Welcome to Trump’s America, The i Paper’s World Insight series presenting the sharpest, deepest thinking on an era-defining shift in history and politics, investigating how Donald Trump and his administration have changed the US and the world – and where we go from here.
• Hegseth is running a PR firm disguised as a defence department
• The rich are building their own America
• Why Americans fear getting old
Every time my pal from Bournemouth comes to visit us here in Colorado, he starts complaining about the NHS: the ridiculous waiting times; the striking doctors; the ageing, decrepit hospitals.
And every time I give him the same reply: “Look, Nigel, it could be worse. What if you had to get your healthcare in the USA?”
Because there’s no question: The American healthcare system is performing worse than the healthcare system in Britain, or, for that matter, in any of the world’s industrialised democracies. The USA ranks at or near the bottom among the developed nations on standard gauges of medical system performance – measures such as life expectancy, neonatal mortality and recovery rates from disease or injury.
How the UK’s child ADHD diagnosis rates compare to the rest of the world
The former president of the Royal College of General Practitioners has said she would “ban the label ADHD” and that it should be treated as a “social construct” instead of a neurodevelopmental condition.
What is the situation?
Speaking to ahead of the Channel 4 documentary The Great ADHD Myth?, Dr Iona Heath criticised overdiagnosis and argued there is no scientific evidence that those diagnosed have neurological differences.
Earlier this year, then-health secretary Wes Streeting said there was an “overdiagnosis” problem and launched a review.
4 min read
What does the UK data reveal?
- and National Institute for Health and Care Excellence (Nice) put the UK rate of childhood ADHD at 5 per cent, and 3 to 4 per cent for adults.
- One study found ADHD diagnoses increased in the UK from 2000 to 2018.
- By 2018, the highest rates were in boys aged 10 to 16 – 3.5 per cent had been diagnosed. Back in 2000, this number was 1.4 per cent.
5 min read
How we compare with other countries
In the US, 11.4 per cent of children aged three to 17 years old were diagnosed with ADHD in 2024. In Europe, a 2023 French study indicated 3.68 per cent of children (800,000) have ADHD compared with 5.5 per cent of adults (1.4 million).
Meanwhile, in Spain, estimates of ADHD prevalence in children range from 5.5 per cent to 6.8 per cent.
A closer look at the review
The ongoing Government review is led by Professor Peter Fonagy, national clinical adviser on children’s mental health.
An interim report, published in March this year, identified rising diagnosis rates as an issue alongside people with ADHD and autism failing to get the support they need.
The final report is set to focus on how to make more support available that is “less dependent on diagnostic thresholds” and “more responsive to functional need”.
2 min read
Why better sleep could keep people working for longer
Researchers in Finland examined data from people aged between 50 and 68 to look at the correlation between sleeping habits and the ability to continue working.
The story in numbers
13 years, five months
Regularly disturbed sleep was linked to leaving the workforce months early.
People who reported no disturbances had a working life expectancy of 13 years and five months.
Six years, five months
The shortest working life expectancy was found among men in routine jobs with low levels of education who slept for more than nine hours a night.
They had an average of six years and five months left in work after the age of 50.
What does this tell us?
Researchers said the findings, published in the journal , suggest healthy sleep (under seven hours but undisturbed) may help people keep working as they age.
“To promote older adults’ participation in working life, supporting sleep of recommended length and good quality may be required,” they added.
3 min read
How some prostate cancers ‘can be diagnosed without biopsy’
Researchers at University College London Hospitals (UCLH) have found MRI scans can be used to detect cancer in some men with a high degree of certainty.
What the research found
- Men may not need to have a biopsy to diagnose prostate cancer.
- Radiologists looked at scan results combined with the patient’s age and their prostate-specific antigen (PSA) score.
- Of the 69 patients deemed to be “99 per cent certain” they had a tumour via their MRI scan, all of them had cancer confirmed through biopsy.
- Researchers said this indicates certain men may not need to have invasive biopsies.
What does this mean?
UCLH consultant radiologist Alex Kirkham said the research indicates prostate cancer could join the list of cancers which can be diagnosed with a scan alone.
