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Parsing GOP, Democratic Health Care Proposals

Next week, almost half of the states will vote or caucus to choose a Republican and a Democratic presidential nominee — 24, to be exact. Poll takers say many Americans remain undecided, so we're looking at a handful of the issues in the campaign. Today's subject is health care. It's always an important issue for Democratic voters, but this year, Republicans also are worried about rising costs — so every candidate has a health care plan. NPR health policy correspondent Julie Rovner and Michele Norris help sort through some of them.

Candidates from both parties are proposing fairly far-reaching health plans. But while the Democratic plans would probably cover more of the uninsured, they would change the health care system for most people less than the Republican plans would, and the GOP plans envision a much bigger shift in the way people get their health insurance.

In the end, it's still back to the same old debate of Democrats pushing a bigger role for government and Republicans more of a role for the free market, Rovner says.

The Democrats

Hillary Clinton's plan would require people to have health insurance — it's called an individual mandate. John Edwards, who just dropped out, also had one, and Barack Obama has one, too, at least for children. All three plans were based on the concept of "shared responsibility," where government, individuals and employers all pay something.

The big difference among the Democrats — really the only meaningful difference — is that while Clinton would require everyone to have coverage, Obama wouldn't. He basically says that if you build it, people will come — you don't have to have a mandate to get people to buy insurance.

So, Clinton and Obama would let people keep their existing coverage if they want to, or buy into a government-sponsored plan like Medicare, and the government would subsidize small businesses and the poor.

The Republicans

The GOP plans are more alike than they are different, although not quite as alike as the Democrats' plans. The Republicans — like President Bush — want to rely more on the free market to create more competition to push down the cost of health care, and they want to use the tax code to encourage more individuals to buy their own insurance.

Mike Huckabee has a provision in his plan that would allow people who live "healthy lifestyles" to pay lower health insurance premiums. And John McCain proposes to pay doctors and hospitals based on how well their patients do, and to "reward wellness and fitness."

Former Massachusetts Gov. Mitt Romney has done what none of the other candidates can claim: He signed a major health reform into law. The Massachusetts plan has a mandate attached to it, something Republican primary voters aren't thrilled by, but Romney has said he'd let states basically do what they want. And he'd roll back the federal standards now in place for the Medicaid program for the poor and let states use that money to figure out how to cover the uninsured — which would be a pretty dramatic change.

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