In from the cold

American medicine is among the best in the world. But for years it has had to compete with the scene stealing awfulness of America’s healthcare system. As the only major industrialised country without universal coverage America has been a sort of rogue state: the world’s richest country spending more on health care per capita than any other, yet dogged by gaping health inequities, poor health outcomes, and social injustice. The evils and absurdities of American health care have filled pages in this and other publications and have been caricatured, as in the film Sicko (BMJ 2007;335:47, doi:10.1136/bmj.39262.638588.59), making America ridiculous outside its borders and embarrassing to large swathes of people within them. And of course there has been the human cost.

Last week’s vote in the House of Representatives changes all that (doi:10.1136/bmj.c1635). The health reform bill will save lives and money, and it brings America in from the cold. As Gavin Yamey reminds us (doi:10.1136/bmj.c1674), it falls well short of the national health system that some had hoped for—“Medicare for all”; and there is no “public option”—a government insurance scheme to give the insurance industry a run for its money. Even so it is undoubtedly historic and will be Barack Obama’s great legacy. Yamey calls it “a triumph of compassion towards the uninsured over the fear mongering stoked by President Obama’s Republican opponents.” It is already being talked of as “the civil rights act of the 21st century.”

But let’s not forget that it was a close run thing. As Susan Dentzer explains (doi:10.1136/bmj.c1576) only seven votes carried the bill and it would have fallen but for a last minute deal with Democrats unhappy about the potential for government funded abortions. And despite the political victory, Obama has yet to win hearts and minds across America, where fears about the economy and NHS-style rationing have soured the public view. Still, we should celebrate. US healthcare reform is here at last.

Where else can right prevail? Gareth Williams tells the story of Edward Jenner’s statue (doi:10.1136/bmj.c1582). Prince Albert raised the money, mostly from his own funds and from foreign donors (Napoleon was a fan), and unveiled it on one of the four plinths in Trafalgar Square in 1858—the other three plinths, and of course the main column, carried the nation’s great admirals and generals. But on Albert’s death four years later, Jenner’s opponents ensured that the statue was quickly and unceremoniously relegated to Kensington Gardens.

The BMJ offered what outrage it could. Contrasting the way military and medical heroes were honoured, the journal said: “The pitiful memorial…to Jenner had been banished even with ignominy from that honourable neighbourhood of men esteemed great because they killed their fellow creatures whereas he only saved them” (BMJ 1862;2:415, doi:10.1136/bmj.2.94.415). This year is the 30th anniversary of the eradication of smallpox. There’s a petition to restore Jenner to his rightful place as the founder of modern immunisation (http://petitions.number10.gov.uk/Jenner2010). If we all signed it, we could make it happen.