Consultant urologist and professor of interventional oncology Mark Emberton said it is particularly important as prostate cancer incidence is only set to rise.
4 min read
3 min read
Th expert reaction
Avoiding unnecessary biopsies is an important goal in cancer care, because they can be painful, invasive and can cause infections… Using MRI alone to diagnose these cancers could make the process much safer and easier for men, and less costly for the NHS.
Dr Matthew Hobbs, director of research at Cancer UK
How some prostate cancers ‘can be diagnosed without biopsy’
Some prostate cancers can be diagnosed without the need for an invasive biopsy, according to a new study.
For some men, cancer can be detected through an MRI scan alone with a high degree of certainty, according to experts from University College London Hospitals (UCLH).
What you need to know
- In many hospitals, men with suspected prostate cancer will be referred for a magnetic resonance imaging (MRI) for detailed images of what is happening in the body. Depending on the images, doctors may also recommend a biopsy.
- In other hospitals, those with suspected cancer will be referred straight for a biopsy – where a small needle is put into the prostate to take a tissue sample so it can be checked for cancer cells.
4 min read
A closer look at the detail
There are two different types of biopsy for prostate cancer, with needles inserted in different places depending on the type chosen.
- Samples taken are then examined under a microscope to check for cancerous cells.
Ut enim ad minima veniam, quis nostrum
There are a number of advantages and disadvantages for having a biopsy, with the disadvantages including side effects; missed cancers and the detection of non-aggressive or slow growing cancers which may not need treatment.
Sales of battery
electric vehicles hit a record high last year.
Starts at £22,995 for the smaller battery
Available with either a 40kWh battery or a larger 52kWh pack, that offers almost 255 miles, the latest, retro-inspired Renault 5 is both a joy to behold and a hoot to drive.
The interior has been lavished with a level of detail that’s typically reserved for more expensive cars.
4 min read
A champion of EV efficiency
It offers a remarkable 491 mile range on a single charge from the 85kWh battery.
It is a technological masterclass inside with the ability to option screens that span the entire width of the dashboard, including an optional display for the front passenger.
Priced from £37,400
2 min read
It’s a lot of money to part with, but this is arguably all the car you will ever need.
The £89,000 Macan is a premium SUV that somehow manages to blend Porsche’s reputation for dynamics and sporty driving with everyday practicality.
The 95kWh batteries can go from 10 to 80 per cent in as little as 21 minutes from the fastest public charging outlets.
With the business class-style six seat configuration costing a staggering £76,995, it is by far the most expensive Kia ever made, but it backs up its financial demands with a suite of genuinely useful and impressive onboard technology.
It’s fast, goes a long way between stops and charges relatively quickly but the interior is bland, the onboard technology is infuriating and the experience is devoid of emotion.
All of its gadgetry can’t disguise the fact that performance is weak, even for a typically zippy EV, the ride is fussy at slower speeds and it’s not in the least bit enjoyable to drive on a country road.
- While good value (prices start at £17,935) for the 200-mile max range, there are more interesting options from Hyundai, Citroen and Renault for similar money.
- It attempts to wow with tech, much of which hinders, rather than helps.
- There’s no tangible benefit over mounting your phone to the dash.
- Simply an average driving experience, adequate range and slow charging speeds.
2 min read
Wetherspoons bans playing music or taking calls on speaker
JD Wetherspoon founder and CEO Sir Tim Martin said “we are kindly asking phone users to pipe down” while in his pubs.
It joins widespread calls for measures to tackle antisocial phone use in public.
What you need to know
The pub chain said it had taken the decision across all of its 792 sites “following complaints from customers, who are being driven nuts by other people’s videos and amplified phone conversations”.
It requested that customers “switch their phones to silent” or “use earphones” rather than disturb others.
3 min read
The fight-back against noise
- The Liberal Democrats have previously called for fines of up to £1,000 for “headphone dodgers” who play music out loud on buses and trains.
- A YouGov poll published in 2025 suggested 62 per cent of people would back the move.
- In London, Mayor Sir Sadiq Khan rolled out a campaign last year encouraging people to use headphones when playing music on the city’s transport network.
us news
What you need to know as Tupac Shakur murder trial begins
Duane “Keffe D” Davis, 63, allegedly orchestrated the killing of the rapper back in 1996.
