The Bush administration claims one of its major achievements to be development of a proposal for expanding health insurance coverage and controlling costs. But the plan wasn't offered until last spring -- too late for serious consideration by Congress before the fall elections.
Both President Bush and his Democratic rival Bill Clinton are seeking a mandate from the election for their competing views of how the current health care system should be reformed.
The central feature of Mr. Bush's proposal is a tax credit and voucher system to help bring health insurance within reach of those who cannot now afford it. He would finance these benefits largely by controlling the growth of Medicaid, the government health care program for the poor.
Mr. Clinton and Democratic leaders agree with some of Mr. Bush's ideas but favor a broader approach. They want to make sure all Americans have at least a basic package of health insurance coverage provided either by their employers or by the government using fees collected from employers who don't provide insurance for their workers.
In defending Mr. Bush's record on social issues, administration officials point to dramatic increases on health spending over the past four years to show that the president has been kinder and gentler than his predecessor.
Working closely with Congress, the administration has greatly expanded programs for children and families aimed largely at disease prevention. New initiatives in infant mortality, immunization, lead poisoning, child abuse and women's health are part of a 256 percent increase in financing for preventive services.
Health Secretary Louis W. Sullivan, a former medical school president, has waged a personal crusade against the tobacco industry, speaking out in stronger tones than any of his predecessors against advertising directed at teen-agers.
Money for biomedical research grew by 35 percent since Mr. Bush took office, slower than the pace of the 1980s but better than what might have been expected in tight budget times, researchers say.
The total budget for AIDS has grown by 118 percent to $4.9 billion since Mr. Bush took office, making it among the fastest growing categories of discretionary financing in the entire bureaucracy. The permit approval process for new drugs that may help AIDS victims has also been sped up to eight months from three years.
That work has been largely overshadowed, though, by the sharp ideological conflicts that tend to define the president's record on health issues.
Advocates for some women's groups, for example, complain the president's political concerns have bred an atmosphere of insensitivity.
Mr. Bush's determination to maintain absolute fealty to the anti-abortion lobby has sparked some of the problem. For example, it put him at odds with even some conservative members of his own party who tried in vain to work out a compromise on a Reagan administration ban on pregnancy counseling at federally-financed health centers.
And the president's recent veto of a bill that would allow fetal tissue to be used in federally-financed research to find a cure for Alzheimer's, Parkinson's and other diseases on the grounds that it might encourage abortions earned charges that he was cowardly or cruel.