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In the primaries, Senators Hillary Rodham Clinton and Barack Obama have magnified their differences over making health insurance mandatory because it provides a rare chance to differentiate themselves on an issue that matters deeply to Democrats. But they are fighting over the narrowest of bands in a broad policy spectrum, and the focus on universal coverage - rather than on cutting costs-may have far less resonance come Nov. 4.
Senator John McCain, the presumptive Republican nominee, agrees with the Democrats that the health system needs major repair. But his solution would stress cost-containment over assuring coverage for all. Its most controversial elements would fundamentally alter the employer-based insurance system through which 71 percent of insured Americans now get their health coverage.
Like President Bush, Mr. McCain wants to use tax policy to create an insurance marketplace that he says would be more competitive. He would end the longstanding tax exemption on health benefits paid by employers, to eliminate what he says is a bias against those who buy insurance individually.
Instead, anyone who buys health insurance would receive refundable tax credits of $2,500 per individual and $5,000 per family. To promote competition, Mr. McCain would allow policies to be sold across state lines and by organizations like churches and trade groups.
The most difficult to insure - the elderly and those with health problems -would be eligible for larger credits, though Mr. McCain has not specified the amounts. By contrast, the Democratic plans would simply prohibit insurers from denying coverage because of health status.
