(CNN) -- Doctor James Braude leads a group medical practice in an elegant Atlanta, Georgia, office decorated with designer furnishings. It doesn't look like a charity asking for handouts. But it is asking.



Obama, pictured July 1 in Virginia, has been touring the states to promote his plan to voters.



"On some days we've counted up to 30 patients a day who've lost their jobs and their health insurance," Braude said.



So Braude and his colleagues offer as much free care as they can afford. The doctors have also begun discreetly inviting paying patients to contribute to a fund, helping more people get care they haven't got the money for.



"We're doctors. We're addicted to helping people. And when we can't, we go through withdrawal."



Millions of Americans have always gone without the kind of routine medical care that is seen as a basic right in many countries. The U.S. economic downturn -- meaning people lose health insurance when they lose their job -- and the election of President Barack Obama have coincided to increase both the need and the opportunity to address the plight of uninsured America.



Obama's ambition is to provide insurance for the estimated 50 million Americans without coverage.  Watch why many in rural U.S. have concerns »



The insurance is expected to cover doctors, hospital care and prescription drugs. But just about every detail is still being negotiated so it's not certain who would be covered, what they would be covered for or whether people who don't want insurance would be forced to have it and pay for it.



The plans that emerge could become the Obama administration's most ambitious domestic program and potentially a big, early test of his presidency.



American medical care needs attention



Even though nearly 50 million of its roughly 300 million people have no routine health care, the United States spends more going to the doctor than any other industrialized nation in the world. Fully one-sixth of the economy is devoted to it.



Under the current hybrid system, the U.S. Government pays for health care for ex-military, the extremely poor and the elderly.



But the vast majority of Americans have to pay for their own health care and most do it where they work; many employers arrange health insurance and partly subsidize the premiums.



The rapidly rising cost is crushing all kinds of businesses, from car companies to family farms. At the same time, hospitals and doctors say they are falling behind because the payments they receive from insurance companies aren't keeping up with their costs.



"Within a decade we will be spending one out of every five dollars we earn on health care," Obama said recently. "In 30 years, it will be one out of every three. That is untenable, that is unacceptable, and I will not allow it as president of the United States."



The politics: Deep disagreement



There is a lot of disagreement about what to do. Congress has the job of actually turning the push for change into a functioning government program. Democratic lawmakers don't all support the president's plan or agree on how to pay for it.



Republicans are split in a different way. Some lawmakers are trying to influence the Democrats' plans and others are proposing entirely different alternatives.



"If you look at their plan, it really is a big government-run plan that will take control of the delivery of health care in America," said Republican congressional leader John Boehner. His suggestion: "Improve the current system so it works better."



The most profound disagreement centers on whether Washington should create its own new health-insurance concern to compete with the private companies that provide insurance now. Obama and many Democrats favor it; Republicans are dead set against it.



Part of the problem is that insurance companies fear the government will put them out of business, by favoring or subsidizing its own scheme.



The other part of the problem is more basic and ideological. The U.S. government already runs enormous health-insurance programs for the poor, the elderly and military veterans -- but many
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