Most agree that the American health model is in meltdown.  Driven by insurance money, surgeons perform too many unnecessary operations while doctors dispense too many unnecessary drugs.  Not only does this aggressively interventionist approach keep medical costs high, it also means others wait longer to get on the medical merry-go-round.

Not content that the model is plain wrong, health officals in the USA want to export something similar to the UK.  The US's deputy health secretary Alex Azar is lobbying the UK government to allow America's drug companies unlimited access to the National Health Service (which, in case I'm accused of bias, also doesn't work well). 

Azar wants a free for all, where every drug that's been approved is made available on the NHS as part of a free market culture.  And to add meaning to this market, drug companies would also be permitted to advertise directly to the patient, just as they are in the US right now.

There's a very special reason for Azar's remonstrations, and it's all to do with an organisation called NICE (National Institute for Clinical Excellence).  NICE's principal function is to act as gatekeeper to the NHS to ensure that its budgets are not overstretched by drugs that are either ineffective or just too expensive. 

NICE has been seen as the bad guy over a range of drugs that patients believe might be their saviour.  If by chance they are, it would be a world first in medicine.  Follow the threads and you discover that many patients have been 'encouraged' to demand a drug be made available either directly or indirectly by the manufacturer itself.

Poor old NICE is seen as the party pooper.  And several recent heated meetings between UK government officials and drug company representatives bear out this image.  The drug companies made it clear they were prepared to withdraw their substantial investment in the UK unless a 'better environment' for novel and innovative drugs was established.

So what will Mr Blair do in the months left to him as Prime Minister?  Will he continue to be the Bush poodle that we all know him to be, or could it be that the recent mid-terms in the USA have shifted the power balance between the two war mongers?

For once, Mr Blair won't cave in.  The NHS is too much of a sacred cow to meddle with, and the American drug companies will be seen to be hollow blusterers.