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Nurses and ambulance men cluster around an elderly man complaining of pain in his chest, asking about his medication and other symptoms. Howard University Hospital seems a model of its kind, smart and modern, with a very good reputation. But that's a triumph over adversity and what many here regard as a perverse system.

Howard is in Washington's north-west, U Street and Shaw, an area that is predominantly black. It has seen very high unemployment, although it is now becoming more middle class, the latest area of the capital to be gradually gentrified. Still 80% of the patients are on Medicare, Medicaid or DC's own local version of these government-funded schemes. Many of the staff and patients here were enthusiastic supporters of President Obama and ecstatic about his victory.

The president has said in a PBS interview that he's "very satisfied" with the Senate bill and that it's not a half a loaf but "nine-tenths of a loaf". I've been down to Howard University Hospital to see what people think.

Evet Hill, an outpatient returning after surgery, tells me: "Everybody should have it as a right. They should have insurance because go to a hospital today, and you don't have it, whatever the sickness they're going to turn you down."

In fact no hospital, and certainly not one dedicated to "serving the under-served", will turn away an emergency patient. But getting follow-up treatment can be a problem, paying for the drugs needed being just too expensive. One of the down sides is that people put off treatment until it is just about too late. I am told a horrific story about a breast cancer allowed to go on so long that it breaks through the skin in what is called "fungating masses". One surgeon who's been treating cancer for six years had never seen a case. When he came to this hospital he treated 18 instances within 21 months.

Another patient in the waiting room, Kayna Curry, says the president should allowed to get on with it. "Let him do what needs to be done to provide health insurance for everyone. He's come across a lot of roadblocks: just let him do his job and he'll do fine."

I have to keep reminding myself that these roadblocks have been erected by senators from the president's own party. All the deals, all the money, all the compromise, has not brought round one Republican senator. It was all about getting Democratic senators to vote for their own policy.

Dr Kevin Scott Smith, the head of the obstetrics and gynaecology division, says he is excited but seems less than happy with the shenanigans on the Hill. "In the purest form healthcare reform is definitely something I espouse, I think most physicians espouse, and this country definitely wants to offer all of its citizens healthcare. What seems to be happening is that there is the dance of politics changing it from its most pure form to" he pauses for a beat "politics".

After this vote, this is not over. This Senate bill has to be squared with one from the House which does include the public option. Some Democrats will argue that without this the bill is pointless. Dr Patricia O'Neill who specialises in sickle-cell anaemia and leukaemia, is not sure.
"I think it is a step in the right direction because I am hoping there is at least some fight left for a public option." I ask if it is worth having without that. With a laugh she says: "I am still trying to decide, I don't know, I really don't know, a part of me is saying yes, a part is saying "no". I am just trying to fathom how you are going to cover these patients who remain uninsured."

The big fear of some doctors I speak to is that the bill will make people take out insurance, while not providing a cheap way of doing it. In an election year that should worry elected politicians who support the bill: and delight their opponents. But the view from Howard, taken as a whole, is that they trust the president, but not some of his colleagues on the Hill.

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