It is the first time anyone has gone on trial in connection with the infamous drive-by shooting.
Everything we know so far
- Prosecutors allege that Davis did not fire the gun himself, but did mastermind the killing.
- He is a former gang leader and uncle of the man long suspected of shooting Tupac.
- Davis has pleaded not guilty and denies the allegations.
- The trial is expected to last up to six weeks and may feature testimony from one of the other passengers of the car.
2 min read
What happened on the night
There were witnesses to the murder who could put together a timeline of events, though police have never arrested a suspected killer.
- On 7 September, 1996, Tupac went to watch a Mike Tyson boxing match on the Las Vegas strip.
- He and Marion “Suge” Knight, the head of his record label, got into a fight with Orlando Anderson, Duane Davis’s nephew and a suspected member of the South Side Compton Crips gang.
- Leaving the match with Suge, Tupac was shot four times in a drive-by shooting from the back of a white Cadillac.
- Six days later, on 13 September, he died in hospital. He was 25 years old.
What have the lawyers said?
Prosecutor Binu Palal told the jury: “Let’s be clear, Duane Davis did not pull the trigger. But he did plan the shooting in retaliation of the beating of his nephew.”
Meanwhile, Davis’s attorneys questioned “what facts do they have after 30 years?” and labelled the allegations “fiction”.
4 min read
The kitchen gadgets under £25
Victorinox paring knife
It’s comfortable to hold, with a point sharp enough for scoring pastry.
ProCook cast iron pan
For unbeatable searing and heat-retention, cast iron is the top choice.
Tesco chopping board
Priced at just £22, I’ve yet to find another board that matches it for sheer value and quality.
The kitchen gadgets under £25
Pyrex jug
It is the perfect vessel for blending smooth sauces, melting butter, or warming stock. It won’t stain like plastic and the red measurements never fade.
Salter scales
“I’ve had my slim little set of Salter Disc Scales for over a decade, and I’m delighted to see they are still made to exactly the same reliable design today.”
Microplane grater
It uses photo-etched stainless steel teeth that stay razor-sharp for a decade, something the lookalike copycats simply can’t match.
Braun hand-held blender
It’s an essential for everything from making velvety soup to getting the lumps out of white sauce.
Bodum cafetiere
As well as delivering great results, cafetieres are easy to clean and there’s no ongoing filter paper costs or pod recycling to deal with.
5 min read
The kitchen gadgets under £25
Oxo peeler
What truly sets it apart is the chunky, rubberised handle that absorbs pressure and stays completely non-slip, even if your hands are wet. It is inexpensive and incredibly durable.
Falcon pie dish
Made by fusing porcelain onto heavy-gauge steel for smooth durability, it is dishwasher, freezer, hob, air-fryer and oven-safe.
Average life expectancy is 80.5 years in the world’s 38 richest countries, according to the OECD. The US ranks near the bottom in that group, with 76.5 years. The UK came in nearer the average, at 79.4 years, while Sweden, Switzerland and Japan have the longest expected lifespans, longer than 81 years.
In a World Economic Forum study of 19 wealthy countries, the US ranked last in keeping newborn babies alive until their first birthday. That’s because pregnant Americans who don’t have health insurance often get no medical care until the day they show up at the hospital in labour.
And most of those metrics have got even worse in Donald Trump’s second term as President.
America does lead in one respect: OECD data show that the US is spending about $14,885 per person per year on healthcare – more than double the average cost among wealthy nations, and 60 per cent higher than the next biggest spender, Switzerland. (The UK comes in near the average, at $6,747 per capita). But Americans are not getting value for their money.
The Commonwealth Fund, an international research organisation, publishes comparative studies of national health – taking into account factors such as access to care, efficiency and health outcomes. In its latest ranking of 10 wealthy countries published in 2024, the US ranked the worst, by large margins, on most of those measures. (For all my friend’s gripes about the NHS, the UK’s healthcare system ranked third overall, behind Australia and the Netherlands).
The Commonwealth Fund also ranks nations on a benchmark called “mortality amenable to healthcare,” which is to say, if somebody has a potentially lethal disease, do they get the treatment that will save their life? Of 11 rich countries on this measure, the US ranks lowest (the UK comes in about the middle of the group).
