Thanks to the efforts of an inspiring physician, Jeffrey Brenner, the Compstat policing method of mapping crime by time and location has been applied to medicine. In Camden, NJ, where he practised, 1% of patients account for a third of the city’s medical costs. The reason for this is the people with the highest need actually receive the worst care.

“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured.