TALKING to Europeans (particularly non-Brits) about things like health care and welfare programmes is a treat. Most of the Europeans I meet seem to believe that huge numbers of Americans get no health care at all, while the rich few wallow in luxury. In fact, the biggest problems uninsured Americans face are not doctors refusing to treat them, but the fact that they use the incredibly inconvenient emergency room for most of their care, and that a really bad illness could force them into bankruptcy. (Some also believe that it reduces quality of care for chronic illnesses like diabetes, but this is much less clear). Not admirable, by any means, but a far cry from the tortured visions of poor Americans dying at the hospital’s door, their pleas for care unheeded.

Americans on the other hand, the overwhelming majority of whom are insured, seem to believe that millions of Europeans die each year from lack of treatment. The reality is much less grim; a fair number of Europeans go without hip replacements and other quality of life treatments, and some do die on waiting lists, but many of those people would have died anyway, because they have nasty diseases with life expectancies measured in months. America caters, expensively, to their desire to live a few extra weeks or months; Europe does not.

Because I’m unhappy with our current state of medical progress, the most important single issue to me is which system encourages research and development. The answer, of course, is that neither does it nearly as well as I’d like, though the U.S. system is pretty clearly better than the European. I want an Andy Kessler world, and I want it soon!