Why the health care reform, from the origins of the "capitalist welfare” to the debacle of Bill Clinton, continues to be among the most controversial and insoluble issues of American social history? Barack Obama recalls the early attempts at reform of Theodore Roosevelt and says: "I am not the first of the presidents who try to achieve it, but I want to be the last." Difficult task, if not impossible. The "public option", which should guarantee some form of universal service in competition with private insurance companies, faces opposition from the medical-industrial complex, the lobbies, and the big machine of ideological distortion. Will reform remain unfinished? The American health care system, with its deep inefficiency and inequality, as a metaphor of the American social model.