America is still the land of remarkable dichotomies, no more so than in the realm of the health of its citizens.

It boasts the world's best and most advanced medical care, for those who can afford it. But there are 41 million Americans who are not even insured to receive it at its most basic level. ...

Last week, after debate in the Republican Party-controlled Congress and Senate in Washington, America now has a new Medicare Bill, a lesson, if not a model, for an Australian Government attempting a makeover of its own health insurance scheme. ...

The Australian Pharmaceutical Benefits Scheme uses bulk purchases and economies of scale to keep a ceiling on prescription drug costs. Under the new Medicare system, these purchases would be negotiated by private drug-benefit managers, rather than a single Medicare representative.

This, according to Democrats, means there is no effective brake on drug prices, the main reason for America's rocketing health care costs. ...

"If you're serious about cost containment, you don't block Medicare from using its enormous purchasing power to bring drug prices down," said Robert Greenstein, of the Centre on Budget and Policy Priorities. ...

The introduction of the new Medicare will be seen as historic, although possibly not for the reasons its sponsors envisaged. While the program is projected to cost $US400 billion over the first 10 years of its life, it is estimated costs will increase by an average $US2.5 billion a year to $US65.2 billion in 2013.