Alan Beattie tells us: "Countries do not become rich by accident. They make choices that determine the path their economies take. It is not always clear which is the right path at any given point, though some general rules can be drawn. But the countries that succeed are those that are flexible enough to learn from experience and that do not become captured by groups whose interests are sharply at odds with those of the country as a whole." (False Economy, 2009.)

OK then, if economic outcomes are path-dependant, that means that small decisions taken by countries can, over time, become amplified by intermediate outcomes and further wrong decisions. Examples abound. Madagascar in the post-independence 1960s during the First Republic under President Tsiranana, was a middle income country comparable to Thailand. With hugely fertile farmland, a rich ecosystem and strong indigenous institutions, it had all the signs of becoming an emerging economy. Development outcomes, like maternal and child mortality, were very good; people were well fed; corruption was non-existant. And yet; and yet... Today Madagascar is among the poorest of the poor, corrupt, unstable, unhappy. Its rich ecosystem is fast disappearing under uncontrolled slash and burn agriculture. It is number 190 in the World Bank ranking of Gross National Income (Atlas Methodology), with under $1.20 per person per day. What happened? The 1972-75 Revolution, the arrival of President Ratsiraka and his clique, nationalization of industy and commerce, realignment with the Eastern Bloc. So many wrong economic decisions taken by groups whose interests were sharply at odds with those of the country as a whole. Thailand, by the way, is ranked 127.

Sierra Leone is number 201 in the same world ranking. Yet, at the start of the "Scramble for Africa" in the middle of the 19th Century, Sierra Leone was the last "civilized" outpost before European travelers arrived in the Dark Continent. Contemporary writers referred with admiration to its university, its schooling system, efficient administration, well educated population, all of African origin. But with so many bad decisions over the years, today it is a country with weak institutions, a poor population, lacking infrastructure, schools, clinics, drinking water.

Are there any wrong decisions being taken by certain rich countries today that they will rue tomorrow? If Alan is right when he says "[T]he countries that succeed are those that are flexible enough to learn from experience and that do not become captured by groups whose interests are sharply at odds with those of the country as a whole", it's difficult not to watch the unfolding healthcare debate in the United States and feel that the country is making a colossal, historic mistake. Already, Medicare (for the aged) and Medicaid (for the poor) eat up as much GDP as the entire UK National Health Service (around 8.5%) but government insurance programs of this kind only cover 27.8% of the US population, whereas the reviled NHS covers 100% of the British population. The overall US healthcare system, at nearly 17% of GDP, is almost twice as costly as the OECD average while healthcare outcomes for American citizens are below those of the OECD. But some groups, in Alan's words, whose interests are sharply at odds with those of the country as a whole, have managed to capture the debate and will ensure that the outcome for the US will be much worse than it need be. It's Madagascar all over again.