Health care waits to ignite as campaign issue

By John Whitesides, Political Correspondent

DENVER (Reuters) - The sharply contrasting health care visions of Republican John McCain and his Democratic presidential rivals offer the promise of a grand campaign debate -- if the candidates find room on a crowded agenda.

While health care reform ranks as the second-biggest domestic issue after the economy in most national opinion polls, it will compete with the Iraq war, taxes, high gas prices and other topics for a prime-time spot in the campaign for November's presidential election.

Nearly two decades of health care debate has made little headway toward finding a consensus approach, and the issue has not been a key factor in a presidential election since the collapse of the Hillary Clinton-led reform effort in 1994.

"There is no question there are fundamental, Grand Canyon-like differences on health care between the two parties," said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group.

"But it's an open question whether it will be a hot issue in the campaign," he said. "I now believe the biggest obstacle to health care reform is this ideological divide -- is there any way to bridge these differences?"

McCain, who has clinched the Republican presidential nomination, and Democratic Sens. Barack Obama of Illinois and Clinton of New York have unveiled ambitious but very different plans to overhaul the health care system.

McCain finished a week-long campaign swing in Denver on Friday that highlighted his plan, which would use tax credits to help shift from employer-based insurance coverage to an open market system where people can choose from competing policies.

Clinton and Obama seek universal health coverage for the 47 million Americans without insurance. Clinton would mandate coverage, while Obama would require it only for children.

The Democratic plans would keep the existing job-based insurance system but expand government involvement in a hybrid public-private system.

TOUGH SELL

McCain calls the Democratic plan a "big government" solution that limits choice. Democrats say his plan reduces the incentive for companies to offer coverage and puts workers at risk of not getting it -- particularly those with pre-existing conditions that insurance companies will not cover.

Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan policy research organization, said the Democratic plans had more political appeal.

"I would expect to see the Democratic approach resonate more with voters. They are very clearly telling voters you are going to be eligible for a public program," he said.

McCain's plan to allow people to move away from job-based coverage is a tough sell, analysts said. Polls show three-quarters or more of Americans are generally happy with the insurance they get through their employers.

At least some of the political fury that doomed Clinton's health care initiative in 1994, when she was first lady, was fueled by the reluctance of people to abandon their employer health coverage.