The United States is one of the most prosperous nations in the world, but every year 45 million of its people and 11 million of its children are left uninsured for basic medical needs. Money earmarked by Congress for state allocation to children's insurance is left untouched. HMOs cut costs by denying clients potentially life-saving tests and treatment. Home to the world's most cutting-edge advances in medical research, the vast majority in our country will never access such advanced biomedical technology.

Clearly, the state of American health care is in crisis. Yet the problems of our health care system are not beyond correction. The upcoming presidential election offers Americans a rare chance to reflect and compare plans of action. Both major presidential candidates, Vice President Al Gore '69 and Texas Gov. George W. Bush, with the help of their spin doctors, claim to offer cure-alls for the gamut of our health care woes. But it is up to voters to judge whether these proposals might succeed as long-term treatments to the system's ills.

In terms of health care choice, Bush has turned to tax exemptions. He has proposed to channel $60 billion into Medicare over 10 years, which will primarily go towards tax credits of up to $2,000 for the uninsured. Under Bush's plan, people would be encouraged to use their tax credits to shop between managed care providers, usually multi-state HMOs, increasing competition and consumer choice.

Gore is not as vocal as Bush about the importance of choice in the health care system. Instead, his preoccupation is with the solvency of Medicare. He recently criticized 1997 cutbacks to Medicare and indicated his support for elevating Medicare funding to $339 billion. Yet Bush's and Gore's proposals are not as different as they first appear. Both are advocating centralized health care providers; Bush in the private sphere with multi-state HMOs, Gore in the public, with state-backed Medicare. Properly administered, centralized health care offers many advantages, most important of which is the ease in which standards can be enforced.

Yet the centralized system also poses several real dangers. Attention to community-based health needs is often sacrificed along with the diversity of health care options available. In this area, Gore is clearly the more concerned with protecting Americans' right to choose. Gore eschews the restrictive lists of preferred or selected providers, typical of most managed care plans. He promises that patients, not companies, will decide which doctors they see and when. Bush, on the other hand, has rallied behind America's smaller communities, in support of 1,200 new community health centers.

On quality control, Bush and Gore see eye-to-eye. Both support increased funding for research institutions, such as the National Institute of Health, and greater regulation of managed care providers. And both have comparable proposals on health care security, proposing prescription drug plans that differ slightly in federal spending caps.

The big difference, however, comes when in considering the health care needs of a vulnerable, albeit non-voting, population: our nation's children. When it comes to safeguarding children's health, Gore appears to be the more secure choice. He has professed it a personal goal that all American children be insured by the end of his first term in office.

Unlike Gore, Bush has no proposals that specifically target uninsured children, preferring to classify them instead under the general bracket of the uninsured. This is particularly troubling, given recent news that states neglected to spend nearly half of the 4.2 billion dollars given to them by Congress in 1997 as part of the Children's Health Insurance Program. Texas and California were responsible for half of that unspent money. Bush's state--which is home to the second highest percentage of uninsured children--reported this year that it could not spend $445 million of its allocated money, largely due to delays in enrolling its eligible children into the program. Given that states have proven themselves ineffective in allocated health care funds, Bush's proposal to dispense Medicare funds through state authorities seems problematic.