It seems as if Doug's worry is that if there was a health service in the hands of the Federal Government, it would be liable to be underfunded. That's not unrealistic, in the light of the tendency of governments, especially those of a "conservative" nature to cut back on any kind of public services as a way of funding tax cuts.

In the UK there is a limit on how far they can get away with that, so far as the NHS is concerned, because there is such strong public support for it, including the vast majority of those who vote Conservative, that this puts a limit on how far they get away with it, even if they wanted it - and of course the sensible ones among them would recognise that funding the NHS adequately is good politics.

But I suppose in the political climate of the USA there might be a real danger of this happening.

I'd have thought that there should be some way of building in some way of entrenching standards of medical provision so that it would be politically very hard to force them down. Basically it's a matter of human rights, though I can't see how there's currently in the US constitution to uphold those rights.

Unless and until that gets put right, the ultimate defence against the trimming of services that Doug evidently fears has to be the same as in the UK - the determination of service users to stop it happening, and their ability to use their vote accordingly.

However the same pressures which might serve at times to force down the quality of services, so as to enable tax cuts, surely exist in the private sector, where the profit motive would be the driving force, resulting in companies seeking to exclude people from receiving the help they have paid for, and doing so in a way that sounds pretty shocking.