The contrast between the American healthcare debate and our own politicians' squabbles about the NHS couldn't be starker. In America, real issues of political and philosophical principle are being argued over. Although there is much that US healthcare does well , there is recognition from both Democrats and Republicans that the system needs reforming and that spirraling costs need to be bought under control; the argument is over how this should be done.

In Britain there is no such debate. Despite the fact that the NHS lags many other nations in terms of treatment results and cost effectiveness, its sacred cow status is impossible to shake. The Tories appear to have concluded that any talk of serious reform will remind voters of the "nasty party", and that their first term priority should be education rather than health. At their most radical, Labour experiment with foundation hospitals and PFI, but remain fundamentally attached to a universal system free at the point of delivery. And what the Lib Dems want is irrelevant unless they form part of a coalition government.

The response to any politician brave enough to question the consensus is always the same: He or she will be accused of wanting "an American" system that throws the dying poor onto the streets. The fact that there are many different models of healthcare provision from around the world - many far more succesful than the British or American systems - is always lost amidst the anger that anyone would dare question the NHS. It's a shame the conversation has to be this way.