Leading article: America's healthy step forward

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How, as he struggles to push through his plan to reform America's health care, President Obama must wish he was working within a British-style parliamentary system. A bill from the White House, a three-line whip on his own Democrats who have clear majorities in both chambers, some modifications at committee stage – and problem solved.

Unfortunately, the separation of powers contained in the US constitution make life far more difficult. "The time for bickering is over," the President declared in his address to Congress. Almost certainly however, it is not. Mr Obama delivered a forceful and cogent speech, made even more effective by the gracelessness of the Republican congressman who accused him of lying when he insisted that illegal immigrants would not be insured.

After a torrid summer of criticism at public meetings across the country, and a long spell in which he tended to sound too cerebral and didactic, the White House has probably now regained control of the debate. But the pre-summer obstacles remain – chiefly opposition from the powerful groups who have a huge vested interest in the status quo and from Republicans whose response to all overtures and suggestions is a flat no – will continue.

Among the biggest unresolved issues are how the $900bn cost of the plan will be covered, and whether the final bill will contain the Government-run scheme that Mr Obama personally favours, intended in his words to "keep the [private] insurance companies honest".

The President can count upon one or two Republican votes at most for his plan. He must therefore navigate a course between liberal Democrats who complain his proposals are too cautious, and conservative "blue dog" Democrats worried about the deficit and opposed to the public insurance option.

But the odds are that Congress will pass a bill by Christmas. Its fate is in the hands of the Democrats. However divided, they surely will not humiliate a President of their own party by failing to pass anything. The final measure is likely to impose stricter controls on insurance companies, and significantly expand coverage. That would be a major step forward. But the bickering will continue.

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