Comprehensive healthcare reform in the United States has been an ambition of many Presidents since the early part of the 20th century. None has succeeded in creating a system that gives all Americans the right to coverage. President Barack Obama is desperate to avoid the same fate.

WHAT IS THE CURRENT SYSTEM?

It is a complex mish-mash of systems. Millions of Americans have their own private healthcare plans, either individually or through their employer. About 47 million Americans have none. However, systems do exist to cover the very poor and the old. The system is fiendishly complex and full of loopholes, so even those with coverage can have it withdrawn.

HOW BAD IS IT?

US hospitals are the best in the world if you can afford them. Many cannot, and an accident or sudden illness can often bankrupt someone.

HOW DOES IT COMPARE WITH OTHER COUNTRIES?

It depends how you measure things. The US spends about 16 per cent of GNP on healthcare, far more than France and Germany, which spend 11 to 12 per cent. Yet those countries provide universal care.

WHAT IS THE BIGGEST PROBLEM?

Critics say the biggest issue is the profit motive that drives US healthcare. This ensures that costs are always rising as the incentive is there to provide expensive treatment. It also gives health insurers the incentive to refuse treatment to claimants, by seeking to withdraw their cover.

WHAT IS OBAMA'S SOLUTION?

Obama has asked Congress to draw up a government option, allowing all Americans to get some sort of cover. The sheer size of the state plan should theoretically allow it to drive down costs by economies of scale.

WHAT'S HAPPENING NOW?

Obama has put his reputation on the line to persuade wavering Democrats and moderate Republicans to vote on legislation by August. The Senate has said this will not happen. Such a major blow would defer debate until September and could see the political momentum stall.

- OBSERVER