ONDONDERRY, N.H. - Jann Campbell has been focused on the Republican debates with a singular zeal, waiting to hear two golden words.
She drove to a town hall meeting during a snowstorm Thursday night just to hear Governor George W. Bush say the phrase: health care. But what she quickly learned, after posing a question to the candidate, is that Bush is focused on many issues, but not on the one that matters the most to her.
''How can they sit there and talk about gays in the military when there's 45 million people without health insurance?'' said Campbell, 45, a registered Independent from Concord who has voted Republican. ''So far, it's like it's not on their radar screen. Particularly Governor Bush. He's the front-runner, and he's the one who should be held responsible for bringing this issue into the debate.''
During six weeks of long debates and a blizzard of political ads, health care is an issue that has curiously stayed off the radar of the GOP candidates, even as they have addressed everything from trade relations with China to the fate of 6-year-old Cuban refugee Elian Gonzalez.
Governor George W. Bush does not mention health care in his stump speech. Gary Bauer does not list it as a topic on his Web site. Senator John S. McCain issued a proposal on it in mid-December, but not a single candidate has focused on it in the televised debates since.
Health care has traditionally been a risky issue for the Republican Party, which is not by nature hospitable to problems whose solutions tend to require costly federal intervention and intrusive regulation. The GOP, as a philosophical rule, has long held that providing for the vast number of uninsured Americans is a problem a federal bureaucracy cannot solve. Debating health care, to Democrats' delight, has often left Republican politicians open to being cast as uncaring. The tendency has been not to raise the topic at all.
But after a year in which the Republican Congress struggled with an array of health care issues, and at a time when both Democratic presidential candidates are making health insurance a centerpiece of their campaigns, the almost universal Republican silence strikes some observers inside the party as odd.
Health care is, after all, ranked by most Americans as one of the two most important issues facing the country, according to consultant Mark Allen. The other issue is education. Yet while several conservative candidates have seized on schooling as a matter of top priority, health care has been almost entirely absent from the debate.
''I think it's a surprise given the amount of weight it's gotten on the Democratic side,'' said Allen, whose firm, Market Strategies, is conducting polling for Bush. ''Health care has always been tilted to the Democrats, so it's not surprising the Democrats have raised the issue first. But this period of quiet on the Republican side can't continue forever.''
Aides to Bush said they are not so much ignoring health care as they are focusing on issues more dear to their conservative primary base, such as tax cuts, improving the military, and reforming education. They point out that, when asked, Bush frequently describes his support for shoring up Medicare. It's just that for now, Bush, like all the GOP candidates, is trying to ''triage the issues in terms of what's important to Republicans,'' according to Patrick Griffin, a Bush media consultant in New Hampshire.
McCain is casting himself as both ready to reform health care and economically conservative. Late last year, he released a health care proposal that featured what he described as ''tailored reforms.'' The highlights of the plan, which would cost $7.6 billion over five years, included giving patients a limited right to sue health maintenance organizations and helping poor senior citizens pay for prescription drugs.
Others, such as publisher Steve Forbes and Utah Senator Orrin G. Hatch, have mentioned health care only fleetingly. Hatch has cited a program to provide health care to uninsured children, an initiative he cosponsored in the Senate.
But overall, said Ron Pollack, executive director of Families USA, a nonprofit health-advocacy organization in Washington, ''it's not something the candidates have brought up themselves.''
In particular, Pollack said, Bush has found himself in a difficult position. When asked about managed care, Bush stands on his record in Texas, where patients are given a limited right to sue their HMOs, can visit an emergency room without prior HMO approval, and where doctors can prescribe drugs outside the HMO formula. But he has come under fire for his initial opposition to those laws when they were introduced in the state Legislature, one possible reason for his reluctance to bring the state's record up now.
''Every indication I've gotten is that Bush does not want to talk about this issue,'' Pollack said.
He was clearly not eager to pursue the topic at the town hall meeting at Londonderry High School on Thursday night. After answering an earlier question about managed care, Bush faced the inquiry by Campbell.
''Will you promise me right here and now that you will put this at the top of your agenda in the speeches and the debates, swear you will put health care right up at the top of your agenda?'' she asked before the crowded room. Campbell explained that the insured were her particular concern.
Bush responded: ''I appreciate that. It's a very important issue.''
He went on to explain that part of the problem is the people who are uninsured by choice, those who might benefit from a tax-free medical savings account to pay for their health coverage themselves.
He said: ''I worry about a debate that says, `Don't worry, we'll let the federal government take care of it.' ... I caution people about demanding and hoping the national government will fix health care ... What I believe in is empowering the consumer.''
Campbell was unimpressed.
After the meeting, she asked, ''What good is a $500 tax cut if you can't afford a family health plan?''
Bush aides are confident that when the issue emerges, as it undoutedly will during a general election fight with either Bradley or Gore, the public will favor his top two health care priorities: saving Medicare and encouraging patients to use tax-free, medical savings accounts.
''It is an important issue,'' said Karen Hughes, Bush's communications director. ''But there's a fundamental difference in philosophy. The Democratic approach is a big-government approach. The Republicans have a private-sector approach.''
