|Many Americans fear reforming healthcare would be prohibitively expensive [GALLO/GETTY]
On the surface, Karen Little has a typical, middle-class suburban life.
She is married, has a grown child and a pretty house that she has worked hard to refurbish in a quiet neighbourhood of Baltimore, Maryland.
But Little, age 52, is living on the edge of disaster - both medical and financial.
She has a serious breathing condition, takes medication for a mood disorder and other illnesses. Karen's husband Tony has had heart bypass surgery.
She showed me a brimming basket full of pill containers and inhalers that she needs to get through each day.
"These are to help me sleep, these are to help me stay calm during the day," she explains, pulling container after container out of the basket.
"This is to help me breathe, this is something for my heart, to keep it from racing... these are for migraine headaches." The list went on.
When Tony Little lost his sales job last year because of the recession, the couple lost their health insurance. Now they are just one major illness away from bankruptcy.
Little sometimes skips her medications, just to make them last. One type of medicine for her lungs costs $325 a month - a price she can no longer afford.
"There must be probably three or four things I'm not getting because I can't afford it," she says. "I have to take one pill a day when it says take two pills a day, because I can't afford it."
|Little takes less medication than prescribed because she cannot afford the full dosage
The US is the only highly developed country on earth that does not provide universal health care to all its citizens. Instead, it has an incomplete patchwork of coverage that leaves an estimated 45.7 million Americans uninsured.
In places like Canada or France or Japan, healthcare is considered an inalienable human right.
In the US, is still thought of as more of a privilege. And its highly profitable for the insurance, hospital, and pharmaceutical industries.
Many doctors in the US pull in large salaries in comparison with their counterparts in Germany or Britain.
The US spends twice as much per capita, on healthcare than the next most expensive country Switzerland.
No job, no cover
The elderly and the most impoverished citizens are covered by government programmes, but the vast majority of adults below age 65 get insurance through their employers. And if you're out of a job, you're out of luck.
In Baltimore, where Karen Little lives, fully 17 per cent of the adult population doesn't have any health insurance.
But the city is also home to Johns Hopkins University Hospital - widely considered one of the finest healthcare institutions on the planet.
Inside its sprawling complex, Hopkins' researchers and doctors search for cures to stubborn diseases and perform intricate, life-saving surgeries.
That's the paradox of the American health caresystem; it is fantastically advanced in medical technology and pharmaceuticals, but those cures aren't available unless you can pay for them.
The highly respected Institute of Medicine of the Academies of Science estimates that, every year, 18,000 people in the US die unnecessarily for lack of medical treatment.
Most Americans agree the system needs to be fixed. But they disagree fiercely over how to fix it.
Most liberals and Democrats want a government-supported, public insurance option to ensure universal coverage. But many Americans fear that would be ruinously expensive.
President Barack Obama has made healthcare reform his number one domestic policy priority.
In his first address to the joint session of Congress in February, Obama declared: "The cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt; health care reform cannot wait, it must not wait, and it will not wait another year."
But Obama's reform push has become bogged down amid a strong conservative reaction, resistance the from health industry lobbies, and the opposition Republican party.
Conservatives believe universal coverage is tantamount to socialism. Although Democrats form clear majorities in both Houses of Congress, they are hesitant to push through a reform package without bipartisan support.
"Republicans have been very active and very aggressive in pushing back against this president on health care"
John Mercurio, the National Journal
So far, Republicans have stalled legislative action.
Obama has been criticised for not showing leadership. Polls show support for reform is falling, along with Obama's approval ratings. Analysts say the Obama White House was caught flat-footed.
"I think they underestimated the sophisticated response they were going to receive from Republicans over the past couple months," says the National Journal's John Mercurio.
"Republicans have been very active and very aggressive in pushing back against this president on healthcare."
On Wednesday, Obama will make an unusual speech before congress in an effort to break the healthcare-overhaul logjam. Aides say he will spell out what he wants in greater detail than he has so far.
Back in Baltimore, Karen Little wants fewer speeches and more action.
"For all the talk, for as much noise as they are making, nobody is addressing the situation properly," she says.