Democratic Hopefuls Stake Out Health Care Positions : Campaign: The issue takes center stage at debate featuring five candidates. The proposals could become factors in a Bush reform plan.

Lambasting the Bush Administration for offering too little too late, five major Democratic presidential candidates vowed Thursday night to enact universal health insurance. But the diverse solutions they offered underscored the uphill struggle any reformer faces in forging a consensus on the increasingly volatile issue.

Nebraska Sen. Bob Kerrey said that, if elected, he would have his package of reforms to Congress within “the first 100 days of my Administration.” He said his “Health USA” plan, unveiled in July, “is national health insurance,” adding that it would impose a total spending limit and would cost families $500 a year less than they currently spend.

His proposal would create an agency financed by state and federal revenues that would pay all the bills and would replace Medicaid and Medicare. Individuals and businesses would not pay insurance premiums; instead, they would fund the program through payroll, excise and income taxes. Private insurance would also be allowed as long as it met federal standards.

Iowa Sen. Tom Harkin said he would ban insurers from excluding people who have pre-existing medical conditions and would provide long-term care while making prevention “the cornerstone” of his plan. “We want national health insurance and we want it now,” he said.

Former Massachusetts Sen. Paul E. Tsongas said universal health coverage “is coming and the Democrats are going to deliver.” Tsongas’ proposal would require all businesses to insure their employees and would contain a safety net for the jobless.

Former California Gov. Edmund G. (Jerry) Brown Jr. said he favors a federally financed system with caps on hospital and physician incomes. His program would end what he called the current “private system of taxation” imposed on consumers by the “medical-industrial complex.”

Virginia Gov. L. Douglas Wilder said he supports reform that “maintains and builds” on the existing system. But he gave no specifics other than saying he would impose a limit on individuals’ out-of-pocket spending. Wilder promised to deliver a detailed proposal in several weeks.

Arkansas Gov. Bill Clinton missed the debate because he had a previous commitment, according to Sen. John D. (Jay) Rockefeller IV (D-W.Va.), who moderated the event. It was sponsored by the New Hampshire National Health Care Policy Forum and the state’s Democratic Party.

Clinton, who previously has expressed support for universal health insurance, is working on a detailed plan, his aides say. In earlier forums, he has called for measures to contain costs and for the next President to “get all the players together, give them 60 days to get a plan and get on with it.”

The nation now spends $671 billion a year on health care, or 12.2% of the gross national product. Nevertheless, 37 million Americans remain uninsured.

Harkin, Tsongas and Kerrey spoke passionately of their own experiences with the health care system.

Harkin noted that he grew up in a poor family with no health insurance. He watched his father suffer from black lung disease, he said, then saw two sisters die from breast cancer because they could not afford regular mammograms that might have saved their lives.

Tsongas, who left the Senate to fight cancer in 1984, spoke gratefully of the treatment he received, including an experimental bone-marrow transplant. His cancer is in remission. “To me, (health care) is not just another issue,” he said.

Kerrey, who lost a leg during combat in Vietnam and won the Medal of Honor for his heroics after he was wounded, gratefully acknowledged the free treatment he received at a veterans hospital. He said under his Administration that this country would have a system of universal health care in which healers would ask not “How are you going to pay for it?” but “Where do you hurt?”

Minnesota’s former Sen. Eugene J. McCarthy also was among six scheduled participants in the forum. He called health care reform “the primary domestic issue in 1992,” and supported universal insurance “almost in the same way that Social Security is run.” But he offered few specifics and repeatedly made irreverent jokes that left some in the audience groaning.

The debate came on the same day that a Bush Administration advisory council recommended spending $6.5 billion to provide school-based health clinics and major medical insurance for children, and to guarantee that all Americans who switch jobs will be able to retain health insurance.

But the group stopped short of proposing ways to provide universal health care. Its proposals could become a key element in a long-awaited Bush Administration reform plan, which the President is expected to unveil in his State of the Union address next month.

Rockefeller, in a dinner session with reporters just before the debate, said he is heartened by the fact that health care reform has taken center stage in the presidential campaign. He urged reporters not to lock candidates in to details because their proposals are still evolving. The important thing, he said, is that all the Democrats have staked out positions far different from President Bush, who so far has called for states to impose limits on medical malpractice litigation and for the medical insurance industry to cut costs by standardizing claim forms.

“The Democrats are for comprehensive reform. . . . The White House is doing absolutely nothing,” said Rockefeller, a leading voice in the Democratic Party for health care reform.

Just as the 90-minute debate was getting under way, two insurgent candidates shouted their way onto the dais.

They were former Irvine Mayor Larry Agran and Lenora B. Fulani, a New York City psychologist representing the New Alliance Party. They also agreed on the need for fundamental reform, but spent much of their allotted time pleading to be included in future debates.