About 47 million people in the United States do not have health insurance.

Both Republican and Democratic candidates, with the exception of Kucinich, envision a health insurance system that continues to be structured around private insurance markets with a supporting role played by public insurance programs.

The candidates diverge significantly, however, on the way this system should operate.

None of the Republican candidates would require that people have health insurance. On the Democratic side, Sen. Hillary Clinton and former Sen. John Edwards would require that all Americans eventually have coverage.

Obama would require coverage only for children, though he would consider an individual mandate for adults if substantial numbers of people do not buy coverage that is deemed affordable. Sen. Barack Obama would not seek to cover adults and would only require that children have coverage.

A Commonwealth Fund survey of adults age 19 and older, conducted from June 2007 to October 2007, finds that large majorities of the public, regardless of political affiliation or income level, say that the candidates' views on health care reform will be very important or somewhat important in their voting decision.

Moreover, they believe employers - long the cornerstone of the health insurance system - should retain responsibility for providing health insurance, or at least contribute financially to covering the country's working families. A majority of adults would also favor a requirement that everyone have health insurance, with the government helping those who are unable to afford it; support for such a requirement, however, is not strong and varies by political affiliation, geographic region, and income.

There is overwhelming agreement that financing for health insurance coverage for all Americans should be a responsibility shared by employers, government, and individuals. (The Public's Views on Health Care Reform in the 2008 Presidential Election)

Health spending in the United States is projected to increase from 16 percent of gross domestic product (GDP) in 2006 to 20 percent in 2016 - from $2 trillion to $4 trillion in 10 years.

At the same time, the number of people who are uninsured is rising sharply, including a growing proportion of middle-income families. More and more middle class families are affected every day, more every year. It's very significant that the number of uninsured people climbs every year and more and more middle-class people are affected. Its effect on our economy is dramatic.

While rising costs are putting all sectors of the economy at risk, the nation currently lacks a concrete, realistic plan for adopting a different approach that could achieve savings and improve value.

The reasons are clear and numerous. The number of Americans without health insurance has continued to climb: 47 million people were uninsured in 2006, an increase of 8.6 million from 2000.

In addition, an estimated 16 million nonelderly adults are underinsured as a result of high out-of-pocket health costs relative to income.

And although employer-provided health insurance remains the predominant form of coverage for U.S. workers and their families, rapid growth in health care costs and premiums has weakened the ability of many firms to offer comprehensive coverage and for many families to afford it. Employers - particularly small companies - are passing more costs to their employees or eliminating coverage altogether. (The 2008 Presidential Candidates' Health Reform Proposals)

With the presence of an individual mandate, it will be critical that health plans are affordable and that the mandate is enforceable. Even the ability of the Republican proposals to expand coverage will depend on whether people have access to affordable health plans....

None of the Republican candidates has identified a source of financing.

The leading Democratic candidates would either roll back the tax cuts of the past few years or allow them to expire for households with incomes above $200,000 (Edwards) and $250,000 (Clinton and Obama).

They have also identified other more minor sources of financing, as well as savings achieved through improved efficiency.

More information about our health care crisis in America:

• Most Americans Agree: We Need Universal Health Care
• Choosing Death or Debt: Is This Our Health Care System?
• 81% Support Expanding SCHIP, Including Republicans
• SCHIP Specifically Designed For Middle Class
• Some important facts on SCHIP
• Our Sacred Obligation To Protect Our Nation's Young
• SCHIP Support Needed
• The Time Has Come for Bold Change
• Those children are our children because they are his
• Cost of Health Care for Unprotected Children
• One American City Leads the Way
• Everybody In! Nobody Out!
• Dying in America: Lack of Access to Medical Care
• We'll Just Take Your Arm
• Who cares that we could save both money and lives?
• Children, Families and Health Care
• Primary Concerns
• Are You Kidding Me, Mr. President?
• 27% of Americans Have One
• Using My Voice: Speaking for Those That Can't
• Texas Proud!
• Matters of Life and Death, Literally