Kerry camp shifts focus to 'imploding' US health system

While arguments about Iraq and terrorism - and even the ancient history of the Vietnam War - have raged back and forth between the two candidates for the White House, a new topic is about to burst on the stage and it is one in which far more voters have a direct and urgent interest: the imploding healthcare system.

While arguments about Iraq and terrorism - and even the ancient history of the Vietnam War - have raged back and forth between the two candidates for the White House, a new topic is about to burst on the stage and it is one in which far more voters have a direct and urgent interest: the imploding healthcare system.

A study released by the Kaiser Family Foundation finds insurance premiums in the United States have soared by 59 per cent since 2000. On average, a family health plan costs workers and their employers $10,000 (£6,000) a year. Moreover, those without any health coverage increased by 3.2 per cent in 2003 compared to the year before to reach no less than 45 million Americans.

Both John Kerry and his running mate, John Edwards, are seizing on those figures and other health care-related statistics - notably the soaring cost of prescription drugs - to indict the Bush administration for failing to take action. The issue was expected to surface both in the vice-presidential debate between Mr Edwards and Dick Cheney last night and on Friday when Mr Bush and Mr Kerry meet again.

"This may be one of the sharpest and most well-defined issues that distinguishes these two candidates in this election," suggested Henry Aaron, a senior fellow at the Brookings Institution in Washington.

President Bush emphasises further privatisation of the system, proposing to allow Americans, who traditionally have relied on insurance provided by their employers, to create so-called health savings accounts exempt from taxation. They would use the money to choose their own insurance plans - the free competition, he argues would lower costs. The hope is that they would spend less on health care if they had to pay for it themselves.

By contrast, Mr Kerry is proposing greater government support to give more people, and potentially everyone, access to some form of insurance. Accusing Mr Bush of "neglecting the crisis of health care", he wants to create a federal pool of taxpayers' money to subsidise companies paying for workers' health plans and provide coverage to the uninsured. His social-medicine proposal would cost $653bn over a decade. Mr Bush's would be cheaper at $89bn.

"Mr President, it's wrong to allow skyrocketing healthcare costs to choke off new jobs, eat up family incomes and leave millions uninsured, living in daily fear and on the brink of medical disaster," Mr Kerry said at a recent rally in Des Moines.

While the minutiae of health policy may befuddle voters, many of whom have grown sceptical of the promises made by candidates every four years, two areas of dispute are already being emphasised by Mr Kerry, who sees the opportunity for winning votes. One is the refusal by Mr Bush to free funding for stem-cell research. The other is his refusal to lift a ban on Americans buying cheaper drugs from Canada.

At a rally on Monday, Mr Kerry berated Mr Bush for holding back federal funds for stem cell research, which scientists say could lead to breakthroughs, especially in the treatment of Alzheimer's. "The hard truth is that, when it comes to stem cell research, this President is making the wrong choice to sacrifice science for extreme right-wing ideology," Kerry said at a town hall meeting in New Hampshire.

He and Edwards are promising to overturn the ban on private citizens buying prescriptions more cheaply from abroad, which usually means from Canada.

Keeping up with the bills for their drugs is the challenge facing Frances and Sal Conza, for example, who a few days ago joined the growing ranks of Americans seeking to bypass the ban. For Frances, 78, and Sal, 79, that meant driving from their home in Mineola, Long Island, to the nearby town of Levittown, to a small storefront in short strip-mall. The sign declares "Discount Drugs from Canada".

Opened a year ago by a Long Islander, David Feinsod, 62, it is one manifestation of a $1bn-a-year industry working in the legal shadows to help Americans - mostly pensioners - buy brand-name drugs from Canada, where, thanks to government controls, they are sometimes 50 to 80 per cent cheaper than in the United States.

Mrs Conza inquires about two heart drugs called Coumadin and Florinef. After a quick look at his computer, Mr Feinsod offers her 100 tablets of each for a total of $99. The saving is not huge - about $50 - but it all helps. Mrs Conza said: "You know, we're the ones that fought the Second World War and we never get a thing back from the government."

LAST NIGHT'S DEBATE: EDWARDS VS CHENEY

Last night's debate in Cleveland pitted two very different men with very different backgrounds.

John Edwards, 51, a youthful Southerner with flair and charisma has often had his lack of political experience questioned. He was elected to the Senate in 1998.

In contrast, his opponent, vice-president Dick Cheney, 63, is hugely experienced, who has served as a congressman and defence secretary.

The bullish right-wing former head of Halliburton is generally considered to be the most powerful vice-president in US history.

The debate in Cleveland, Ohio, took place in one of the election's most crucial states. Both Democrats and Republicans need to win this swing state if they are to succeed in November.