A Republican Congress and President Bill Clinton abolished a welfare programme in 1996 under the (largely fallacious) pretext that it bred fraud, waste and abuse. Thirteen years on, the reforms that Barack Obama is proposing will not fundamentally change the United States' abysmal healthcare system because those who profit from it have been able to buy protection from the lawmakers. The welfare programme ditched in 1996 absorbed about 1% of the US budget; today's well-ensconced private insurance companies swallow most of the 17% of the budget set aside for healthcare.

Paradoxically, the US president is one of the most spirited prosecutors of the system he has chosen to retain. Day after day he recounts how "we are held hostage by health insurance companies that deny coverage, or drop coverage, or charge fees that people can't afford for care they desperately need… We have a healthcare system that too often works better for the insurance industry than it does for the American people".