US President Barack Obama has made one of the most important speeches of his presidency¹, as he faced Congress over his plans for healthcare reform.

美国总统奥巴马做了上任以来最重要的一次演讲，就他的医疗改革方案面临国会的审核。

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.

Republicans said Mr Obama's plans would make healthcare much more expensive.

Mr Obama told Congress that the US was the only developed 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," he said.

"These are not primarily people on welfare. These are middle-class Americans."

But Mr Obama said the current system did not serve well those Americans who do have health insurance either.

"Those who do have insurance have never had less security and stability than they do today.

"More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too."

He said the US spent one-and-a-half times more on health insurance than any other country but Americans were no healthier than other people.

Heckled

Mr Obama set out details of his plan to reform the system.

He said that nothing in his proposal would require Americans who already have health insurance to change their coverage² or doctor.

But he said he would make the insurance work better for individuals by prohibiting（禁止，阻止） insurers（承保人，保险公司） 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.

Mr Obama said a public insurance option could help keep the private health insurance companies honest and competitive.

But he said it would not be subsidised by the government, so would not create unfair competition for the private sector³.

He added that the public option was only a means to an end, and he remained open to other ideas if they had the same effect.

When Mr Obama said illegal immigrants would not benefit from his plan, the Republican ranks showed signs of near mutiny（兵变，反抗）, says the BBC's Jonathan Beale in Washington.