The House of Representatives, it has already passed its own bill November 7, and if the Senate does the same, he'll have both houses agree in January on a joint text, the result of merging the two projects, before President Obama can not sign the final package.

The head of state and could not sign a bill reforming the health system before the end of this year, as he hoped.

The stakes are high for the president, whose popularity comes in two surveys, go below 50%, ten months after his inauguration. The spokesman for the White House, Robert Gibbs, said that Barack Obama was very pleased with the outcome of the vote and "looks forward to a thorough debate and fruitful".

For this first test of Senate reform bill, the Democrats and all supported the motion agreeing to a debate, while 39 Republicans voted against. A Republican senator, George Voinovich, did not vote.

"The debate on the health reform is now officially underway on the text of 2074 pages (...)", said the head of the Republican minority in the Senate, Mitch McConnell. And it be noted that virtually all the bills in the Senate, crossed the first hurdle - the vote on a debate - were ultimately adopted.

This first victory was largely acquired last few hours with the decision of two Democratic "centrists", Blanche Lincoln and Mary Landrieu, supported the motion on the debate. They did not, however, provided a commitment to vote for the bill if it does not suffer in the meantime changes.

"I think it is more important that we start this debate in order to improve the health of our country for all Americans, instead of confining ourselves to abandon the issue", said Blanche Lincoln, the last Senator still reluctant, just hours before the vote.

Ben Nelson, Nebraska elected often considered the most conservative Democrat in the Senate, had meanwhile ended the suspense by announcing on Friday that he would vote in favor of opening a debate.

LARGEST SINCE MEDICARE REFORM

In the Senate, Democrats had absolutely need to win at least 60 votes from a total of 100, because otherwise the Republicans have been engaging in obstruction (Filibustering).

So they had no margin of error, the Republicans are united in their opposition to this proposed reform. The defection of a single elected Democrat could bring a halt to the flagship reform of the Chief White House. Such a defeat would put up a serious political setback for Barack Obama.

The U.S. president has made this site its priority domestically. He wants to extend health coverage to the widest possible part of the 46 million who are currently excluded and to put an end to certain practices of insurance companies, such as refusal to provide certain risk groups of population.

Republicans denounced an expensive project and deny that the federal government encroaching on health insurance managed by the private sector.

The plan unveiled by the Senate would provide health coverage to 31 million Americans who do not currently have, as an employee of the Congress.

Before being adopted, this plan will have to face daunting challenges. The head of the Democratic majority in the Senate, Harry Reid, has much to do to reconcile the divergent views within the group on issues such as reimbursement for abortions, the public option under the reform and reduction efforts costs.

The adoption of this reform would mean profound changes for the health system of the United States since its inception in 1965, Medicare, the health insurance system for seniors, managed by the government.

On an annual cost of 2.500 billion dollars, the health system represents 16% of the GDP of the United States, a unique weight in the OECD countries to unsatisfactory results: in one ranking in 2000 Organization World Health Organization, the United States arriving at the 37th.

With Jeremy Pelofsky Version French Jean-Stéphane Brosse, Henri-Pierre Andre and Eric Faye