It is an iron law of American politics that Democratic party politicians who propose relatively detailed healthcare reform plans – as Barack Obama did last Tuesday – get trashed. If they propose a plan that might actually pass, securing the 60 needed votes to close off debate and proceed to a final vote in the Senate, they will be trashed for having abandoned their base and their own principles. If they propose a plan that corresponds to the world that they wish they could attain, they will be trashed as having no practical sense. In either case, they lose. It is like hitting yourself on the head with a hammer: a pointless and painful exercise.

This is too bad, as the US needs to have a debate on its healthcare system. It spends twice as much as western Europe for little clear benefit: Americans are no more healthy or long-lived than western Europeans. If the US could get the same value for its healthcare dollars as western Europe, it would have an extra $800bn a year to spend: enough to pay room, board and private college tuition for every American 18-21 year old, and still have enough left over for Marshall Plan-scale economic development programmes for Bangladesh, Pakistan, Egypt and the Maghreb.