Extending coverage

Two health care issues, polls show, concern Americans most: rising health care costs and the uninsured. The Democratic candidates have concentrated their policy firepower on the latter, proposing little that would stop spiraling costs.

Health costs, which most Americans pay in the form of monthly health insurance premiums, continue to increase primarily because modern medicine is devising ever more sophisticated ways to diagnose, heal, and treat disease. Ultrasensitive scanners give doctors clear pictures of the inner workings of patients bodies. An expanding arsenal of drugs holds in check ailments ranging from heartburn to HIV. Americans get more care than ever -- and they are paying for it, with costs rising about an average of 6 percent every year over the last decade.

It would take sweeping reform to keep the costs associated with these developments from increasing as they are -- and none of the Democrats has proposed to do so. Senator John F. Kerry of Massachusetts comes the closest, advocating that the government pay 75 percent of the costs of all patient bills over $50,000. Right now, everyone splits the tab of this expensive minority of severely ill patients. Kerry's plan would deliver a modest reduction in costs, health finance specialists say.

But it's the 40 million-plus Americans without health coverage the candidates really focus on.

Retired general Wesley K. Clark says he would offer health care tax credits to families making up to $90,000 to help pay for insurance costs. Former Vermont governor Howard Dean says he would offer government-paid coverage for every American up to age 25. Senator Joseph I. Lieberman of Connecticut talks of insuring all children upon birth and help extend coverage for all laid off workers.

Representative Richard A. Gephardt of Missouri has the most extensive plan: His adminstration, he says, would give companies tax subsidies in exchange for covering all their employees. It would cost $280 billion, which the candidate says would come from rescinding President Bush's tax cuts. In fact, all the candidates would fund their health plans, in some part, from raising taxes.

Senator John Edwards of North Carolina says he would give tax breaks to families to buy coverage, and to small business to cover their employees.

Three candidates -- the Rev. Al Sharpton, former Illinois senator Carol Moseley Braun, and Representative Dennis J. Kucinich of Ohio -- argue for a single-payer system: The government would simply buy health care for every American, taking over the health care system.