Americans greeted President Barack Obama's pledge to reform healthcare with enthusiasm tinged by skepticism Wednesday, saying changes in the country's expensive and often inaccessible health system are overdue — but hard to achieve.

"I'm sick and tired of hearing about it with what seems to be little if any reform," said Steve Kissing, a 45-year-old advertising professional, as he read the morning newspaper at a Cincinnati coffee shop. "I just hope he can muster the support to make some progress."

In towns and cities across the country, ordinary Americans said they were desperate for some kind of change in the U.S. healthcare system, under which 46 million people have no insurance coverage to pay for medical costs.

"If it wasn't for Medicaid my kids wouldn't get no care, none. I don't like it that way ... because I was raised to pay my own way. I want insurance. But how I'm supposed to do that on what I make?" said Latoya Simms, a delivery woman and mother of two in Little Rock, Arkansas.

"I want them (Congress) to give him what he's asking for. We need help. We need it now," said Simms.

In the United States, health insurance is typically tied to employment, with the employer and employee sharing costs to buy insurance coverage. With costs rising, many employers have raised premiums so workers are paying hundreds or thousands of dollars annually for only partial coverage.

Other employers have dropped health benefits altogether, saying they cannot afford the cost amid the plunging economy.

Unemployed Americans usually have no coverage, while the elderly and poorest Americans are covered by government-funded insurance programs known as Medicare and Medicaid.

In an address Tuesday night — his first speech to Congress since his January 20 inauguration — Obama said the nation's leaders must address "the crushing cost of healthcare" and said reform would not be delayed.

Obama promised to cut waste to trim down Medicare. Money would also be spent on preventative care and cancer research to save lives and money in the long run.

Worries About Getting It Done

Bernice Shiney, a licensed practical nurse in Nashville, Tennessee, liked what she heard from the Democratic president but worried the Republican opposition in Congress will block reform.

"He acted as if he knows what he's talking about but I wonder if the Republicans are going to work with him. Everything he talked about makes sense," said Shiney.

Some were also concerned that Obama's plan to provide coverage for all Americans, perhaps by expanding the Medicare program, would ultimately cost too much.

"Usually a bureaucracy has a way of eating up all the money, but if it actually goes through, healthcare for people without insurance is very good," said Salvador Reza, who runs a day labor site in Phoenix, Arizona, and has no coverage.

Others were skeptical change would ever come to healthcare, noting many U.S. politicians, including former First Lady Hillary Clinton, had made similar attempts and failed.

"Obama said all the right things," said Ed Luetkemeyer, who works for a retailer in Chicago and voted for Obama's Republican opponent John McCain in last November's election.

"He talked a big game, I just wonder how he's going to make it all happen."

No More Middle Man?

In Fort Worth, Texas, unemployed computer engineer Rodney Ringler said one solution Obama should look at is eliminating the middle man — insurance companies who set many prices, decide what is covered, and often determine treatment.

"The insurance companies need to do what they're supposed to or we need to get rid of them," said Ringler, 49. "We are a rich country and have given to so many poor countries and so it is shameful that our poor elderly and poor don't have these things (health benefits)."

Obama's focus on preventative care won several fans, including Milwaukee physical therapist Bill Lois, 32. But Lois wasn't sure how such a change could be implemented.

"As a practitioner, I think preventive care is incredibly important. But how does the government go about improving one's sense of personal responsibility?" asked Lois.

"That said, do we really want to have people filing for bankruptcy because of overwhelming healthcare bills for unpreventable injuries or illnesses?" Lois asked. "I truly believe that some sort of reform is necessary."