How can this be? The US is the world’s richest nation. We have world-class schools of medicine, nursing and public health. All over the planet, people are walking around who would be dead if it weren’t for some medical innovation developed in the US.
But our country has squandered these resources through a crazy quilt of a healthcare system that gives us the highest doctor bills in the world and still leaves millions with no health insurance. Most developed countries have settled on a basic system of healthcare delivery and payment that covers everybody. America has settled on a hodgepodge.
US military personnel and veterans get their care, at no cost, through a system like the NHS – government doctors in government-run hospitals. This works so well that members of Congress, including those who loudly decry “socialised medicine”, have given themselves the right to use military hospitals as well. Most civilians rely on private insurance and a mix of public and private hospitals.
Because insurance companies have refused to cover pensioners – too expensive, they say – there’s Medicare, a government-run plan for people over 65. There’s a separate government system with different rules for low-income Americans, called Medicaid. Tens of millions of people are covered by one plan for some ailments and a different plan for others – and often have no coverage for hearing, vision or dental care.
It’s all so complicated that a local medical practice generally needs to employ more staff in the billing office than in the treatment rooms. Hospitals routinely have hundreds of people just to do the paperwork. The result: 25 to 35 per cent of Americans’ healthcare spending goes on administrative tasks, not medical care. In the NHS, administrative costs make up about 1 per cent of the Department for Health and Social Care’s resource budget.
Around 26 million Americans had no health insurance when Trump returned to the White House in 2025. Since then, various Trump “reforms” have raised the number to more like 30 million. Trump’s biggest impact on healthcare comes in his One Big Beautiful Bill, passed last summer. The changes in that bill will take effect in January 2027 – Republicans strategically delayed the effective date until after this November’s midterm elections. There will then be a large reduction in federal subsidies for health insurance premiums, and stricter eligibility rules for Medicaid. Millions more people will lose their health coverage.
Trump says these changes will cut costs, but economists agree that forcing people off insurance only adds to the national medical bill. A petrol station attendant or a farmhand with no insurance can’t afford to go to a doctor for a minor pain or cough. But three months later, when that mild complaint has escalated into a life-threatening problem, the patient will head to the emergency room, the most expensive possible place to provide medical care. A condition that might have been managed with a single doctor’s visit, if confronted early, will now cost thousands of dollars for treatment in the ER. Hospitals are required by law to treat emergency cases even if the patient can’t pay. To cover the cost of caring for the uninsured, they raise their fees for everybody else.
The US healthcare system is designed to maximise profit, not public health. America is the only advanced nation where insurers are allowed to make a profit on basic medical coverage. Other countries have recognised that there’s a direct conflict between insuring a nation’s health and making a profit on its insurance. Health insurance exists to help people get the preventive care and treatment they need by paying their medical bills. The way to make a profit is to avoid paying those bills.
US insurance giants have devised ingenious methods for evading payment. They require “pre-authorisation” for many procedures and prescriptions; the insurance adjuster, not your doctor, determines what treatment you get. They set up “narrow networks” of approved doctors; if your favourite doctor isn’t on the list, insurance won’t pay. Insurers regularly deny claims weeks or months after treatment; then the hospital demands that the patient pay up.
My Colorado neighbor Pam was injured in a highway crash while traveling in Arizona. With a shattered bone protruding from her arm, she was rushed to the nearest ER. After two surgeries, and four days in the hospital, she was billed $490,000. Her insurer refused to pay, on the grounds that this wasn’t an emergency. Months later, Pam is still appealing, with no payment in sight.
So, Americans can often pay twice for healthcare: first, through the insurance premium, then the bill that the insurer declines to pay. Americans also pay twice as much for medicine as the Brits pay for the same pill made in the same factory. One of Trump’s sensible reform ideas was a rule saying we would pay only the average price of the drug in other advanced nations. Big Pharma has so much political clout that this proposal has gone nowhere in Congress.
All in all, American healthcare tends to create more headaches than it cures. As I told my buddy from Bournemouth, the whole system makes me yearn for my days in the NHS.