... President Bush proposed capping the tax break at $15,000 for families and using the savings to provide a tax deduction to help the uninsured afford coverage. Republican presidential contenders Rudy Giuliani and Mitt Romney have offered similar ideas.

Sen. Ron Wyden, D-Ore., has proposed financing universal coverage by ending the tax break on employer-provided coverage. He would redirect those savings to help people with incomes of less than 400% of the poverty level pay insurance premiums.

The Wyden plan, which has a handful of GOP sponsors, "allows you to cover every single American without repealing the Bush tax cuts," said Len Nichols, director of health policy at the New America Foundation.

In contrast, the top Democratic contenders would repeal the Bush tax cuts for higher earners. Clinton's plan would raise $52 billion a year by reversing the income-tax cuts for households making more than $250,000.

Clinton, alone among the Democrats, also would cap the exclusion on employer-provided care -- but only for those making more than $250,000. This would save an estimated $2 billion a year.

While noting the savings from tax reform in Clinton's plan are "tiny," Nichols suggests the senator is signaling a willingness to consider more substantive reform.

But Clinton's rhetoric suggests she might not go very far. Her plan overview "rejects calls to limit the tax exclusion for middle-class Americans who have negotiated generous coverage."

The alternatives to restraining costs through tax reforms are mostly "draconian" ideas such as capping payments to doctors and hospitals, he said.

The candidates are in no mood to talk of draconian measures. Clinton has even talked about closing the gap in Medicare drug coverage, which the Congressional Budget Office has said would cost $39 billion a year by 2010.

Nichols said it is not surprising the candidates don't want to talk about performing the equivalent of "root canal" in the middle of a campaign.

But in the process of trying to push a universal coverage bill in 2009, they'll have no choice but to get serious about cost containment.

"That's when we want the adult conversation to happen," Nichols said.

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