Michael White on how Darzi looks from abroad

Before I catch up, let me predict one modest measure of Darzi's long-term influence: how, if at all, major US media like The New York Times treat his ideas.

Management-speak window-dressing was the snap reaction of one US website devoted to the worldwide evils of "socialised medicine". But Darzi - immigrant, polymath and superstar - is a very recognisable American type. And US voters are looking for answers to the soaring cost of their own healthcare system - $2.2 trillion dollars (£1,100bn) or $7,500 per head in 2007, according to last week's NYT.

Deep uncertainty about their country's future as the presidential election looms (and China rises) even means looking to the wimpy EU, whose proposals for expanded cross-border treatment got respectful attention, even from the socialised medicine site, because it stimulates competition.

A friend explained: "Americans deeply resent the real services which Europeans get for their taxes, services we don't get here - most notably good healthcare. They tell themselves it's unaffordable, but they're no longer convinced."

Hence the prominence of rival plans from the McCain and Obama camps to provide affordable insurance cover for all Americans. That, plus a new $40m campaign, Health Care for America Now, which hopes to reverse the ruthlessly effective media campaign which helped sink Bill 'n' Hillary Clinton's over-ambitious reforms of 1993-94.

Being in the US for a few days is enough to hear doubts about Barack Obama's policy making skills, even among hardened Democrats who expect him to win as the candidate of change against a vindictive, bad-tempered ("as bad as Nixon" says my friend) John McCain.

Senator Edward Kennedy, from what may be his deathbed (he has brain cancer) is working to prepare the ground for a consensus that eluded the Clintons, one that will give an Obama health initiative a better chance this time.

Intimidating in an opposing direction is the defensive power of the health lobbies: doctors, but also insurers and big pharmaceutical and high-tech manufacturers. Only the other day vested interests blocked a bill in Congress seeking a fairer burden of costs between the public and (much larger) private US sectors.

If there was an aggressive website called "Capitalist Medicine" it might have highlighted shortcomings I noticed: AstraZeneca won a federal court ruling against generic drug makers offering cheaper versions of its bipolar disorder drug Seroquel.

A big campaign, which many docs mistrust, is under way to promote wider use of Vitamin D's still-unproven "sunshine" benefits, especially for black Americans. A new study suggests that words like "cancer", "fat" and "green" will always sell a product or a scare.

Fascinating was a piece in the NYT on the pressure cardiologists and manufacturers exert on GPs and patients to sell the doubtful (for most people) benefits of CT scans.

Costing $500-$1,500 a time such examinations are vital to diagnosing a minority of serious cases, but largely pointless for the kind of people most likely to be persuaded to have them, experts explained. But Americans lurve high tech and scans are advertised on TV: a growing $100m market.

Far worse than here, the US divides between the educated thin classes and fat folk feeding killer food to fat kids. But prevention is much harder. It has taken 32 years to get a review of the hazards of mercury in dental fillings.

With CT scans, Medicare, which provides most healthcare for pensioners, threatened to refuse to pay unless doctors could prove their value. It was bullied into backing down. The floodgates may open.

US medicine does wonderful things too and they worry about many things we fret over, like dirty wards, neglected mental patients and electronic records.

But market forces are much more powerful. I cherish a TV advert for an impotence pill which ends: "If your erection lasts more than four hours call your doctor." Only in America.