If the problems with Obamacare weren’t already apparent, the evidence arrived in a letter from my medical insurer last spring. It served notice that my premium would rise by 33 per cent in 2017.

“The population is sicker than anticipated and using health care at a higher rate than was expected, factors that have created the need for a market correction,” it said. The problem lay firmly with the Affordable Care Act and its requirement that policies be sold to the sick and to the healthy at the same price, was the gist. People signing up for the first time were iller than forecast. And the federal funds designed to pay for the extra charges simply did not go far enough.

The problem was clear – at least to a clueless Brit trying to navigate the complex system of private insurers for the first time. Using the insurance system to pay for a universal system of healthcare was nonsensical. Insurance markets work by charging less for coverage for people less likely to use the service whatever it may be.

Crash your car and your premium goes up. Obamacare tried to break this formula. It may have helped about 17m people get coverage for the first time but the system was creaking badly.