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Hospital syringes Can the White House broker a deal on healthcare reform?
Passing a healthcare reform bill is proving tricky for US President Barack Obama, as different groups mobilise to remove the parts of the plan that they dislike.
The various players in the healthcare debate - from the White House to the insurance companies - all want different things from the reform process.
THE WHITE HOUSE
After initially choosing to leave the specifics of reform to Congress, on 9 September President Obama laid out more detailed proposals in an address to both chambers of Congress.
See how healthcare spending is divided up
Mr Obama wants to provide more security and stability to Americans who have health insurance, provide insurance to those who do not and slow the growth of health care costs.
He supports tougher regulations for the insurance industry, ensuring that people with pre-existing conditions cannot be refused cover, and preventing insurers from dropping people's coverage when they get ill.
For those whose employers do not provide coverage, Mr Obama will create Health Insurance Exchanges - one-stop shops for people to compare different options. The president supports the proposal to set up a government-run scheme that would be offered to people who are eligible for the Exchanges, but he has indicated that he would still support a bill that did not include this so-called "public option".
Under Mr Obama's plan, every American would be required to get insurance, or face a fine. Less well-off Americans would be offered subsidies to help them pay for their coverage.
The president would pay for his $900bn (£600bn) plan by cutting waste from the existing Medicare programme, and levying fees on insurance companies who offer "gold-plated" insurance plans.
LIBERAL DEMOCRATS
Many American liberals would like Mr Obama's healthcare reform proposals to go much further, but are prepared to support his plans as long as they are not watered down too much in Congress.
They favour the increased regulation of the insurance industry that Mr Obama has proposed and support efforts to extend coverage to all Americans by offering generous subsidies to the less well-off.
For many liberals, both in Congress and in trade unions like the Service Employees International Union (SEIU), the most cherished feature of healthcare reform is the "public option".
But Republicans and some moderate Democrats are threatening to remove the "public option" from the Senate's version of the bill, setting up a clash with liberal Democrats.
CONSERVATIVE DEMOCRATS
Moderate and conservative Democrats in the House of Representatives belong to a grouping called the Blue Dog Caucus.
During the healthcare reform bill's passage through the House Energy and Commerce Committee, the Blue Dogs threatened to block the bill unless its price-tag was cut.
They also demanded that more small businesses be exempted from the requirement to provide healthcare for their employees and insisted that any public scheme would be barred from paying the same (low) rates to doctors and drug companies as the government-run Medicare programme.
Democratic leaders agreed to the Blue Dogs' requests, and the deal appeared to smooth the way for a healthcare reform bill - including a public option - to pass in the House.
In the Senate, however, conservative Democrats like Kent Conrad of North Dakota and Ben Nelson of Nebraska have expressed opposition to the public option.
Mr Conrad has suggested that a network of healthcare co-ops could be established instead of a publicly-run scheme.
REPUBLICANS
Republicans in the House and the Senate have been staunchly opposed to the Democrats' healthcare proposals. If Mr Obama's reform bid fails, the Republicans will benefit politically, so they may be calculating that outright opposition is their best strategic option.
During the 2008 presidential campaign, Republican candidate John McCain outlined a healthcare reform plan: end the tax-free status of employee health benefits, and give all Americans tax credits for the purchase of health insurance.
Republican Senator Chuck Grassley Moderate Republican Chuck Grassley may support a compromise bill
This would remove the incentives for Americans to keep their employer-provided health coverage, so more Americans would shop around for private insurance. The power of the free market would then force costs down, Mr McCain argued.
He also argued that medical malpractice lawsuits were forcing up the cost of hospital care, and favoured caps on the amount of money patients could claim.
Some Republicans have described similar proposals when asked to outline their plans for healthcare reform, but the party's strategy appears to be geared more towards defeating the Democrats' policies than coming up with alternatives.
Many of the features of reform that Republicans have been attacking - like the so-called "death-panels" or coverage for illegal immigrants - are not actually being proposed in any of the plans put forward by Democrats.
INSURANCE COMPANIES
Although vilified by many liberals as the enemy of reform, health insurers had - in public - been fairly supportive of the Democrats' efforts for several months.
But that approach changed in October with the release of a report claiming many people would face significantly higher costs if the proposed reforms went ahead than they would under the current system.
The study, commissioned by the industry body AHIP, was quickly dismissed as a "hatchet job" by senior Democrats, while some analysts suggested it was biased and based on cherry-picked data. However, the insurers stood by their claims.
The report says the cost increases will be the result of new taxes and a decision by lawmakers to weaken the requirement for Americans to get insurance coverage. Insurers say that means many people will wait to sign up until they become ill, thus driving up costs for everyone else.
The insurers' earlier cautious support for the Democrats' efforts was attributed in part to the fact that the reforms could benefit them.
In particular, the "individual mandate" (the rule forcing all Americans to take out health insurance or face a fine) will create a lot of new customers for insurance companies, and many of the newly-enrolled members will be young, healthy people who have previously opted not to get insurance.
However, the insurance companies are less sanguine about the prospect of a government-run public insurance option, fearing it could drive them out of business.
DOCTORS AND HOSPITALS
US doctors (represented by the American Medical Association or AMA), and hospitals (represented by various organisations, including the American Hospital Association and the Federation of American Hospitals) broadly back the Democrats' reform proposals.
Their biggest fear is that the government will create a powerful publicly-run insurance scheme that will - like the government programme for the elderly, Medicare - use its bargaining power to cut the amount of money it pays to doctors.
The three biggest hospital groups in the US have offered to reduce their costs by $155bn over 10 years in an attempt to make health reform more affordable.
The reductions will be achieved by cutting the amount of subsidies that hospitals receive from the government to cover uninsured people in emergency rooms. As more and more people get insurance, the hospitals reason, the need for the subsidies will be reduced.
But the hospitals have warned that they will only make the full $155bn reduction if the government meets its target of extending coverage.
PHARMACEUTICAL COMPANIES
Manufacturers of drugs and medical equipment are not very supportive of the Democrats' reform plans.
The industry - represented by the Pharmaceutical Research and Manufacturers of America (PhRMA) - is concerned that the Democrats' proposed publicly option could use its negotiating power to start bargaining down drug prices.
It is also opposed to the reformers' proposal to establish a government body to conduct research into the relative effectiveness of different treatments.
Drug companies argue that this could eventually lead to a situation in which government bureaucrats dictate to doctors which drugs they are allowed to prescribe.
Supporters of the proposal insist that "comparative effectiveness research" is simply a useful tool to help doctors avoid prescribing expensive drugs that work no better than cheaper treatments.
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