March 22 (Bloomberg) -- John Edwards was the first presidential candidate to get one. Mitt Romney signed a Massachusetts law creating one that he now distances himself from. Barack Obama promises one. Hillary Clinton had one in 1993 and won't talk about it now.

``It'' is a plan to revamp U.S. health care, the world's most expensive system and, compared with those of other industrialized countries, not necessarily the best. While candidates for president are reluctant to take on a $2.1 trillion industry that makes up 16 percent of the U.S. economy, surveys show that a majority of Americans want the government to overhaul the system.

The political environment may be right for the first time since former President Bill Clinton took on health care 14 years ago. The puzzle of how to hold down costs while providing health care to 47 million Americans who don't have it has only grown more intractable. The leading Democratic candidates will discuss solutions at a forum this weekend in Las Vegas.

``The system isn't working well for employers who are paying more for insurance, for workers who are paying more, and certainly not for the uninsured,'' said Karen Davenport, director of health policy at the Center for American Progress in Washington. ``It takes leadership to make change happen.''

Health-care costs outstrip even what America spends on food, according to a January study by McKinsey & Co., the New York consulting firm. Infant mortality, at 7 deaths for each 1,000 live births, is the highest among 23 developed countries studied by the Commonwealth Fund, a New York-based health-policy center.

Seizing Initiative

Democrats see health care as an opportunity to seize the initiative on an issue where Republicans have little momentum. Romney and other Republican candidates declined invitations to speak at the health-care forum, at 9:15 a.m. local time March 24 in Las Vegas.

President George W. Bush's four-year-old push to shift more of health costs to individuals and away from employers hasn't gained traction. He proposed this year to tax employer-provided health benefits and give everyone a medical insurance deduction to help provide coverage for more of those who don't have it.

``Polls show that health care is a less significant issue for Republicans compared with Democrats,'' said Robert Blendon, professor of health policy and political analysis at Harvard University's Kennedy School of Government in Cambridge, Massachusetts. Republican candidates may decide they can wait until after the primaries to tackle the subject, he said.

Deadline for Positions

The forum in Las Vegas is serving as a deadline for the leading Democrats to stake out positions. In addition to Senators Clinton and Obama and former Senator Edwards, four other candidates agreed to appear at the event, sponsored by the 1.8 million-member Service Employees International Union labor organization and the Washington-based Center for American Progress.

``Candidates know they have to engage on this issue, and they will,'' said Chris Jennings, a former senior health-care counsel to President Clinton who is working informally with Senator Clinton of New York.

The candidates must find ways to provide more coverage without making people afraid that they will lose the benefits they already have, he and other advisers say. Another issue is whether to focus on America's uninsured or take on the entire health-care system, from rising costs to the role of insurance companies.

``The public is good at what it is against, but if you ask them what they are for, they usually are unclear,'' said Robert Moffit, director of the Heritage Foundation's health policy center in Washington. ``They want high-quality health care, access to the best drugs, the most medical technology, and they don't want to pay for it.''

The Edwards Plan

Edwards, the 53-year-old former North Carolina senator and his party's 2004 vice presidential candidate, has come the closest of the three leading Democrats to explaining what he would do on health care. He said today that he will continue his campaign after his wife, Elizabeth, was diagnosed with a recurrence of cancer. She had breast cancer three years ago.

Edwards has proposed providing insurance for everyone in America within four years by expanding federal programs like Medicaid, the insurance system for the poor; giving tax credits to make insurance premiums more affordable; and creating what he calls health markets to offer insurance plans, according to the candidate's campaign Web site.

Health markets would be state or multistate insurance pools offering a choice of plans, including government-run insurance based on Medicare, the federal health program for the elderly and disabled. Multistate pools generally aren't allowed now.

Repealing Tax Cuts

To help pay for this, Edwards would repeal Bush's tax cuts for people earning more than $200,000, he said in February on NBC's ``Meet the Press.'' Businesses that didn't provide health insurance for employees would be taxed to help cover the cost of enrolling people in other plans.

``Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the plan,'' Edwards said on his Web site.

Americans generally don't like the idea of a single national insurance program, surveys show. They are suspicious of big government, afraid of medical rationing and worry they won't be able to pick their own doctors. The Edwards plan would leave the choice to individuals.

``It's an interesting compromise between those who want Medicare-for-all and private plans,'' said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who has given informal advice to Edwards on health care.

`Hillary Care'

Clinton, 59, knows first-hand the difficulties of changing America's health-care system.

In 1993, her husband named her to lead a task force on providing medical coverage for everyone. The effort crashed a year later amid accusations that ``Hillary Care'' would create a new government bureaucracy and decimate middle-class health care.

Campaigning for president, she says she won't lay out a plan until she hears what people want.

``This time, we're going to build a consensus first,'' she said at a campaign stop on Jan. 28 in Davenport, Iowa.

Clinton wants to make sure everyone in America has affordable coverage, she said. She co-sponsored a proposal this month to expand a federally funded program for poor children to cover every uninsured child. About 6 million kids are now enrolled in the $5 billion-a-year program, and she wants to more than double the total to 15 million.

``I think the emphasis on children is a reasonable and sensitive one,'' said Paul Starr, a Princeton University professor who worked on the 1993 Clinton health plan. ``You can move more quickly on something that is smaller. The difficulty with comprehensive proposals is that they affect so many different interests that it's difficult to move quickly.''

Obama's Promise

Obama, 45, the first-term Illinois Senator, has promised to get everyone insured by the end of his first term as president. He hasn't said much else.

Avoiding specifics is a smart move, said Stuart Butler, a senior policy analyst at the Heritage Foundation.

``Politics is littered with people who have come up with great health plans,'' Butler said. ``They sound great in eight- second sound bites, and then people ask how it will affect them. Once you talk about specifics and big change, people get cold feet.''

The place to look for new ideas is at the state level, Butler said.

Romney's Reluctance

As governor of Massachusetts, Republican presidential candidate Romney, 60, championed and signed a law mandating that everyone have health insurance by July 2007.

Some of the Massachusetts funding will come from a $295-a- worker assessment on businesses that don't provide health benefits and have more than 10 workers. Now Romney is distancing himself from the plan, the Boston Globe reported last month. This reflects a reluctance among Republicans to make health insurance mandatory and tax businesses to pay for it, the newspaper said.

Vermont, Illinois and California also are aggressively pursuing their solutions and, in the process, advancing the debate on universal health care.

Whatever their concerns, Americans don't want to risk losing their insurance coverage, said Gruber, the MIT economist.

``You've got a situation where you're on a ship and a bunch of people are sitting on their comfy deck chairs and a bunch of people are walking around without deck chairs, and you want to do something without making a lot of people stand up,'' Gruber said.

(To see the Web cast of the Las Vegas forum at 9:15 a.m. Pacific time March 24, go to http://www.seiu.org/ or http://www.walkadayinmyshoes2008.com/.)

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net.

Last Updated: March 22, 2007 12:38 EDT