AS AN American who has lived in the UK for 11 years, I love both countries. The debate over healthcare has reminded me of my heritage as a daughter of a physician. Obama is courting America to extend healthcare coverage in the US, triggering a mild UK/US incident and crashing Twitter.<br /><br />What many people outside of the US don’t realise is how far the US federal government has extended Medicare and Medicaid over the past 30 years. People don’t die on the steps of emergency rooms in the US.<br /><br />The NHS is the best metaphor for modern Britain I can think of. The British are good at supporting the underdog, and are caring people. In the same way that they tackled the world, they tackled disease through the establishment of the NHS after the war. The two tier system in the UK also reflects their comfortable relationship with different levels of service if you are from different classes of people.<br /><br />Every once in a while you’ll see an interesting statistic about how much it costs the NHS to have no-shows in at the doctor’s surgery. I’m always fascinated how people refer to healthcare as free in the UK; of course it’s not free, it’s just paid through taxes, but the feeling is that it’s free.<br /><br /><strong>HEALTHCARE IS NOT FREE</strong><br />My father always shook his head when the two pack a day cigarette smoker would miss the $40 office visit, not take her medicine, and show up at a cost of $4,000 at the emergency room not feeling well. That 1,000 per cent inflation of the cost of medicine happens when people are not responsible for their own health and are not paying a small portion of their own healthcare costs.<br /><br />Going back to principles, it’s a good thing for society when people take responsibility for their own actions. It’s also human nature not to value things which are free.<br /><br />That combined with the simple economic fact that governments will not be able to offer “free” healthcare equally to all citizens due to lack of funds, expect a day when your healthcare will be tied to the choices you make in your life about how healthy you want to be.<br /><br />The internet is changing people’s expectations of what they have a right to know about their health as well as their health institutions and doctors. The net brings rabid and relentless transparency to everything.<br /><br />I wrote about Neil Bacon’s Doctor Review site a while ago – web services and tools are enabling people to become better educated about their health. Real improvement in healthcare depends not only on who pays, but on the competitive environment to enable great service to happen for all.<br /><br />Julie Meyer is chief executive of Ariadne Capital.