With barely four months to go to the day of the US presidential election, the BBC’s James Naughtie finds Americans worse-off than they were seven years ago - and worried about the future.

East Grand Boulevard in Detroit is still handsome, in its way. There are wooden and brick houses on spacious plots, with trees front and back. They have that early 20th Century confidence that American architects were able to exploit, with high chimneys, wide porches and plenty of room inside.

East Grand Boulevard represents a generation of inner city decline

You can find plenty of prosperity around the edges of Detroit. But take a trip down East Grand Boulevard and into the enclave of Hamtramck, which was the heart of the American car industry, and you can sense the economic angst that’s gripping the country.

It’s not simply that there is poverty in Detroit - which you can find at the busy soup kitchens that were established in the Great Depression - but that a city which once boasted some of the best-paid industrial workers in the US is in steady decline.

Politics in Detroit is a mess - the mayor has just been deposed by his own Democratic supporters over his use of public money to try to cover up an extra-marital affair - and economic prospects are bleak.

FIND OUT MORE… James Naughtie’s series, American Dreams, continues on BBC Radio 4, on Mondays, at 2000 BST Or Listen Again to the first programme in the series

People who thought they would remain reasonably comfortable are discovering that rising medical bills, falling wages and petrol at $4 a gallon are making life difficult. Add to that the pressures from the banks and mortgage lenders, and you find trouble.

Watershed

More than 73,000 homes were repossessed in the city in the second half of 2007 because the owners couldn’t keep up with loans: Detroit is a prime example of a contagion that’s sweeping the whole country.

Home repossessions in the US are expected to spiral

This is one of the painful facts that lie behind the rhetoric of the presidential campaign. The reason why both John McCain and Barack Obama talk about "change", is that most Americans feel that this election year marks some kind of watershed.

They’re not agreed, of course, about which way the country should turn. But there is a general sense that after the eight Bush years, in which the country has been tormented by post-9/11 national security worries and war, and in the course of which government spending has soared and personal debt has become an obsession, this electoral choice will be important.

Searching for the worries that give rise to that belief, you first of all confront the lack of economic optimism.

Although you can find those who talk of a cycle that will turn once again, about the long-term inevitably of recovered prosperity, it’s much easier to find people who are starting to question their birthright. Is it true, as they’ve always been taught, that the next generation will always be better off than the one before it, that hard work will produce rewards and the freedom to choose a lifestyle?

In short, is the American Dream still in business?

‘Katrina-like crisis’

I found in Detroit that there are doubts. Among car workers, who were once the elite of the labour force, there is deep gloom.

The weakness of the dollar overseas can be seen a measure of the troubles of the superpower

Talking to some of those who are losing their homes through foreclosure, having stumbled into loan agreements that allowed interest rates to be ratcheted up, I became quickly aware that the problem is not one that is confined to what might be called, over-simplistically, an "underclass".

As one woman put it, it’s a "Katrina-like crisis" - the waters are lapping around the feet of those who never thought that their homes would be inundated.

In America, it’s always important to balance bad news or public anger with the country’s innate capacity for ingenuity and recovery. But, as Joe Stiglitz, Nobel-prize winning economist, put it to me: "The reality of each generation being better off than the last is becoming destroyed."

Most Americans, he says, are worse off than they were seven years ago. So, when they come to make their political judgements this autumn, this is what will affect them most.

Change has become a buzzword of the election

They know that China holds much of America’s public debt, and that jobs are going overseas. And they’re aware that the weakness of the dollar overseas can be seen a measure of the troubles of the superpower.

They wonder, therefore, whether they can assume that in the 21st Century their country will remain an economic superpower, even if its military strength is still unmatched.

It’s a deep question, lying far beneath the surface of a presidential campaign in which the personalities of the candidates and a speech here or there often determine the headlines and the tone of the exchanges.

The truth is, this is a troubled nation. And one of the problems is this: change may be necessary but where should it lead? In the next four weeks that’s what I’ll be trying to find out.

You can listen again here to the first programme of James Naughtie’s series, American Dreams, for BBC Radio 4. The next three programmes can be heard on Monday evenings at 2000 BST.

