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MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

Health care is a top issue for both Democratic and Republican voters this year. So candidates from both parties have plans for curbing health costs and boosting insurance coverage. There are lots of promises of change.

NPR's Julie Rovner has this report on which plans would change the system the most.

JULIE ROVNER: The Democratic candidates have mostly emphasized covering the 47 million Americans who don't have health insurance. Here's former Senator John Edwards.

Mr. JOHN EDWARDS (Former North Carolina Senator; Democratic Presidential Candidate): The single, most important element is, does it cover everybody? Because if it doesn't cover everybody, then I think whoever the candidate is should be made to explain what American they believe is not worthy of health care coverage.

ROVNER: Republicans, on the other hand, tend to stress ways to bring down health care costs. Here's former Senator Fred Thompson at the GOP debate just before last week's New Hampshire primary.

Mr. FRED THOMPSON (Former Tennessee Senator; Republican Presidential Candidate): We've got the best health care in the world. It costs more than it should. We can either go one of two ways. We can let the government take it over, and they'll lower costs, like they do in other countries. We will also sacrifice care, which nobody wants to do. We're not going to do that in this country. Or we can make the markets work more efficiently.

ROVNER: It's true, says Drew Altman, president of the nonpartisan Kaiser Family Foundation, that the Democrats want to rely more on government programs and the Republicans more on the free market to fix what's wrong with the nation's health care system. And it's true that Democrats are proposing to spend more money on their plans

Mr. DREW ALTMAN (President, Kaiser Family Foundation): But it's actually the Republicans who are proposing the bigger transformation of the health insurance system and indeed the more radical change, and that's been completely lost and misunderstood.

ROVNER: That's because most of the Democrats — still smarting from the failure of the last health reform effort in the 1990s — want to build on the existing system, in which most people get their health insurance on the job. Their plans would have government fill in around the edges and offer subsidies to make coverage more affordable. Republicans, on the other hand, want to go in an entirely different direction, using the tax system to encourage people to purchase their own individual coverage. Here's how former New York Mayor Rudy Giuliani explained it at that New Hampshire debate.

Mr. RUDY GIULIANI (Former New York Mayor; Republican Presidential Candidate): Only 17 million Americans right now buy their own health insurance. If 50 million Americans were buying their own health insurance — because it would be just as tax-advantageous to do it that way — and we had health savings account, people — economists believe there'd be a 30 to 50 percent reduction in the cost of health insurance and quality would come up.

ROVNER: That last contention is debatable. But what isn't, says Altman, is how the average consumer would be affected by the Republicans' proposals.

Mr. ALTMAN: Because they see a world in which we move away from the current employment-based system, and to some extent, our existing public programs, and many more Americans purchase their health insurance themselves, that's a much bigger change.

ROVNER: But other health analysts aren't convinced the GOP plans are really all that radical. Joe Antos of the conservative American Enterprise Institute said he thinks the Republican changes would likely be more gradual.

Mr. JOSEPH ANTOS (President; American Enterprise Institute): So, I think what the main Republican candidates are really talking about is the idea that we want to level the playing field on taxes, but I don't think they seriously imagine that the employer-sponsored health system is simply going to dry up and blow away — in fact, it won't.

ROVNER: That's mainly because big employers, at least, still use health insurance as an important tool to recruit and retain workers. And besides, says Antos, when it comes to changing health care in this country, nothing ever happens fast. That's something Democrats and Republicans do agree on.

Julie Rovner, NPR News, Washington.

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