Health-care fix looms large over 2008 races

By Joanne Kenen

WASHINGTON (Reuters) - Health care could undergo its biggest revolution in decades under the proposals of presidential hopefuls trying to fix a system that has left one in seven Americans without insurance.

No other major industrial democracy has such a large number of people without health coverage.

Opinion polls have shown health care to be the top domestic issue for Democrats. At least one survey found that Democrats ranked it as important as Iraq. Republican voters also are paying more attention than in past years.

Democratic candidates are proposing universal health coverage through a mix of public and private plans. Republicans say they will make insurance cheaper and more accessible through tax and market changes that may speed up the shift away from an employer-based system.

"This will be the broadest philosophical debate we've had about health care in a long time," said Robert Blendon, an expert on health politics and policy at Harvard's Kennedy School of Government.

Candidates are churning out health plans that are unusually detailed for this point in a campaign, although none are likely to become law without significant evolution, compromise and input from Congress.

Even that may not be enough. The country has wrestled with health coverage off and on for decades without consensus.

The two main parties have deep and defining differences.