There are many valid criticisms to be made of American healthcare, but let me tell a story that helps explain its strengths. Only 15 years ago, the retrovirus, HIV, was killing thousands in America — six times as many young Americans have died of Aids as died in Vietnam — and researchers had never found a way to stop such a sophisticated and constantly evolving organism from burying itself in people’s immune systems and slowly destroying them. I was told in 1993 that I had a few years to live. I write this 16 years later with a stronger immune system than I have ever measured before.

America’s much-maligned healthcare system did this. Without this vast and free market in medical care and pharmaceuticals, without the potential for making large amounts of money from affluent and insured patients, the innovation of treatments and regimens would never have occurred at the pace it did. Yes, publicly funded research was also vital — but it is rightly restricted to basic science, not finessing drugs for humans. Now we have dozens of anti-HIV drugs, from several private companies, competing with each other, and my life is saved. How do I put a price on that?

Here’s the catch. This miraculous process was possible for me only because I had insurance through my employer. When I quit my job editing The New Republic, in part to grapple with HIV’s toll, my employer compassionately allowed me to stay on staff at a low salary solely to protect me from going without insurance at all. You see: once without insurance in America, I would never have been able to get it again. I would have had a “pre-existing condition” and no insurance company would have accepted me.

An uninsured freelancer with HIV had one option if he were to survive: heading fast into personal bankruptcy. If I had finally lost everything, I would then have been able to apply for public assistance. Losing everything you have ever had to prevent your own death was nearly my fate. It is the fate of many in America — not the very poor, who are helped, however badly and expensively, in hospital emergency rooms — but the working middle classes who lose their healthcare soon after they lose their job.

It is this that is at the centre of Barack Obama’s proposals for reform. Yes, finding a way to control soaring costs is essential, and Obama’s final compromise bill, especially if it is without an option for an affordable publicly provided plan, doesn’t do nearly enough. Nonetheless, what the president was really selling last week was a little more middle-class security. And that was why it was more politically lethal, I suspect, than the pundit class has yet to absorb.

Some see the potency of this move. Back in 1993, when the Clintons proposed a much more ambitious plan, the Republican strategist Bill Kristol wrote a famous memo arguing that the right should not negotiate or propose an alternative but should simply do all it could to kill the bill. In it, he shrewdly homed in on the danger as he saw it: “The long-term political effects of a successful Clinton healthcare bill will be even worse — much worse [than its medical consequences]. It will relegitimise middle-class dependency for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”

I understand this sentiment and, given my libertarian leanings, tend to resist government intervention when it is unnecessary. I opposed the Clinton plan as too centrally dictated and bureaucratic. In an ideal world, I’d like to scrap the US system entirely, sever the connection between employment and health insurance, allow individuals to buy insurance from competing healthcare exchanges, and leave the rest to fee-for-service medicine. But it is a political fact that this won’t happen in America, as solid a fact as that the NHS will not be abolished by the next Tory government.

Obama’s speech last week was therefore directed at people like me: suspicious of change and government, but aware that the current system is both inefficient and at some point cruel, even immoral. He played the Burkean card: “I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.” He dangled the prospect of relief: “As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick, or water it down when you need it most.” And here’s the best pitch for universal healthcare to conservatives in a long time: “That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character.”

This patriotic appeal was the real import of the speech. Obama continued to frustrate both the left and right, by refusing to cede too much to either. His plan is extremely close, after all, to Republican Mitt Romney’s relatively successful universal insurance programme in Massachusetts. He wants some guarantee to ensure that people are not simply priced out of access to insurance, but he has avoided endorsing the left’s public option. He has funnelled a huge new customer base to private hospitals, insurance companies and the pharmaceutical industry. If his “public option” were to pass, it would still be likely to include only 5% of all Americans — 95% would still be covered by the private sector. Now imagine if David Cameron were proposing that only 5% of working-age Britons would stay in the NHS under a Tory healthcare plan. Do you think his proposal would be deemed “socialist”?

All this is worth remembering in the context of the political brouhaha. The current proposals are nobody’s ideal, but they do create healthcare exchanges that could develop into real arenas for consumer choice; they do remove a huge amount of insecurity and anxiety from many middle-class Americans; and they amount to the passage of universal coverage in a largely private system. If this passes, Obama will become a hero to the Democratic party. And if it works, he will be a hero to everyone who, like me, once feared sickness because it meant potential bankruptcy.

This immensely complex and arcane piece of messy legislation is quite simple: it’s about baseline security for a lot of people who have little. Even a free-market conservative should be able to see that as a good thing — and take it, while working for something better.

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