Hardly a day goes by without someone recording another slide in President Obama's popularity or the man himself appearing somewhere on the stump. We are watching, though our transatlantic telescopes, the latest battle for US healthcare reform – battle being no exaggeration, given reports of public meetings that have descended into fistfights.

It is discouraging, to put it mildly, to see this acrimonious re-run of the arguments about "Hillarycare" 15 years ago over something that, to most Europeans, is beyond dispute: the right of everyone to decent healthcare they can afford. It seems to defy a basic sense of justice that, at any one time, more than 40 million Americans have no health insurance and that the financial damage from losing a job is compounded by the loss of the insurance that went with it.

Defenders of the status quo have to face the unpalatable fact that the US spends proportionally far more than any other developed country on a system that produces worse results, in terms of life expectancy, infant mortality and cancer survival. Now, as 15 years ago, however, such facts are no deterrent to insurance groups and drug companies, not to mention high-earning doctors, who fear financial loss from any change. Now, as then, they are using the basest of tactics to defend their interests.

Capitalising on surveys that show more people to be satisfied with the current system than not, they are appealing to Americans' worst instincts: the streak of meanness that blames the poor and weak for their condition and makes self-reliance an article of faith. Adverts play on the fear of the haves that extending health insurance to the have-nots will reduce quality and accessibility for the rest. Curiously, our own NHS has acquired a bit part in the drama, with tales of waiting lists, rationing, age discrimination and even supposed encouragement to euthanasia, all vying for expensive US airtime.

Mr Obama is fighting back doughtily, as he must. It would be tragic if the reform agenda of a President whose election showed America at its open-hearted best should be derailed so soon by arguments that epitomise America at its selfish worst.