Certain images spring to mind at the mention of California—Hollywood, Arnold Schwarzenegger, the Oscars, Clint Eastwood, and Big Sur are just some of them. But glancing through the career history of Margaret Allen, a family practice physician assistant at Ravenswood Family Health Center in East Palo Alto, gives a very different impression of the US’s most populous state. Here the words uninsured, working poor, immigrants, and homeless predominate. They are the people Ms Allen has worked with for the past 17 years and part of the population at the centre of a storm on Capitol Hill as President Obama tries to pass legislation that will guarantee health care for all US citizens.

Ms Allen is in an unusual position. Born and raised in the UK she has nevertheless spent most of her professional life in the US, except for one stint working in the NHS. Her father was a general practitioner and her mother a nurse; both trained at St Thomas’ Hospital in London and were very supportive of the formation of the NHS in 1948. “I grew up with the NHS,” she said.

Ms Allen is lead clinician for the health centre’s outreach project for homeless people. She provides primary care to any uninsured person who needs it, regardless of their ability to pay. On her rounds she works out of a mobile unit, scouring neighbourhoods for street people who need medical attention and then tending to them.

The furore in the US over …