Even before his wife, Elizabeth Edwards, learned that her cancer had returned, John Edwards had made health-care reform one of his signature issues in his quest for the White House.

Edwards mailed a DVD to every active Democratic household in the critical state of Iowa in March, outlining his plan to extend health insurance to every American. He has said health-care reform would be one of the first issues he would tackle as president. And Edwards has defied conventional political wisdom, saying he would raise taxes to pay for it.

"What we have is a dysfunctional health-care system in the United States of America," Edwards said at a recent Democratic presidential forum on health-care reform. "We need big, bold, dramatic change, not just small change."

But what kind of plan is Edwards putting forward? Who would it help? Who would pay for it? And does it have any better chance of getting through Congress than the plan backed by the Clintons more than a decade ago?

Edwards is not alone among the Democratic presidential hopefuls in advocating universal health insurance. His chief Democratic rivals, Sens. Hillary Rodham Clinton of New York and Barack Obama of Illinois, have both voiced support for the idea.

But Edwards is the only major candidate who has laid out a specific plan for making sure that everyone is insured. (Ohio Congressman Dennis Kucinich, a Democratic presidential candidate, has proposed extending Medicare to cover everyone.)

Democrats had largely avoided dramatic health insurance changes since President Clinton's proposed reforms crashed in 1994 amid strong opposition from the insurance industry and Republicans. The insurance industry attacked the Clinton health plan with its famous "Harry and Louise" TV ads -- commercials featuring a middle-class couple complaining about its bureaucratic nature. Republicans ridiculed the plan, dubbing it "Hillarycare," in recognition of the leading role played by the then-first lady.

Since then, Democratic candidates, including Edwards during his 2004 presidential run, have offered politically safer, incremental proposals such as extending the insurance coverage of children.

But the political climate has rapidly changed. The insurance issue was once mainly the province of those concerned about the poor. Spiking health-care costs have become a major problem for businesses seeking to provide insurance and for employees who are paying higher premiums for skimpier benefits.

Health care ranks second to Iraq as an important problem for the government to address, according to a recent national poll by the Kaiser Family Foundation, a California-based nonprofit that focuses on domestic health-care issues. Respondents ranked health care ahead of terrorism and jobs.

"Health-care costs have been rising far faster than people's ability to afford them," said Larry Levitt, vice president of Kaiser. "Insurance premiums are up 87 percent over the last six years, far eclipsing wage increases. The uninsured have been rising consistently.

"Politicians are starting to catch up with voters' concerns. The combination of John Edwards pushing it on the campaign trail and a couple of prominent governors pushing it, particularly Mitt Romney of Massachusetts and Arnold Schwarzenegger of California, have helped make it a front-burner issue."

Schwarzenegger and Romney, a GOP presidential candidate, have pushed through health-care plans in their states.

Impetus for change

The changed environment has emboldened Edwards, who has also been moving to his political left on such issues as poverty and the war in Iraq to attract liberal primary voters. Emphasizing health insurance also helps Edwards' courtship of organized labor.

Next page >