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Pennsylvania district four. At Ferri's pharmacy in , manager Enid McClung finishes off measuring out some pills and picks up the phone to a customer. "It appears you don't have coverage," she tells him. It appears the man's lost his job and so lost his health insurance. "The prescription is rather expensive. It's $464."

Few doubt health care reform of some sort is necessary. Few I speak to here think the bill that will be voted on within the next few days is the right way forward.

The chemist's owner, Bill Ferri, has some advice for his congressman:
", you should not be for this plan. I think we do need healthcare reform but this is not the healthcare reform that we need in this country. The majority of the people, in my opinion, are against it."

It is solicited advice. Congressman Altmire has not decided how to vote. He is playing it right up to the wire, and has gone out of his way to ask his constituents in Pennsylvania district four to tell him what they think. It is a suburb of Pittsburgh with a rural feel, made up of small towns, along the line of the William Penn Highway. Mr Altmire, a health care administrator before he became a politician, won this marginal (swing, for American readers) seat with the support of Republicans and independents.

I talk to him inside the on Capitol Hill. His office here has been inundated with thousands of letters and many telephone messages.

Several of those calls were from the White House, in what he calls "a continuing conversation" with the president. Obama even tried to ring him from Air Force One but that call didn't connect. I put it to him straight: this is about the president's authority - if it falls, he's damaged.

He says: "I am not worried about the political implications. I have the competing goals of representing my district and making sure we have good policy. And those two things should be working together. If I have a vote that my constituents aren't comfortable with, I am not going to be able to support the bill."

So is he worried about losing his seat in the November elections?

"I still have to go home to my district to look my family and friends and neighbours in the eye for the rest of my life on this important vote, and know that I did the right thing. This is not about politics."

In Dick's Diner on the William Penn Highway in Murrysville, old friends meet across the political divide. John Cicco is a Democrat, Jill Cooper a Republican. They both think this is a bad bill, driven by the need to score a victory, rather than get a good bill.

John deplores the lack of a public option (a government-run insurance scheme) but wants his congressman to vote for it. You couldn't describe him as enthusiastic though.

"It's a garbage can of different ideas, some of which may be good but aren't honed out, others that are bad ideas, and it is all being delivered at once in order for the Democratic Party, my party, to look as though it can lead."

Jill thinks this has become about the president's authority. She tells me: "He looks like someone who is trying to win for the sake of winning. Leading not listening."

In another part of the district, , I catch up with Loretta Worsham, who's an independent voter (which has a specific meaning in America - someone who is not registered as a Democrat or Republican).

She says of healthcare: "Obviously it is a mess but I don't think having the federal government involved in it is the solution. I just fundamentally don't like the idea of government being involved in health care."

She voted for Jason Altmire two years ago. "He voted 'no' last time on it and I would hope he would do that again. I saw him as an independent thinker but if he voted for it this time I am not so sure I would vote for him again."

Mr Altmire may find he's torn between his constituents, his conscience and his president.

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