During the 2000 election, much of the health care debate focused on reducing the skyrocketing costs of prescription drugs. Both then-Gov. George Bush and Vice President Al Gore campaigned on promises to offer seniors more access to cheaper drugs.

To achieve this, President Bush proposed and Congress passed a prescription drug discount card.

"Seniors are going to be able to save between 15 to 30 percent off the retail price of most brand drugs and more for generic drugs," President Bush said in a May 27 speech. "As well, there is going to be a $600 credit for poor seniors. This is the beginning of a reform package that will affect seniors' lives in a very positive way, by making sure our drugs are more affordable."

However, critics have pointed out that Canadian drugs are still cheaper than those purchased using the new Medicare cards. And while the new card law prohibits the government from negotiating prescription drug prices, federal benefit programs for seniors have also been able to make drugs available for cheaper than the new drug cards.

Cardholders are locked into using their cards for one year, while pharmaceutical companies can change the prices within the program at any time. And with more than 70 different cards to choose from in certain parts of the country with varying benefits, getting and using the cards has been called confusing.

"You'd think with all of the money the government is spending on advertising, more people would have the cards," pharmacist Isam Salah told The Detroit News. "But they're not too sure about it yet."

In the late 1800s and early 1900s, as American industries began to develop so too did their employee medical programs. However, despite the efforts of social reformers, it wasn't until after World War II when President Harry Truman proposed a national health program plan that there was a serious attempt on the behalf of government to provide health care to the American public.

Truman's ideas were labeled an attempt to socialize medicine and made little headway in the face of opposition from the American Medical Association. The piecemeal system left in place meant health care options were limited to private insurance for those who could afford it and welfare options for the poor. Then, in 1965 President Lyndon Johnson signed Medicare and Medicaid, the largest government effort ever to guarantee some level of medical care in the United States.

While Medicare and Medicaid provided needed support for the poor and elderly, Americans across the board faced increasing medical costs, driven mainly by the increasing lifespan of Americans and the cost of new medical breakthroughs. In response, President Richard Nixon established federal support for health maintenance organizations (HMOs).

HMOs expanded quickly through the 1980s, making health care more of a corporate endeavor. HMOs have been criticized for being more interested in profit than patient care, but have also made health services available to more Americans by reducing costs. While the American public adjusted to changes brought by wide use of HMOs, those who could not afford coverage -- the poor and the elderly -- still relied on federal government programs such as Medicare and Medicaid.

The 21st century has higher health care costs and a push for the government to do something about them. Companies have had trouble keeping up with increasing premiums it must pay and the number of uninsured has continued to inch higher. Some studies have shown that as much as a third of American families, nearly 82 million people, lack coverage. Six states have already frozen enrollment in Medicaid.

With rising costs, more uninsured, people living longer, and an eventual Medicare budget crisis on the horizon, polls show more and more voters are demanding changes to the health care system. Whether President Bush wins reelection or John Kerry takes control of the White House, health care policies will likely be a major factor in the outcome of the 2004 presidential race and will weigh heavily on the president in the next four years.

-- By Chris Nammour, Online NewsHour