The US health care system is on the cusp of radical reform. There are cultural reasons why there has been such strong opposition. European values of universality, equity and solidarity are still alien to the US.

With 47 million uninsured citizens unable to access health care unless they are women about to give birth, or face an immediate life threatening emergency or are able to pay up front, you would have thought that the case for change in the US healthcare system was overwhelming. If you add to that, the fact that the US spends twice as much per head on health care as the UK, with higher rates of infant mortality, shorter life expectancy and runaway obesity rates, the allure of a different kind of health system – or at least a radical break from the status quo – would seem irresistible.

Some aspects of the US and UK health care systems are not in fact as far apart as might first appear to be the case. The ‘denials’ depicted so emotively by Michael Moore’s film ‘Sicko’ because the care is deemed ‘experimental’ are similar to those often rejected as exceptional cases by  English PCTs as they make their own judgements about priorities and clinical effectiveness. Waiting times (an alien concept in the US) are coming down fast in the UK: 18 weeks is the maximum but for most procedures (at least in England) and in many hospitals it is much less than that. Rising costs and utilisation and issues around productivity continue to bedevil both systems.

The wider set of cultural beliefs and norms that have underpinned the two health care systems are however very different. The UK signed up in 2006, together with the other 24 ( at that time) European Union member states, to a set of principles for health care systems which include values about universality, equity and solidarity. These stand irrespective of whether the countries run a government operated (such as UK) or statutory health insurance system (such as in France). The principle of universal coverage, reinforced by the WHO Report Primary Health Care: Now More Than Ever published in 2008, is increasingly considered the hallmark of a civilised country, whatever the prevailing politics.

The trick for the Obama health team has been to use a policy window to map the rhetoric of the original founding fathers frontier spirit on to a moral code which is fitting for a civilised society in the 21^st century whilst steering clear, in the minds of  at least the majority of Democrats although none of the Republicans in the House of Representatives, of the charge of imposing ‘socialised medicine’.

It may be the moment for us to put a caveat to that famous phrase, and to add ‘free only at the point of use’, because there is a price (and an opportunity cost) for each and every NHS consultation, test, intervention, treatment, operation and therapy. And these nationally set prices (the national tariff) are widely known about within the NHS management community as they form the basis for how hospitals are paid. Would it not make sense for these prices to be widely published and debated in the media so that patients and staff are aware of the costs of services? The objective would not be to deter, but to account to end funders (UK citizens as taxpayers) and to optimise the wisest use of a scarce resource. The public could request information about the invoices sent to their primary care trust for their treatment so that they could check for accuracy and value for money. The arguments about levels of activity and balance of resources across disease groups, primary and hospital care and mental health services could then be weighed by a wider group of patients, staff, public and media who would be more fully engaged in the costs and consequences of choices made by and within our health care system.