ANDREA SEABROOK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Andrea Seabrook.

Health care was a major point of contention for the leading Democratic presidential candidates this week. Their sparring partners weren't Republicans, though, but each other. Some political watchers say with spats like these, the Democrats may end up wounding themselves on what should be one of their strongest issues.

NPR's Julie Rovner has this report.

JULIE ROVNER: A central source of strife was this television ad Senator Barack Obama's campaign began running this week in New Hampshire. It featured pictures of his mother who died of cancer at age 53.

(Soundbite of Senator Barack Obama's campaign ad)

Senator BARACK OBAMA (Democrat, Illinois): For 20 years, Washington's talked about health care reform, and reformed nothing. I've got a plan to cut costs and cover everyone.

ROVNER: But that's not true, says rival Hillary Clinton. Here's how she put it in a speech in Iowa on Wednesday.

Senator HILLARY CLINTON (Democrat, New York): Senator Obama's plan does not and cannot cover all Americans. He's called his plan universal then he called it virtually universal, but it is not either. And when it comes to truth and labeling, it simply flunks the test.

ROVNER: The Clinton campaign, on Friday, sent a letter asking the Obama campaign to stop running the ad; the Obama campaign refused. An Obama spokesman said in a statement, the Clinton campaign never said a word about the ad when it came out a month ago, and, quote, "the only thing that's changed since then is the poll numbers."

But while Clinton may be in a tighter race than before, she does have the support of health policy analysts and most of her fellow Democratic candidates when she makes this claim: The only way you can get everyone covered is to require people to have insurance.

Sen. CLINTON: It is impossible to get to universal health care if you don't have a mandate.

ROVNER: Obama, meanwhile, has been criticizing both Clinton and former Senator John Edwards whose plans do have mandates for failing to spell out how they would enforce those requirements; that prompted responses from both candidates. Edwards, for example, told the Des Moines Register he would consider withholding tax refunds or garnishing wages for those who failed to pay health insurance premiums. He also supports something called default enrollment, which Clinton also endorsed in her Iowa speech.

Sen. CLINTON: He set up a system where people are automatically enrolled when they come into contact with the health care system or with schools or colleges. You could also work with employers so that they automatically enroll people.

ROVNER: But all these discussions about the details aren't likely to appeal much to primary voters, says Jonathan Oberlander, who teaches health policy at the University of North Carolina.

Professor JONATHAN OBERLANDER (Associate Professor, Department of Social Medicine, University of North Carolina): The problem is once you talk about the specifics of enforcement mechanisms, this sounds punitive. When you start talking about garnishing people's wages or having some kind of financial polity in the tax system, you've gone from making health care a right and something that you want to give people to making it something where you're imposing a penalty.

ROVNER: Oberlander says that while Clinton may technically be correct that Obama's plan wouldn't cover everyone, the plans are far more alike than different, and differ considerably from all the plans being offered by the Republican candidates.

Prof. OBERLANDER: I think where they want to have the debate is over health care security, and health care that can never be taken away, and making sure that every single American has access to affordable health care and that they have a choice of health plans and doctors. I don't think they want to have the debate on the details of enforcement mechanisms.

ROVNER: No matter who becomes president, Oberlander says, changing the health care system won't be easy. So far, polls show the public trust Democrats more than Republicans on the health care issue, but weeks like this past one aren't likely to boost Democrats' health care stock.

Julie Rovner, NPR News.

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