Unless you drill down into their plans, each leading Democrat sounds a lot like the other leading Democrats, and each leading Republican sounds a lot like the other leading Republicans.
The issue promises to be a flashpoint in next fall's general election, in which the two nominees will have dramatically different views on the subject.
Caucusgoers can choose the candidates they believe are most likely to win the argument in November and shepherd changes through Congress.
"I think people are looking for someone who can get this done. Who has the ability, the experience and the finesse to do it?" said Kathy Stangl of Des Moines.
Stangl has attended more than 65 campaign events, hitting almost all the candidates from both parties and asking them questions about how they would reform health care. Stangl has a fatal lung disease and is spending her remaining time helping keep the issues of preventive care, medical research and health insurance in the forefront of the presidential race.
She said she generally gets more details from the Democrats, whose health care plans call for bigger government roles than what the Republicans want.
The top Democratic contenders generally want to increase the governments' involvement in health care and help provide insurance coverage for the 47 million Americans now going without. The Republicans generally want to encourage citizens to be healthier and to help make the health care market more efficient and easier to navigate.
John Hale, policy director for the Iowa CareGivers Association, said he's thrilled to hear the discussion, which he described as the most intense national focus on health care in decades.
"It's clear that this is one of the top - if not the top - domestic issues that the Democratic candidates have talked about," he said.
Hale, a political independent and health policy aficionado, said the leading Democrats differ in details, but the gist of their universal health care plans is the same. When asked how he would advise Democratic caucusgoers to choose, he said the difference could come down to which candidate could build national support for a major shift. "It comes down to who is going to lead most aggressively on this, and who has the best chance of actually producing results."
State Sen. Jack Hatch, a Des Moines Democrat, said his party's health reformers used to talk more about implementing a "single-payer" system, in which the government would directly insure everyone. But the only presidential candidate still backing that idea is Ohio Congressman Dennis Kucinich, whose campaign is gaining little traction. "The candidates are moving away from that, which shows they're being realistic," he said.
Hatch, who is leading a health reform effort in the Legislature, describes himself as one of the most liberal legislators at the Statehouse. But he said that even many lefties like him have decided to back off single-payer proposals and to look for more pragmatic approaches.
Top Democratic presidential candidates all are talking about ways to improve and expand the country's current mixed system of public and private insurance plans, Hatch said. Their more moderate stances demonstrate their belief that major health care changes can pass if they're not too extreme.
State Rep. Linda Upmeyer, a Garner Republican who serves on the state health reform commission, said her party's presidential candidates talk more about ways to help Americans get better, affordable health care through private markets instead of through government mandates. Most of the Republicans' proposals include tax credits or deductions to help individuals afford insurance.
A national health care consultant said there are differences among the plans if you dig into them.
Jon Cohen, a managing director for Pricewaterhouse-Coopers, said Democratic candidates Hillary Clinton and Barack Obama propose offering tax credits to small businesses to help them pay for the health insurance they would be required to buy for employees.
The third leading Democrat, John Edwards, does not propose such tax credits, Cohen said. He said credits could help build support among small employers, who have provided some of the most significant opposition to proposed state mandates.
He also noted that Edwards and Clinton propose requiring that everyone have health insurance, while providing subsidies to those who could not afford it.
Obama would require only that children have insurance, while offering incentives for adults to get it.
Edwards and Clinton say mandates are the only way to ensure everyone is covered. Obama says his approach is more realistic.
Overall, Cohen said, the country has seen an amazing increase in discussion on the topic.
"I'll tell you, in 2004, nobody was talking universal health care," he said.
Copyright ©2007 The Des Moines Register.