ONCE upon a time, when foreigners remarked that there was much to

learn from the British National Health Service their meaning was

perfectly plain: they meant the system as introduced by Nye Bevan in the

post-war period. Nowadays the same remark could mean one of a number of

things -- envy of the original concept of the NHS, a desire to emulate

the Government's pseudo-market reforms, or determination to learn from

Britain's mistakes. Dr Fitzhugh Mullan, a member of Mrs Hillary

Clinton's health task force, was evidently referring to the basic ideals

of the NHS and the principle of universal health provision when he spoke

in Edinburgh yesterday at the World Medical Education Summit and

expressed misgivings about what happens when the market enters the

system. Markets do not serve certain populations well at all, he pointed

out: they do not take care of the poor, or rural populations, or people

in institutions.

Dr Mullan's speech could hardly have been more timely. Now that

Congress has passed President Clinton's budget the plan for overhauling

health care is rising to the top of the agenda -- though residual

bitterness after the budget struggle will not smooth its already

problematic progress. Despite Dr Mullen's praise for the NHS it is

inconceivable that anything similar will be adopted in the US. The plan

is expected to centre on community insurance-purchasing co-operatives,

and at a time of sharply rising health inflation the task force's job is

to cut costs as well as make the system more equitable (aims that are by

no means incompatible, since the costs of the inferior American system

are higher than those of the NHS).

Dr Mullen himself, despite his caveats about the market, sees

''managed competition'' as the key -- with free markets coming under

closer control and state systems bringing in the market philosophy. The

latter aim might seem to echo the UK Government's introduction of an

internal market to the NHS, but the US would be approaching this point

from the opposite direction. The American rhetoric, too, is different:

Mrs Clinton speaks of injecting ''compassion and caring'' into the

system, which is not Mrs Bottomley's kind of language, and the stated

aim of the draft plan is ''making sure that Americans will never again

lose their health coverage''. Its progress in the months and years ahead

will be interesting to watch, and may even provide lessons to be learned

on this side of the Atlantic.