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A cautionary tale from the US

Imagine a healthcare system where old ladies have to choose between medicines and food - while the drug companies whose medicines they cannot afford make more than the GDP of some countries.

And health insurance is so expensive and inadequate that 70% of bankruptcies are due to medical bills - while insurance companies award tens of millions in salaries to their CEOs. This is what is happening the US - the symptoms of a broken system you would think anyone in their right mind would want to change. An apparently growing and ever more obnoxious faction do not.

Though English raised and trained, I have been a family physician (the US version of a GP) in Virginia for the past 23 years - getting an up-close-and-personal view of the insanities of the US healthcare system.

I have plodded on, through multiple presidential administrations, waiting for Americans to come to their senses. Never have I seen vitriol and bile like that being unleashed in opposition to the Democrats' relatively modest proposals for healthcare reform, personified by some of those who came to two Town Hall meetings in my home town of Fredericksburg last week.

Opponents of reform were vociferous and belligerent - wearing 'Guns Save Lives' badges, and harassing an Irish woman friend because she didn't join in reciting the Pledge of Allegiance.

One belligerent old geezer exemplified 'I'm alright Jack' selfishness, wagging his finger and saying: 'I didn't do my part so I could give an illegal immigrant part of my Social Security.'

I suspected racism could have been behind the plain denigration of the country's first African American president - abuse of a type I have never heard levelled at any white Democrat. One strident woman said: 'For the first time I don't believe the president we have is a patriot.'

The US healthcare system is rife with absurd insurance company regulations - firms can cancel your policy if you're costing too much, or refuse to insure you if you are sick. It is massively overpriced and inefficient, with estimates of 30% waste. Those who can afford it get 'Cadillac care', but those who can't get nothing. Healthcare in the US costs far more than any other country (16% of GNP), but was ranked 37th by the World Health Organization (between Costa Rica and Slovenia). You would think even Republicans would baulk at such madness.

Instead, there is misinformation. The rational use of limited resources was described as 'death squads' that will be 'genocide to the old people of this country', by one meeting attendee. 'Government-run healthcare doesn't work,' one emergency room doctor told us - he called the NHS 'Orwellian'.

It's getting near showdown. But opposing views seem to be getting more partisan and entrenched - getting in the way of any rational consideration of what can be done to fix this broken system.

Dr Patrick Neustatter, Virginia, US (originally from the UK)

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