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The gap between the Republican and Democrat proposals for addressing the US budget deficit is the difference between $1.2tn and $2.7tn. These are the amounts by which the two parties would aim to reduce expenditure over a decade. If they do not agree the US Government will go bust on 02Aug11. Neither party proposes to raise new revenue from taxes.

During my lifetime most Finance Ministers have shifted their views from having no responsibility to redistribute wealth to making it their second most important job. Over the same period, the rights of individuals have generally gone from being second to those of society to being the more important of the two. Where is the balance?

Shortly after WWII Britain introduced its National Health Service. The basis of this is that all health shall be free at the point of delivery. It has been, without question, the biggest single social advance in my lifetime. However you measure it, quality of life for everyone has increased more as a result of this service than from any other cause.

The National Health Service (NHS) is not perfect. There are long waiting queues for attention, even at the A&E Departments of hospitals. Over GBP1bn is known to be stolen from the system every year. The NHS is not financially or technically sustainable in its present form. In spite of all this it has delivered something the public could have received in no other way. It has a reputation for good handling of acute cases, a rather less satisfactory record for chronic cases.

Many lessons can be learnt from the UK’s NHS and it is a surprise that some international body has not, as far as I can see, produced a variation on the model attempting to redress the worst of the failings while retaining the basis of accessible health for all. Perhaps everyone has and they are all keeping it to themselves.

Free for all is generally a bad idea. People do not appreciate what they do not pay for even if the amount paid is small if they are poor. But the principle that everyone should have access to medical treatment at a price within their means when they need it is incontrovertible. What the two parties in US are arguing about at present is how much.

Most people acknowledge today that the ever-widening gap between the rich and the poor is unsustainable and obscene. Failure to address it will lead to increasing unrest among the have-nots. Nobody wishes to de-motivate people by taking away what they have rightfully earned but, significantly, the younger generation increasingly looks for rewards other than money to result from its efforts.

Now that there is widespread water and food shortage as well as serious consequential health problems it is surely time to address these issues on a more fundamental basis than dependence on charity. Wealth distribution is here to stay.

We need to examine urgently how best to do it practically and equitably.