Presidential Voters Scrutinizing Candidates on Health Care

WASHINGTON — For the first time in 15 years, health care is a major issue in the presidential campaign, with voters consistently ranking it as one of the top issues government should do something about.

Nearly 80 percent of voters say a presidential candidate's position on health-care coverage for the nation's 47 million uninsured will be "somewhat" to "extremely" important, said Gary Ferguson, a Republican pollster with American Viewpoint.

The candidates have offered two basic choices:

— Most of the Democrats would expand existing government programs such as Medicare, Medicaid and the State Children's Health Insurance Program. They also would make it easier for individuals to buy private insurance through small-business insurance pools and state, regional or national insurance plans modeled after the Federal Employees Health Benefits Program. They call this universal coverage.

— Republicans generally advocate tax breaks — deductions, credits and tax-free health savings accounts — to help individuals buy private health insurance. They also would lift many regulations on insurance to eliminate required coverages and make it easier for people to buy coverage across state lines. They call this consumer-based health care.

Within each party, the major candidates have been "straining at the margins to find distinctions," said Thomas P. Miller, a resident fellow at the American Enterprise Institute.

With the exception of Rep. Dennis Kucinich, D-Ohio, who advocates a Medicare-for-all plan, the Democrats' version of universal coverage is a far cry from the national health systems of countries such as Canada or Britain. The other Democratic candidates seek to get within striking distance of universal coverage by a combination of public and private measures.

Among the front-runners, former Sen. John Edwards, D-N.C., has been the most aggressive in touting health-care policy. On the stump, he tells voters "there is a threshold question" they should ask the other candidates: " 'Does your health care plan actually cover every man, woman, and child in America?' Because if it doesn't, my view is, you ought to be looking for another candidate."

But the Democratic candidate with the most experience in the health-care arena is Sen. Hillary Clinton, D-N.Y., who spearheaded her husband's administration health-reform effort in 1993 and 1994 with disastrous results. She tells audiences she learned a lot from her previous health-care reform efforts, and has "the scars to prove it."

Amid considerable hoopla, Clinton unveiled her health plan Monday in Iowa. Like other Democrats' plans, it would require everyone to have health insurance, require employers to provide coverage or pay into an insurance program, and offer federal subsidies to uninsured people who need help buying their own insurance.

The Republican candidates have been less specific about their health-care plans. Their strongest lines are for what they are against: a government-run health-care system.

"I believe we can reduce costs and improve the quality of care by increasing competition," says former New York Mayor Rudy Giuliani in a video on his Web site. "We can do it through tax cuts, not tax hikes. We can do it by empowering patients and their doctors, not government bureaucrats."

Giuliani, former Massachusetts Gov. Mitt Romney, and former Arkansas Gov. Mike Huckabee are the Republicans talking most often about health care.

Of the three, Romney has the most extensive record. He and the Democratic legislature compromised on a plan last year in Massachusetts that expanded insurance coverage by requiring businesses to either insure their workers or pay into a program to help them purchase insurance. Romney touted that plan last month in Florida, while also advocating that states be allowed to find their own solutions with federal help and encouragement.