Reform of the health service was one of the most debated subjects in the presidential campaign of 2008, and it now appears as one of the priorities of the newly elected President Obama. The article explains how the American health service is organized, bringing out the logics of how it functions and its main malfunctions. This means that particular attention is given to Obama’s reform proposal in the election campaign and to the first measures adopted by the President when he arrived at the White House.only subscribers can see the full article