Nothing matters as much as this.
The healthcare battle will shape America and impact the lives of everyone here, but it will also shape world perceptions of America, which are as much affected by US domestic foibles and strengths as by foreign polic. In fact more so, I think.
Today happens to be "pump night" at the Washington Children's Hospital. Newly diagnosed Type One diabetes patients (my son included) will be told about the benefits and disbenefits of the various pieces of technology that can deliver insulin into their bodies on a regular basis.
There are - as ever in America - choices to be made. And - as ever in the American healthcare system - huge prices to be paid, though not necessarily by those doing the choosing.
In the UK, meanwhile, a friend writes to say that in his local health authority there is no pump night, because there are no pumps: the local decree is that children can inject themselves regularly (and cheaply) for exactly the same clinical benefit.
How are Americans to make an informed and sensible choice? In particular, how are they to get to grips with a system that seems so utterly devoid of cost controls? And what about the risk of crimping future medical progress by crimping profits?
Some British doctors are issuing warnings to the Obama Nation about what reducing healthcare expenditure actually could mean.
On the other hand, some Americans are willing to be arrested for the cause of socialised medicine.
I am glad Sam has the right to a pump. On the other hand, I can see the benefits of keeping costs down and clinical benefits in the driving seat. On the other hand again, I know that a wealthy person in the UK will simply get the damned pump anyway and where is the fairness in that?
Barack Obama will need every ounce of his steely self confidence to persuade the nation that this step - whatever it turns out to be - is wise.