The United States finally has a chance to reform health care, said Len Nichols, director of the health policy programme of the New America Foundation, a non-profit public policy institute based in Washington and California, at a conference on innovation in health care in San Diego last month.

The main driver, said Dr Nichols, is the cost of health insurance to middle class families. In 1987 the median spend on health insurance was 7% of family income, but now it’s 17%. Cost was also a driver of the failed reforms of Hillary Clinton, but last time the pain was caused by the recession and went away when the recession ended. “Now,” said Dr Nichols, “it’s systemic.”

Another crucial driver is the cost to business, accompanied by the growing intensity …