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LYNN NEARY, host:

This is MORNING EDITION from NPR News. I'm Lynn Neary.

STEVE INSKEEP, host:

And I'm Steve Inskeep. Good morning.

If you want a contrast between Republicans and Democrats, look no further than health care. All three presidential candidates have health care plans. Democrats Hillary Clinton and Barack Obama differ in significant details, but Republican John McCain proposes a very different plan. His plan would move the health care system in exactly the opposite direction from the Democrats.

NPR's Julie Rovner reports.

JULIE ROVNER: For the Democrats, the major focus and the disagreements have come over how to cover the 47 million Americans who currently have no health insurance. For Senator John McCain, however, that's a secondary issue.

Senator JOHN McCAIN (Republican, Arizona; Republican Presidential Candidate): The problem is not that most Americans lack adequate health insurance. The vast majority of Americans have private insurance, and our government spends billions each year to provide even more. The biggest problem with the American health care system is that it costs too much.

ROVNER: The thrust of McCain's plan is to encourage people to buy their own insurance, rather than get it through their jobs. He'd do that using several different strategies: giving people tax credits, encouraging more people to set up tax advantage health savings accounts, and letting them buy insurance policies across state lines. None of those ideas are new, but together, said McCain at a forum on health care last fall, they can help harness the purchasing power of individual consumers.

Sen. McCAIN: When it's their money and it's their decision I think they make much wiser decisions than when it's provided by somebody else.

ROVNER: McCain also wants to rein in the government's big health care programs, Medicare and Medicaid. Just this week in Pittsburgh, for example, he criticized Medicare's new drug benefit for being too generous.

Sen. McCAIN: People like Bill Gates, Warren Buffett, don't need their prescriptions underwritten by taxpayers. Those who can afford to buy their own prescription drugs should be expected to do so.

ROVNER: And one thing McCain says he won't do is impose any sort of requirement that people have health insurance, the sort of mandate that Clinton and Obama are currently sparring over.

Sen. McCAIN: I think that every American should have the available and affordable college education, but I'm not going to mandate that every American go to college. I feel the same way about health care. If it's affordable and available, then it seems to me that, again, it's a matter of choice amongst Americans.

ROVNER: But there are a lot of questions about whether McCain's plan actually would make health insurance more affordable and more available.

Ms. ELIZABETH EDWARDS: John McCain and I have something in common. Neither one of us would be covered by his health care policy.

ROVNER: That's Elizabeth Edwards, wife of former Democratic presidential candidate John Edwards. Because McCain's plan doesn't require insurance companies to accept people with pre-existing health conditions, they could be turned down or have their condition excluded from coverage. Both McCain and Mrs. Edwards are cancer survivors.

Ms. EDWARDS: The truth is a health care policy that covers everything but cancer doesn't exactly do me a lot of good.

ROVNER: Bob Lashefsky, a health care consultant, says McCain's plan not only doesn't address how people who've been sick would get insurance, but he also hasn't answered the question of how older people will be able to afford coverage.

Mr. BOB LASHEFSKY (Health Care Consultant): If you're older, you're going to pay a lot more than younger, because individual health insurance is age-rated. So he hasn't talked about what he's going to do with older people paying a lot more than younger people, and how he's going to make health insurance affordable both for people who are sick and who are older and how he's just plain going to make it available for people who wouldn't pass medical underwriting now.

ROVNER: And Lashefsky says that for all of McCain's emphasis on holding down costs, he's not convinced the senator's plan would do that, either. Many of McCain's cost-cutting proposals, things like putting more emphasis on prevention and electronic medical records, are the same as those in the Democrats' plans. And as for making patients more financially responsible...

Mr. LASHEFSKY: Providers, insurance companies, employers have all failed at that. And now the big question is why is the consumer going to be any more successful at doing that than the people who do this for a living.

ROVNER: Still, one thing McCain's health plan will do is give voters a clear choice from the plan that will be offered by whichever Democrat wins the nomination.

Julie Rovner, NPR News, Washington.

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