WASHINGTON – The American health care system is sick, and the 2008 presidential hopefuls are ready to play doctor.

The ailments are clear: the cost of health care and insurance premiums have skyrocketed and the ranks of the uninsured have swelled.

These twin problems have badly frayed the current health care system, in which employers are the leading source for health insurance and the government provides a safety net for the poor and elderly.

Employers are now balking at insurance costs and shifting more of the burden to workers. And lawmakers are facing new demands for health care programs at a time of growing budget deficits.

“Health care has been catapulted to the top of the priority list in terms of domestic issues voters want to hear about,” said Ron Pollack, executive director of Families USA, a consumer health care advocacy group. “In the past, health care has often been viewed as an issue of altruism for somebody else. … This issue has now been transformed into an issue of self-interest.”

It has also already been the subject of one of the hardest-hitting political ads of this campaign season. The ad featured a newspaper clip about Vice President Dick Cheney’s treatment for heart problems with the headline, “If he were anyone else, he’d probably be dead by now.”

The spot, which ran last month in 10 Iowa newspapers, was paid for by a nurses’ group advocating “single-payer” national health care, in which a government agency would collect all health care fees and pay out all costs to doctors, hospitals, and other providers.

Health care is often an emotional issue with many voters. Increasing health care pressures have put some families over the brink, mired in medical debt or forgoing crucial care.

Even among those who can afford insurance, there’s rising discontent over the quality of health care, as many families find themselves paying more money for their coverage (bigger premiums, higher deductibles and co-payments) and getting less (fewer choices, more restricted coverage).

Take Norma Burnett, a 35-year-old Florissant, Mo., resident who had hoped to stay at home with her two young children until they were school age. But after discovering an ulcer and winding up in the hospital last summer, Burnett and her husband, a financial analyst, are facing $3,000 in outstanding medical bills not covered under her husband’s insurance.

The couple realized she would have to restart her career as a social worker early to help the family climb out of debt. “We can’t take this new hit … on one income,” she said. “We keep getting all these unexpected bills.”

Public opinion polls reflect her anxiety. A Gallup poll and a Kaiser Family Foundation survey, taken in October and November respectively, both showed health care was the second-ranking problem cited by respondents, second only to the war in Iraq.

In a recent St. Louis Post-Dispatch poll, 14 percent of respondents said health care was their top concern, coming in third after the economy and the war.

The White House hopefuls seem to have gotten the message.

“We have an approaching perfect storm in health care,” Sen. John McCain, R-Ariz., and a top presidential candidate, wrote last week in a New Hampshire newspaper editorial. “More families are without health insurance as premiums increase … Our safety net programs of Medicare and Medicaid are headed to financial meltdown.”

All the major candidates have sketched out health care proposals. But there is a political gulf between the Democrats and Republicans over the best prescription. And Democrats have emphasized the issue far more than Republicans.

The election results could prove pivotal for direction of the nation’s health care system, since the two parties have such different ideas about how to solve the growing crisis. A Democratic administration would likely build on the employer-based system and take steps toward a greater government role; a Republican administration would pull back from employer-based health insurance to a more individual-focused market-driven system.

Some experts say a nominee of either party is likely to take an incremental approach because the politics of health care in Congress and elsewhere are so treacherous, as Hillary Clinton discovered in 1993 when the health proposal she helped craft collapsed under a barrage of criticism.

Still, whoever wins the White House will have a major opportunity to lead on the issue.

“The health sector accounts for $2 trillion, 16 percent of the economy,” noted Joseph Antos, a health policy analyst at the conservative American Enterprise Institute. “Any little thing that politicians think to do will affect everyone in this country.”

Antos thinks “big reform is not in the cards” no matter who wins the election. “There’s too much at stake. It’s too complicated. And we don’t have a good road map about what we should do to solve the problem.”

But he added that if a new president takes a series of small steps toward health reform, “it might add up to something that’s very significant over time.”