People in America have a low life expectancy and there is a high infant mortality rate. It is estimated that 40 million American citizens do not have health insurance, but there is a ferociously competitive health insurance industry in that country. In many instances, decisions which should be made by medical experts about where people should go and what treatment they should receive are made by people in the insurance industry. Few terms are more calculated to raise the ire of Americans than that of "HMO", which refers to health maintenance organisations. These are universally loathed and if they make the wrong decision, they cannot be sued due to a clause in the legislation governing their operation.