United States President Barack Obama has made one of the most critical speeches of his presidency, as he faced Congress over his plans for healthcare reform.
Mr Obama said that failure to introduce reform had led the country to breaking point and it was now time to act.
He said he planned to improve health insurance for those who have it and to create an insurance exchange to extend cover to those who do not, the BBC reports.
Members of Congress are preparing to fight over details of the reforms.
Mr Obama told Congress that America was the only rich country that allowed millions of its people to endure the hardship of going without healthcare.
"Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans."
But Mr Obama said the current system did not serve those Americans who do have health insurance well either.
He said the US spent one-and-half times more on health insurance than any other country but Americans were no healthier than other people.
Mr Obama said that nothing in his proposal would require Americans who already have health insurance to change their coverage or doctor.
However, he said he would make the insurance work better for individuals by prohibiting insurers from dropping coverage for sick patients or by capping it.
He would also require insurers to cover the cost of routine check-ups and preventative care.
For the millions of uninsured Americans, he said he would create an insurance exchange - a market place where individuals and small business will be able to shop for health insurance at competitive prices.
Healthcare reform has been the central issue of his change agenda but has divided the public and the country's political establishment.
Mr Obama said that Congress agreed on about 80% of the reforms that are needed.
But he said months of partisan bickering had only hardened the disdain many Americans have towards their own government.
He is facing almost unanimous opposition from Republicans, who are uneasy about the idea of government-run healthcare and who have accused Mr Obama of attempting to introduce a "socialist" policy.
In theory, there are enough Democrats in Congress to approve the changes.
But in practice, the party is deeply divided between those that want a publicly-run insurance scheme and those alarmed by the borrowing necessary to fund it.