Health at the hustings

With the presidential primaries beginning in the United States, Elias Mossialos, Martin McKee, and Alexandra Pitman examine how the candidates are proposing to tackle health care

By the time this year's presidential elections take place, the number of Americans with no health insurance cover is expected to reach 45.5 million. Although the biggest increases in recent years have been among black and Hispanic populations, these groups have been joined by others who in previous years have not considered themselves to be at risk of losing cover.

Downsizing by employers has created a large pool ofpeople in their late 50s and early 60s who, although no longer employed, are too young for Medicare. Moreover, the number of children who are not insured is estimated to have reached 11 million.

In these circumstances there is a high level of support for change. Despite the failure of President Clinton's 1994 proposals, most voters none the less favour covering those currently not insured, particularly children and those with low incomes. This is reflected in the decisions of the leading Democratic candidates, Al Gore and Bill Bradley, to make access to health care a central issue of their campaigns.