WASHINGTON - In a presidential contest featuring two candidates who disagree about almost everything, the challenge of dealing with soaring health care costs stands out as one of the largest points of conflict between President Bush and Sen. John Kerry.
"If you want to define a single issue that crystallizes the essential differences between the two candidates on domestic policy, health care would be it," said Henry J. Aaron, an economist at the Brookings Institution.
Whatever their political stripes, voters across the nation are deeply concerned about health care, and looking to the next president to lower their costs and make it easier for them to get and keep insurance coverage. National polls show that health care ranks near the top of voters' concerns, just behind the economy and national security.
Bush's and Kerry's campaigns view health care as a key issue, and the candidates have been sparring on the issue in campaign events and television ads in battleground states such as Florida.
That's because virtually everybody is facing health care worries. Americans who have health coverage have watched in recent years as costs have skyrocketed. And the ranks of the uninsured have swollen to 44 million, with many more at risk of losing coverage as costs rise.
If there is wide consensus that something must be done to address those problems, there also is vehement disagreement between Bush and Kerry about the answers.
Republican Bush favors a private-sector program that uses tax breaks to steer people into individual health insurance plans.
Kerry also backs tax credits, but his plan is far more ambitious - and expensive, relying on the government to solve people's health care problems.
The Massachusetts Democrat would greatly expand federal insurance programs to cover more people, and try to lower costs for those who already have insurance by creating a government safety net to help employers pay for the highest-cost cases.
To finance his plan, Kerry wants to roll back Bush's tax cuts for those earning more than $200,000 a year.
"I think they're about as far apart as I've ever seen," said Joseph A. Antos, a health care expert at the conservative American Enterprise Institute (AEI).
The blueprints offered by Bush and Kerry - with starkly different priorities and paths for the future - could weigh heavily in voters' decisions about who is the right person to lead the country for the next four years.
Most experts agree that Kerry would provide health insurance to about 25 million people who lack it. His plan also aims to bring down costs for people with insurance by 10 percent. Kerry's campaign tallies the cost of his plan at $653 billion over 10 years, but some experts say it could be from $800 billion to well over $1 trillion.
Bush's plan is far smaller. His campaign says it would cover 11.2 million people without insurance but some experts disagree, estimating as few as 1 million will get help. The bulk of its roughly $145 billion cost is spent on a tax credit to help low-income people buy individual health insurance.
But many agree with Bush that bigger is not necessarily better when it comes to easing the nation's health care woes.
Bush calls for a radical shift in the way people get their health insurance, beginning to move people away from getting employer-provided insurance and toward buying it themselves.
"Ours is common-sense plan," Bush told a campaign crowd last week in Bangor, Maine. "Ours is . ... a plan that doesn't let the federal government decide everything for you."
The centerpiece of his plan is a new tax credit for low-income people - $1,000 for individuals and $3,000 for families - that they could use to buy health insurance. They also could use the credit to fund their Health Savings Accounts (HSAs), which allow people who buy high-deductible insurance plans to save tax-free to pay out-of-pocket health care costs.
Bush wants to promote HSAs, first enacted as part of the 2003 Medicare overhaul, by making the premiums tax-deductible. He also would give small businesses a tax credit of $200 for individuals and $500 for families for contributing to an HSA.
Small businesses would be allowed under Bush's plan to band together to form so-called Association Health Plans - exempt from many insurance regulations - that could pool risk to get better health care rates.
To control health care costs, Bush advocates reforming medical liability laws, including capping damages in malpractice lawsuits, to hold down doctors' insurance premiums. Kerry advocates similar reforms, but opposes capping damages.
Many Democrats and liberal health care economists view Bush's proposals with dread, saying they could give employers incentive to drop workers from insurance and leave poorer, sicker people without affordable health care options.