President Obama is gearing up for a half-hour televised speech on the American health care system tonight – an address that could shape the future of his presidency. There is a lot at stake for Obama, who made health-care reform a mainstay of the campaign that put him in the White House. The issue has even divided his own Democratic Party, and sparked a summer of angry words over its scope and cost.Speaking on Monday in Ohio, Obama said: “The Congress and the country have now been vigorously debating the issue for many months. The debate’s been good. And that’s important because we’ve got to get this right. But every debate at some point comes to an end. At some point, it’s time to decide. At some point, it’s time to act.” There is a lot at stake too for insurance companies, pharmaceutical giants, hospital managers and the American public themselves – one reason why Obama’s reforms have been so tricky to formulate. In his speech tonight, Obama is expected to outline exactly how he plans to expand cover to the 46-million Americans without any health insurance, and give more safeguards to the 25-million who do not have enough. Currently only the most vulnerable are cared-for by the Medicare scheme, and Medicaid only covers the very poorest Americans. But the plans will not come cheap. They are estimated to cost at least a trillion dollars – that is 705-billion euros – over the next ten years. Among the changes Obama wants is the introduction of a new government-run insurance scheme – but that is fiercely opposed by Republicans and not suprisingly the private insurance companies. The president’s speech is expected to draw a big TV audience, and a wave of comment.