First in a series of Sunday stories of where two presidential candidates stand on issues. This week is health care.

DES MOINES -- Presidential candidates John McCain and Barack Obama have made some big promises on health care throughout their respective campaigns.

Both have vowed to expand health insurance access to millions of uninsured Americans.

They've promised to stem the rising costs of health care and cut prescription drug prices.

But they don't see eye to eye on how it should be accomplished.

On the issue of medical insurance, for instance, Obama wants to establish a nationalized health plan, while McCain's strategy relies on tax credits and market forces.

About 241,000 Iowans don't have health insurance, according to Iowa for Health Care, a health care reform advocacy group.

That puts Iowa in good standing when compared to other states, said Bruce Koeppl, state director for the AARP.

But there's still room for improvement, Koeppl said.

Access to treatment has grown as a concern among rural Iowans, especially on the subject of accessibility to doctors, he said.

"It's different because in Iowa, if you live out in rural Iowa, the number of doctors is shrinking, so accessibility just means you have to travel farther," he said.

He also said medical costs have steadily risen in Iowa for the last few decades, chewing up a greater portion of the average Iowan's income.

An AARP study conducted this summer found that swing voters in Iowa rank health care among their top concerns.

The survey, which targeted voters who said they had either not made up their minds or only leaned slightly toward a candidate, found that 52 percent of those interviewed wanted to hear more from the candidates on their health care plans.

Dr. George Weiner, a professor of internal medicine at the University of Iowa, praised Obama, a Democrat, for his emphasis on insuring all Americans.

Weiner said Obama's plan to guarantee all Americans access to a nationalized plan will keep citizens from falling through the cracks.

Obama would grant subsidies to Americans who couldn't otherwise afford to pay for the national plan, and Weiner said that'll help a significant portion of the estimated 47 million uninsured Americans, some of whom have jobs but still can't afford insurance.

He said Obama's strategy would also grant those uninsured citizens access to preventive care that can save tax dollars in the long run by detecting medical problems early.

"Very often they (uninsured) end up getting care when they desperately need it, but they don't get preventive care early on," he said.

Weiner said Obama's promise to update information technology in the medical realm will streamline health care by improving communication between doctors and patients and preventing doctors from prescribing medications that may not react well with those prescribed by other doctors.

"If we invest upfront by insuring and giving preventive care, that would be a huge advantage," he said.

Dr. Christi Taylor, who practices internal medicine in West Des Moines, said McCain, the Republican nominee, wants to put patients in control of the health care they receive, while Obama's policy gives too much responsibility to the government.

McCain's plan would grant $2,500 tax credits to individuals and $5,000 tax credits to families to purchase private health coverage.

Critics have said that the tax credits won't cover the costs of an insurance plan for many Americans, but Taylor said the plan would likely pay for basic coverage while also keeping health care costs in check by emphasizing competition among private insurance providers.

She said Obama's plan to establish a nationalized health care program would suffer from the inefficiencies of government bureaucracy and remove patients from decisions on which physicians they see and which hospitals treat them.

"I think that we need to provide coverage for people, but we still need to have choice and have doctors and physicians and patients be responsible for their choices, not the government," Taylor said.

She also applauded McCain's support of tort reform to protect physicians from frivolous lawsuits.

She said doctors often order unnecessary tests or studies for patients to protect themselves from lawsuits, but reforming the tort system eliminates the need for such unwarranted tests.

That would save money and lower health care costs for patients, Taylor said.

"Without tort reform we'll never be able to control the costs of medicine, and McCain realizes that's necessary," she said.

Charlie Wishman, an organizer for the Iowa Citizen Action Network, said the current U.S. health care system has reached a point of crisis as costs have risen and more citizens are uninsured.

Wishman said the next president will likely face a polarized and thorny environment on health care reform, and he called for quick and decisive action.

"Whoever does get elected, it is vitally important that they take this up, and they need to take it up in the first hundred days," he said. "It's that much of a crisis. Once you get past that, things get too politically charged. Whoever it is needs to do it, and they need to do it quickly."

Fred Love can be reached at (515) 243-0138 or fred.love@lee.net.