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ROBERT SIEGEL, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

A new report from the Census Bureau says 47 million Americans didn't have health insurance last year. That's an all-time high. Even people who have insurance often worry about losing it. Add to that the rising cost of care and the issue is likely to be significant in next year's presidential race.

NPR's Scott Horsley reports.

SCOTT HORSLEY: When the Gallup organization asked people last month what's the most important problem facing the country today, the situation in Iraq was number one. Number two was health care. It's becoming an issue that presidential candidates in both parties have to pay attention to. As Republican Mitt Romney acknowledged in a speech to Florida doctors last week.

Mr. MITT ROMNEY (Former Republican Governor, Massachusetts; Presidential Candidate): Health care is not a Democrat issue. It's a Republican issue. It's a conservative issue.

HORSLEY: Romney starts with the premise that America is already paying for universal health care since even the uninsured ultimately get treatment albeit it late and at a price.

Mr. ROMNEY: So they're getting health care, they're just not paying for it. Who's paying for it? Well, the rest of society is. And wouldn't it be smarter to take the money that's being spent on the cost shifting and use that money instead to help people buy their own private insurance?

HORSLEY: That's the basis of the Massachusetts health care plan that Romney help lead as governor. He wants to deregulate the insurance market to encourage more low-priced policies, give individuals who buy insurance the same tax breaks as those who are covered through employers, and provide government subsidies to people who can't afford the premiums.

Romney's national proposal leaves out two features of the Massachusetts plan that might be unpopular with Republican primary voters: There's no requirement for big employers to contribute to coverage, nor for individuals to obtain health insurance. Romney says he's against any sort of one-size-fits-all health care system, a view that was echoed last week by his GOP rival, Rudy Giuliani.

Mr. RUDY GIULIANI (Former Mayor, New York City; Republican Presidential Candidate): Health care done privately, not socialized medicine.

(Soundbite of cheers and applause)

HORSLEY: Almost no one's actually calling for socialized medicine. Democrat John Edwards' plan actually shares some of the same features as Romney's and Giuliani's including tax breaks, government subsidies and continued reliance on insurance companies. Unlike the Republicans, though, Edwards would impose new rules on insurers to keep them from denying coverage. And he and other Democrats would also require employers to contribute to their worker's coverage.

Mr. JOHN EDWARDS (Former Senator, North Carolina; Democratic Presidential Candidate): What single mother in America is not entitled to health care coverage? What father, who's responsible for his family, is not entitled to health care coverage?

(Soundbite of applause)

HORSLEY: Barack Obama suggests letting everyone buy into a new national health care plan like the one offered to federal employees. And Hillary Clinton, who still wears the scars of a failed effort to health care reform in the 1990s, plans to unveil her plan next month. Speaking at a cancer forum in Iowa yesterday, she promised it would cover everyone.

Senator HILLARY CLINTON (Democrat, New York City; Presidential Candidate): If people can't get access to the preventive services they need, if they can't get the incredible advances in medical care that we're pioneering in our country, it won't matter.

HORSLEY: Only one candidate, Dennis Kucinich, has gone so far as to call for a single-payer health care system. He says he wants to challenge the system of premiums, co-payments and deductibles.

Representative DENNIS KUCINICH (Democrat, Ohio; Presidential Candidate): We have to break the hold, which the insurance companies and the pharmaceutical companies have a health care.

HORSLEY: Dana Goldman of the RAND Corporation says when it comes to health care, politicians tend to promise more than they can deliver. But, he says, this year's candidates all have some smart advisers, so there's a chance of real reform.

Mr. DANA GOLDMAN (Public Policy Expert, RAND Corporation): There's also the possibility that we don't have to pick one winner, you know. We have 50 states and we can let the states serve as natural laboratories to see what works.

HORSLEY: Both Republican Mitt Romney and Democrat Barack Obama's health care plans explicitly make room for that kind of experimentation.

Scott Horsley, NPR News.

BLOCK: You can read summaries of the major candidate's health care proposals at npr.org.

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