I spent yesterday afternoon at the New School in New York listening to a panel of Senators and one Congressman discussing what to do about the US healthcare system. They were sponsors of rival bills in Congress intended to reform the expensive and inefficient status quo.

Aiming off for the fact that it was a New York academic audience confronting a bunch of inside-the-Beltway reformers, a few things struck me.

1. The US  system is not only widely regarded as absurd by the outside world but has lost credibility in the US itself. That is not just because the country spends $2,300bn a year on health while an estimated 47m Americans are without health insurance. Important constituencies, notably employers that are the primary sponsors of health insurance, are also groaning under the strain.

2. A single-payer universal healthcare system such as the National Health Service in the UK is a non-starter. John Conyers, a Congressman who has proposed extending Medicare - the federal programme for the elderly - to the whole population, won applause from the audience by denouncing flaws in the US system. But the US is simply not going to accept a "socialised" health care system.

3. Change is going to come. One of Hillary Clinton’s achievements in the current campaign for the Democrat nomination is to put behind her nasty memories of Hillarycare and propose a health reform that is radical and yet acceptable. My colleague Clive Crook wrote interestingly about this last month.

4. Nobody quite knows what should be done. As Ron Wyden, a Democrat senator for Oregon, said, you can elicit equal applause from a US audience by denouncing the notion that the government should run healthcare and by criticising the vagaries of US insurers.