Most Americans think that their healthcare system is broken - and they are right. This has been an article of faith among Democrats for years. Lately, Republicans have come around as well. As governor of Massachusetts, Mitt Romney, a contender for the Republican party's presidential nomination, championed a reform that widened access to health insurance in his state, and the legislature gave it overwhelming bipartisan support. In California, Arnold Schwarzenegger (another Republican) has proposed a similar scheme. All the presidential candidates are going to be pressed on their plans for healthcare.

What principles should guide them? Universal insurance coverage ought, indeed, to be a priority. It beggars belief that a country as rich as the US has failed, alone among advanced economies, to secure this. A second main requirement is an effective mechanism to contain costs - remembering that America's healthcare system, despite big gaps in coverage, is easily the most expensive in the world. A third, desirable in its own right and a political requirement too, is a promise that the quality of care should not fall for those (the majority) already covered.