To your health

HEALTH-CARE reform would be center stage in this year's presidential campaign even if one of the leading candidates hadn't unsuccessfully championed the issue during her husband's first term in the White House.

That's because an estimated 47 million Americans lack health insurance, potentially putting them just one serious illness away from financial ruin.

TV ads funded by health and insurance industry lobbyists and featuring the fictitious Harry and Louise, fretting over a supposedly rapacious government bureaucracy, helped stall comprehensive reform back in 1993.

But since then, health-care costs have risen exponentially, putting a huge burden on businesses big and small and swelling the ranks of the uninsured.

This set of facts makes the United States a shameful anomaly among industrialized nations, most of which help see to the medical care of their citizens. It also poses a problem for the Republican candidates, although not one they recognize. On ideological grounds, they are still driven to insist that health care is primarily a personal responsibility, not a government one.

Sen. John McCain of Arizona is fairly representative of the thinking on the right. In a Washington Post summary of issues, he said "the road to [health-care] reform does not lead through Washington and a hugely expensive, bureaucratic, government-controlled system."

Mr. McCain thinks the best way to expand access to health care and control costs is to harness competition to offer more affordable insurance options. He is in favor of low-cost health clinics in retail stores and calls for more emphasis on preventive care. He supports tax-exempt health savings accounts and tax credits to help people pay for insurance, even though many of the people who need help don't pay enough in taxes to take advantage of such benefits.

Mitt Romney, when he was governor of Massachusetts, helped put in place a ground-breaking health care plan that mandated coverage but utilized private insurers (with subsidies for the needy). But now styling himself as a true conservative, he does not promote his state's plan as a model health club; he just wants to give states incentives to deregulate and reform their health insurance industry so that market forces can work.

Mr. Romney also favors improving health savings accounts and making qualified medical expenses fully deductible. More controversially health club, he would stop the "free riders" in emergency rooms, using some of the money currently spent on providing expensive care for the uninsured to help the needy to buy private insurance.

Mike Huckabee, the former governor of Arkansas, health club was once obese and now is thin - and so it is no surprise that he puts great emphasis on personal responsibility for health, calling on Americans to quit smoking, lose weight, and exercise. He believes people who live healthy lives should be rewarded with lower health-insurance costs.

That's a good idea, but beyond this he can only offer conservative nostrums that would be a Band-Aid on the chronic national problem.

To paraphrase Senator McCain, what we have is a hugely expensive, bureaucratic, privately controlled system that is not going to get seriously better without the attention of candidates who take it seriously - and the Democrats do.

Sen. Hillary Clinton has learned something from her 1993 defeat. She favors health insurance for all Americans health club, while allowing people to keep their own plans if they like. Those who want to change plans or who are not covered could choose from the same plan available to members of Congress - a nice populist touch - or opt into a public plan like Medicare.

Senator Clinton would create a level playing field of insurance rules across states and markets to ensure that no American is denied coverage, refused renewal, or forced to pay excessive premiums health club. The senator from New York would provide working families with a refundable tax credit. Although her plan foresees cost savings in stressing prevention, modernization, and efficiency, her own cost estimate is at least $110 billion.

Sen. Barack Obama has a price tag on his plan of $50 billion to $65 billion, but it has been criticized because it would not mandate coverage for everyone as Mrs. Clinton's does health club. The senator from Illinois would create a National Health Insurance Exchange to help Americans who wish to purchase a private insurance plan. The exchange would act as a watchdog and help reform the private insurance market by creating rules and standards to make coverage more affordable and accessible.

As with the Clinton plan, no American would be turned away because of a pre-existing condition. Mr. Obama also proposes a benefits package like the federal plan that covers Congress.

During President Bush's eight-year tenure, the number of Americans without health coverage has increased greatly, and Mr. Bush has done little about it. Now even business wants a government-aided solution because companies that cover their own workers are saddled with ever-rising costs, yet they know how vital such coverage is to their loyal employees.

The next president of the United States must work with Congress to deliver a plan that tames the costs, delivers the care, and extends peace of mind to every American, regardless of income.