As the state of Massachusetts pioneers a new scheme to increase state involvement and get everyone insured, the BBC’s Jill McGivering asks whether it could be a model for the rest of the country.

Massachusetts General Hospital in Boston is private, making most of its money from patients’ fees.

The US spends more on healthcare than any other country

A tour of the facilities is certainly impressive. It bristles with multimillion-dollar technology.

But it could be more efficient. Dr David Torchiana, a hospital chief executive, told me paperwork eats up a vast amount.

"We send bills to probably about 25 different payers," he said.

"Every one of them has a different set of rules. If you printed out our regulations around billing for radiology studies, it would be a pile of paper seven inches thick."

‘Crazy’ system

That sort of waste disturbs those who see chronic imbalance in the US system.

All the rewards come from more procedures. The more talking you do, the more time you waste and the less money you make John McDonough Healthcare for All

Americans spend more than twice as much per person on health as the British. Yet more than 40 million Americans - about 10% of the population - are completely uninsured.

John McDonough, who heads consumer lobby group Healthcare for All, describes the system as "crazy".

"All of the incentives right now in our system reward healthcare providers for the volume of services they provide," Mr McDonough said.

"So, all the rewards come from more procedures. The more talking you do, the more time you waste and the less money you make."

The effect is that people with money have treatments they may not need and see specialists when a more junior doctor would do.

At the other end of the scale, the poor can’t afford even the basics.

‘Brave attempt’

Now Massachusetts is introducing pioneering new reforms which give the poor a much needed safety net.

More than 40 million of Americans are completely uninsured

It makes health insurance mandatory for all. Anyone who fails to buy it faces a tax penalty. It helps those who can’t afford insurance by providing subsidised or even free cover.

"We have taken the exiting system, and we have said we’re going to try to fill in all the holes," says Jon Kinsdale, the programme’s executive director.

"Altogether we’ve enrolled about 340,000 newly insured in the last 18 months."

It doesn’t create a totally level playing field. Private insurance companies still play a central role.

Mr Kingsdale admits that the rich will still end up with better quality health care than the poor.

But it is a brave attempt to address gaps in US healthcare without trampling on a core US value: freedom of choice.

‘Shared responsibility’

The scheme has some enthusiastic supporters.

We’re all mandated to get health insurance Reverend Hurmon Hamilton

I went to one of Boston’s poorer neighbourhoods to attend a church service.

Several worshippers here now have health insurance for the first time, and they say it has made a huge difference in solving chronic health problems and catching early potentially life-threatening conditions.

The preacher, Reverend Hurmon Hamilton, sees the Massachusetts reforms as a model for the rest of the country.

"We’re all mandated to get health insurance," he said.

"There’s a role for the government to play, in terms of subsidising those who are poor. There’s a role for employers to play. And then there’s a role for insurers to play. So, it’s shared responsibility. That’s how this country is going to have to figure it out," Hurmon Hamilton said.

There is one problem: paying for the programme has only been possible because of extra cash from the federal government.

So, its survival is very dependent on political will. All eyes, then, on the presidential elections in November.

that it was increasingly likely Israel would attack Iran in the coming months.

An unnamed senior defence official told ABC News that if attacked Iran would retaliate against Israel and the US.

The official said Iran’s nuclear programme was nearing "red lines" that would trigger an Israeli offensive.

State department spokesman Tom Caset dismissed the anonymous comments as ill-informed and discourteous.

"It’s rather foolish of people who often have no clue what they’re talking about to assert things and not even have the courtesy to do so on the basis of their name," he told reporters.

The defence official told ABC that one red line would be when Iran’s nuclear facility had produced enough enriched uranium to create an atomic weapon.

According to US and Israeli intelligence estimates, ABC News reported, that could occur later this year.

"The red line is not when they get to that point, but before they get to that point," the official was quoted as saying. "We are in the window of vulnerability."

Other analysts point out that - as far as is known - Iran has not been producing weapons-grade enriched uranium at its Natanz nuclear facility, but rather low-enriched uranium which can be used for energy generation.

Iran denies its nuclear programme is anything other than a peaceful.

The other red line the defence official identified was Iran’s purchase of Russia’s SA-20 air defence equipment.

Pentagon officials have refused to comment on the ABC story.