Like no time in the past, health care has come to the fore in the presidential race.

The issue has taken on extra urgency because of spiraling costs, aging baby boomers, fears about the long-term financial solvency of the Social Security system and Medicare, and the estimated 47 million Americans who have no health insurance.

Indeed, almost two thirds of voters polled at the end of last year said the United States should adopt a universal health insurance program “in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers,” according to the Associated Press.

And 54 percent said they would agree with a single-payer system in which everyone could get their health insurance from a federal plan, financed by taxpayers. The AP-Yahoo News poll, conducted over the Internet by Knowledge Networks, surveyed more than 1,800 people.

Presidential candidates on both sides of the political aisle talk about the issue on the stump, citizens ask about it in forums, and questions about reforming the system are put to the candidates during debates.

Democrats and Republicans all agree that the system is broken, that costs must be reined in and that those without health insurance must have access to it. Some of the candidates strongly support an emphasis on preventive care.

But how to repair the system is where the party-line divide becomes a chasm. Republicans want citizens to take more responsibility for their own health care and to limit the federal government’s role. Democrats want universal coverage – some would mandate it – and to share the responsibility for coverage among the government, employers and individuals.

Here is a look at some highlights of the six top candidates for president – three Democrats, three Republicans. More details can be found on their websites.

Democrats

Hillary Clinton

Clinton calls her plan “The American Health Choices Plan,” in which the key words are “affordable,” “available” and “accessible.”

She proposes tax credits for working families to help cover insurance premiums; portability so if you change or lose your job, you keep your health care; and that insurance companies not be allowed to deny coverage for pre-existing conditions.

She also contends that savings will be realized through modernizing the entire health-care system, and that insurance companies spend “tens of billions of dollars figuring out how to avoid costly beneficiaries.” Prevention also is a key element of her plan that she says will save money.

The bottom line for Clinton is that she wants everyone to have health-care coverage, including teens and the uninsured. Her plan says that individuals “will be required to get and keep insurance in a system where insurance is affordable and accessible.”

She proposes that people be able to:

• Keep existing coverage through their employer or individual coverage.

• Chose from the same quality of private health-care options as members of Congress have.

• Opt for a public plan similar to Medicare.

Details at hillaryclinton.com

Barack Obama

Obama’s plan says that everyone has a right to health care. He doesn’t mandate coverage, except for children, but says his plan will guarantee coverage for every American.

Obama takes a three-pronged approach to the health-care issue. His plan would:

• Provide “affordable, comprehensive and portable” coverage for everyone.

• Modernize the system in the United States to contain costs and improve the quality of patient care.

• Make health insurance universal.

Obama proposes that no one be denied insurance because of illness or pre-existing conditions, that benefits be similar to what members of Congress have, and that premiums, co-pays and deductibles be affordable.

To rein in health-care costs, he proposes simplifying paperwork for providers, which he says will increase savings to the overall system.

His plan also would establish a “National Health Insurance Exchange” to act as a watchdog and help people who want to buy private insurance.

Employers who don’t offer decent coverage or make a “meaningful” contribution to health-care costs for their employees would be required to contribute toward the national plan.

Details at barackobama.com

John Edwards

Edwards’ goal is universal coverage. His plan would require all Americans to get insurance, once the following are in place:

• A requirement that employers either cover their workers or help pay for their health insurance.

• Insurance is made affordable through new tax credits, expanding Medicaid and the State Children’s Health Insurance Program (SCHIP), reforming insurance laws and taking steps to contain health-care costs.

• Creation of regional health-care market purchasing pools to give every American the bargaining power to buy “affordable, high-quality” health care, increase insurance-plan choices and cut the costs of businesses that offer insurance.

These nonprofit purchasing pools, which the federal government would help states and groups of states set up, would offer a choice of competing insurance plans, at least one of which would be a public program based on Medicare.

Under his plan, Edwards says, families who don’t have insurance would be able to get it at an affordable price; families with insurance would pay less, have more choices and more security in keeping the benefits; and employers would insure their workers more easily, and for less.

Details at johnedwards.com

Republicans

John McCain

McCain says the country is facing a “perfect storm” of problems, including the high cost of health care and a Medicare system that is going broke. Soon more money will be going out of the Social Security system than coming in, he says.

His reforms are based on paying only for quality medical care, having diverse insurance choices that meet individual needs, and restoring personal responsibility. And he maintains that the solution to fixing the health-care system is not a “one-size-fits-all big-government takeover of health care.”

Key points of his plan:

• Putting families in charge of their own health-care money.

• Reforming the tax code to cut the bias toward employer-sponsored health insurance. Individuals and families would get $2,500 and $5,000 tax credits, respectively, to increase the incentive to obtain health care.

• Encouraging competition in the open market to keep insurance and other medical costs down.

People would be allowed to obtain insurance through any organization they want, including their employers, church, professional association, or on their own. The policies, his plans says, would be portable, automatically bridge the time between retirement and Medicare eligibility, and would be required to meet strict standards.

Details at johnmccain.com

Mitt Romney

Romney echoes fellow GOP challenger McCain in his desire to not rely on a government-run “one-size-fits-all” health-care system. He wants states to lead reform, and favors expanding and deregulating the private health insurance market. Doing that, he says, will cut costs and make “affordable, portable, quality” private health insurance available to more Americans.

Romney offers a six-point approach:

• Deregulate state markets, which he says will encourage states to cut insurance regulations that “drive costs up and providers out of the market.”

• Fix the tax code by making all health-care expenses tax deductible, and not giving preferential status to employer-provided health plans.

• Stop what he calls “free riders” by using some of the money now being spent on providing care to the uninsured at emergency rooms to help the “truly needy” buy private insurance.

• Reform the medical liability system by setting a federal cap on non-economic and punitive damage awards. The idea is to eliminate “frivolous” lawsuits and end the practice of defensive medicine.

• Promote innovation in Medicaid by giving states the flexibility to spend their Medicaid dollars how they determine to be the most efficient.

• Improve quality and transparency through competition.

Details at mittromney.com

Mike Huckabee

Huckabee contends that the U.S. health-care system is hurting the country’s competitiveness in the global economy, saying that General Motors, for example, spends more on health care than it does on steel.

Costs have climbed, he says, “because the party paying for the health care – the employer – and the party using the health care – the employee – are not the same. It is human nature to consume more of something that is essentially free.”

He opposes federally mandated universal health care.

The former Arkansas governor favors, among other things, reforming medical liability laws, making health insurance more portable from job to job, expanding health savings accounts to everyone, and making health insurance tax deductible for individuals and families.

He opposes government controls that he says would come with universal health care. And he favors people having more control over options for their own health care, shifting from the employer-based system now in place.

“It is time to recognize that jobs don’t need health insurance, people do,” Huckabee says, “and to ease the burden on our businesses. Our employer-based system has outlived its usefulness, but the answer is a consumer-based system, not socialized medicine.”

Details at mikehuckabee.com