After my post on Scotland’s “NHS 24″ helpline, a reader writes from the dreaming spires of Oxford University to scoff:

Funny how the average Brit lives almost a full year longer than the average American. What a medieval healthcare system America must have to be outperformed by the NHS!

Well, as I wrote in NR a week or two back, life expectancy is all much of a muchness:

Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory.

But, more to the point, my post was about the Scottish NHS. Which is an entirely separate body from the English NHS, the Welsh NHS, and the Northern Irish NHS. And, interestingly, according to its own government, Scotland has worse life expectancy than the United States. And, when you break down the statistics regionally, there are parts of Glasgow where male life expectancy is 53 — ie, lower than Russia and heading to West African territory.

Now I could simply respond with a snide twerpism equivalent to my reader’s — “What a medieval health-care system Scotland must have to be outperformed by the heartless, cash-up-front Yanks!” — but instead I’ll invite him to consider the following, which gets to the heart of the debate:

The NHS was, as the then Health Secretary Nye Bevan said at its inception in 1948, a “moral” project, designed to eliminate the inequalities in health outcomes between rich and poor. Yet, as the Registrar General of Scotland has acknowledged, in the last six decades the inequalities have, in fact, widened — not least in basic life expectancy. So much for the social justice of government health care.