WASHINGTON - In the U.S., the Senate voted by 60 votes against 39 on Saturday night to open the debate on reforming the health system.


Universal coverage will still go through several votes before becoming reality. This first question is only the beginning of the debate on the bill of Majority Leader Harry Reid.


The text provides for extending health insurance to some 30 million Americans who do not currently taxing insurers and richer. Insurers could no longer refuse to cover people with medical history or exclude policyholders who get sick.


The Democrats have this reform as a historic step and necessary, the United States being the only major developed nation that does not provide health coverage to its entire population. Most employees are insured through their employer, but 50 of the 300 million Americans lack health insurance.


A long undecided centrist, Ben Nelson, senator from Nebraska, announced Friday he would say yes. "This is not for or against this new bill proposed by Senate Health, but only on the opening of the debate and the opportunity to make improvements," he said. "If we do not like this law, why deprive themselves of the opportunity to amend it?".


Following the same reasoning, the Democratic Senator Mary Landrieu of Louisiana has announced his support for a few hours of voting, like Senator Blanche Lincoln.


Mrs. Lincoln was a Democrat elected conservative state, Arkansas (center), and his reelection in legislative mandate in mid-November 2010 is uncertain. She had so far avoided provide clues, but ultimately announced Saturday it would vote with his party to open a debate in the Senate.


It is "imperative" given the challenges and complexity of the case, she argues. More discussion extends to 2010, plus the prospect of elections in mid-term weakens the chances of the text.


Some centrist Democrats elected in conservative states are concerned about such a possible state of competition with private insurers and require assurances that federal funds not be used for abortion.


And if the project was approved in the Senate, which would take weeks and go through other votes requiring at least 60 votes in favor, the amended version will still be merged with that has passed only the House of Representatives early month. Each of the assemblies will then rule on the summary before it landed on the president's desk for enactment.


The Republicans are at least determined to thwart reform. "This is not a true reform of the health system and this is not what the American people want. This law will lead to higher premiums and health spending Americans. Point", has dealt Senator Mike Crapo in the weekly address to the opposition on Saturday.


The Democratic majority in the Senate, however, hopes the adoption of the draft Reid by the end of the year that Congress is working to merge the text in January.


The bills contain common elements, including the obligations of insurers and the establishment of a scholarship enabling self-entrepreneurs and small employers to compare offers, including a federal offer to which insurers and employers' federations opposed .


In terms of differences, the House of Representatives requires medium and large businesses cover their employees, while the Senate provided them a fine if the state should pay for health insurance for employees. Both houses of Congress intend to include a saving of over 400 billion U.S. on Medicare, health insurance for seniors, to fund major reform sought by Barack Obama.