A hastily convened mob of heartland conservatives descended on Washington DC on Friday in protest of health-care reform legislation. “Kill the Bill,” they shouted in the halls of Congress after passing their anti-socialism-screaming placards through the metal detectors.

It’s hard to imagine any of them have been in an emergency room of late.

I spent the best part of a day and night in one last week. They are miserable places filled with people who can’t afford to be in them. Here, at least, reform is not even a question.

My experience of the US health-care system? Painfully bureaucratic and agonisingly slow. Which probably makes it no better or worse than any public hospital in Australia.

But then, I’m not paying the bill. And that’s clearly the big difference.

To Australians who enjoy the comparative luxury of Medicare, the idea that anyone could be opposed to a financial safety net for hospital patients is absurd. Encouragingly, away from the din of Fox News and Rush Limbaugh, this is not lost on some Americans. The few I spoke with through our mandatory surgical masks (swine flu remains rampant) simply shake their heads at the ideological ignominy of the debate.

How I arrived at Penn Hospital — the “gold standard” for medical care in Philadelphia, I’m repeatedly assured by our host — is too long a story. Let’s just say shattered glass is not a nutritious Caesar salad ingredient.

What followed was a whole lot of paperwork and a whole lot of waiting. I’m told by a local my bill for some X-rays and a couple of brief consultations with doctors would have been at least $US10,000 ($A10,888). It’s an extraordinary number.

There isn’t a spare chair in a waiting room filled with the wheezing coughs and bloody wounds you might expect in a big-city hospital. They are assessed by a nurse quickly enough but nobody sees a doctor for many more hours as more urgent cases are wheeled in and emergency helicopters land on the roof with worrying regularity.

As one Philly local tells me, the ER has become “the health care of last resort”. Those who can’t afford to have their ailments examined end up here in desperation, much sicker than they should be.

I finally leave with the all-clear after almost seven hours. We all walk out without paying — but these poor, wretched souls will receive a bill in the mail. Even if they recover their health, they’re unlikely to escape the black hole of debt in which they now find themselves.

Health care in America is shamefully corporatised. Television viewers are bombarded by advertisements for hospitals and drug companies; right before Saturday Night Live over the weekend I saw an ad for a cancer clinic insisting it provided the best childhood care. A little bald-headed patient smiles out from the screen, clearly having the time of his life.

It’s unseemly and says everything you need to know about the system. Money talks — great news for subsidised Australian tourists, not so for the much sicker Americans waiting in the ER.

Democrats passed their flawed legislation in the House of Representatives over the weekend, but a Senate vote will be even tougher. Both sides of the aisle marched on the Sunday talk shows today with even Democrats acknowledging the legislation is imperfect.

But it’s a start. It is unthinkable how bad American health care will become if this country can’t at least do that.