For years foreigners have struggled to understand how the US, the most productive country in the world, can fail to offer its citizens what is taken for granted in every other rich economy: universal health insurance. Increasingly, Americans are asking the same question. The country’s mood on healthcare is shifting, and the next administration and Congress will probably do something about it.

One sign of this, and of how isolated the Bush administration has become on the subject, is the debate over expanding the state children’s health insurance programme. This gives tax-supported health insurance to the children of low-income families. At the end of last week the Senate voted 67-29 for a big expansion; enough Republicans supported the Democratic majority to overturn the promised presidential veto.