So it would be deeply misleading to imply that this campaign will be a contest between what Britain likes to call “progressive” politics and some atavistic longing for a return to frontier America where everybody made a success of his own life with no help from anybody but his kith and kin. In the midst of the impassioned and often nasty debate about the future of health care, in which Ryan was depicted as a granny-killer, there has been some serious Republican thinking about the universal provision of medical care for pensioners (or “seniors” as they are called in the US). Because, you see, the debate over there has gone way beyond welfare reform: the need to restrict benefit dependency among the underclass is an argument that has been won. What is at issue now is much more politically contentious: universal entitlements such as comprehensive Medicare and social security are known to be unaffordable in their present form. Ryan, the radical economic thinker, suggests a solution for Medicare in the form of a voucher system. Patients could choose from competing health providers, with a ceiling on the cost of procedures and treatments, instead of simply being given blanket no-choice care. Thus, the government would get better value for money, and individuals would have more say in their own treatment. Now why doesn’t anybody here think of applying that mechanism to the NHS? Oh, yes, some people have – but nobody in power will listen to them.