So what does Barack Obama's election victory mean for the future of the US health system? And what lessons, if any, are US policy makers likely to derive from recent NHS reforms?
Answering the first question requires a brief outline of his health plan, followed by wild speculation about how much of it will actually come about. Answering the second would take much more than my allotted 950 words.
That's despite the fact that seen from Britain, the conversation about US healthcare often begins - and ends - with two rather clichŽd observations; first, that the US spends a lot - currently about $2.4trn a year - while each year adding the equivalent of another NHS to its spending totals. And second that it is a patchwork quilt, comprising multiple healthcare subsystems that together cover about 85 per cent of the population. So as a country of 300 million people, it makes no more sense to talk about the US healthcare system than it does to talk about the equivalently sized western European healthcare system.
Yet in the US - as in Britain - most people actually like the healthcare they and their family receive. As academic researchers Lawrence Jacobs, Bob Blendon and others have consistently shown, while the majority may say they worry about quality, access or cost nationally, only a small minority are dissatisfied with their personal experience in these three domains.
Candidate Obama was therefore careful to frame his plan as offering voters more options and choices, rather than taking away anything they currently value. So unlike John McCain he did not suggest doing away with employment based health insurance for working age adults. (People aged over 65 are covered by tax-funded Medicare, partly run on the government's behalf by private sector commissioners.) Instead Obama's insight was that regardless of whether or not you would start from where we now are, around 180 million Americans currently get their healthcare coverage via their employer. So he argued the pragmatic answer was to build out from that platform rather than try to scrap it and start again.
Indeed what makes the US unusual is not that it partly relies on employers for healthcare financing - so do Germany, France and others. Instead the distinguishing feature of the US is the lack of compulsion - be it for employers to offer health insurance or for individuals to pay.
Whereas Hillary Clinton proposed to make the purchase of health insurance mandatory for individuals (similar to the scheme introduced by former Republican candidate Mitt Romney in Massachusetts), Barack Obama's plan has three core tenets. All large and medium sized employers would be required to pay for their employees' coverage either directly or via a new payroll tax; people not covered by an employer would be able but not required to select a private or public health insurance plan from a new national clearing house; and parents would compulsorily provide healthcare coverage for their children.
So how much of the president-elect's plan will see the light of day?
The obvious obstacle could be the $1trn financial sector bailout package Obama will inherit from his predecessor. Has this pre-empted the several hundred billion dollars of new spending it is estimated might be needed to do something dramatic on healthcare coverage? Or do the current economic circumstances require precisely the sort of Keynesian fiscal boldness that a large expansion of access to healthcare might imply, particularly if financed through state-based expansion of Medicaid? If the new administration has decided which path to take, at this stage it is not saying.
The other key consideration is whether the US Congress will actually pass the president's proposals. Although Democrats now control clear majorities in both houses, they will probably lack the 60 votes necessary to block a filibuster in the Senate. And in any event, rival Senatorial and House committees have diverging views on how best to proceed. One of the lessons from the Clintons' failed health reforms of 1993-94 is that the president simply cannot serve up a bill and demand Congress pass it. So whatever legislation eventually emerges is going to be a hybrid version of several alternatives currently under discussion, rather than the pure form Obama proposal.
So while there was little interest from any of the leading presidential candidates in a big bang move to a Beveridge-style single payer government financing system, there are a number of items from recent NHS reform experience that are of greater relevance.
It seems probable, for example, that the US will create its own version of the National Institute for Health and Clinical Excellence, probably at arm's length from government. To this end, former senator Tom Daschle recently proposed the establishment of a new Federal Health Board modelled on the Federal Reserve to be just that.
Meanwhile just about everyone agrees the US needs proper electronic health record systems and Connecting for Health provides rich insights on the problems that stand in the way of doing so on a comprehensive national basis.
There is also a real head of steam about moving to much stronger pay-for-performance incentives. Many US insurers have been developing and using these approaches for some time, but Medicare has tended to lag. So the experience of the new GP contract in Britain may be of real interest.
And finally the search for industrial strength approaches to tackling chronic disease will continue, ensuring the US will remain a laboratory for innovation and insight for clinicians, managers and policy makers in the UK and elsewhere.
So good luck Mr President-elect. There's a lot riding on your shoulders.