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BRATTLEBORO - President Bush and his Democratic foes, tapping an unresolved national frustration over the state of health care, are readying dramatic proposals to lower the number of uninsured and control exploding costs.

Bush's market-based approach would provide tax credits to individuals and small businesses to help them purchase private-sector plans. Some Democrats are sticking with a single-payer or employer-based plan, which they say are more likely to make sure more Americans get some kind of coverage.

Analysts expect health care, a signature issue of the 1992 presidential race, to reemerge as an issue in the 2004 campaign. Former governor Howard Dean of Vermont, a medical doctor, hopes that health care can do for him what it did for Bill Clinton a decade ago, catapulting a little-known governor to the White House.

So far, Dean is alone among the Democratic presidential candidates in offering a detailed plan for health care, a scheme that builds on a Vermont program called Dr. Dynasaur to provide health care coverage to virtually every child in the state.

''Howard Dean has the potential of putting health care front and center in the national debate the way Ross Perot did for the deficit,'' said Garrison Nelson, a political science professor at the University of Vermont.

But while analysts commend Dean for his approach - a political hybrid of tax credits and expanded Medicaid coverage - they question whether the Dr. Dynasaur plan that has worked for Vermont can be translated into national policy.

The government-funded program covers everything from surgery to braces by building on Medicaid, a program established for the poor, but which Vermont has transformed into one of the most inclusive children's health insurance plans in the country.

Together, employer-based insurance and Vermont Medicaid have cut the rate of uninsured children in Vermont to the lowest of any state. As a result, just 3.7 percent of Vermont children, or 5,000 of them, are uninsured, compared to 5.9 percent in Massachusetts and 11.8 percent nationally, according to 2000 and 2001 US Census data.

But Dr. Dynasaur also underscores the enormous difficulty of making health care universal. While Vermont has come closest for children, it's a tiny rural state with few minorities, and health insurance specialists say that large states such as California and New York have found that African-Americans and Hispanics are the hardest groups to enroll in government insurance programs. The current budget problems of state governments make it unlikely they could afford to expand their Medicaid programs anytime soon.

Even Dean admits that his national plan, which also includes financial help for small businesses and the self-employed to purchase health insurance and for the elderly to buy medications, will be expensive. He estimates that it will cost the federal government $600 billion over 10 years, and he wants to roll back part of President Bush's tax cut for people earning more than $300,000 a year to pay for it, a politically risky proposal.

And Vermont doctors are upset about Dr. Dynasaur's low fees, which pay them far less than private insurance. Dr. Karen Moreau, a local physician, said she lost so much money under the state's Medicaid expansion that she had no choice but to sell her practice to Brattleboro Memorial Hospital across the street.

Still, Dean said, ''we're about as close as you can get to universal insurance in Vermont without some kind of federal action.''

''And that's basically what I want to do for the country,'' he said.

With a crowded Democratic field, Dean's early focus on health care promises to push the issue to the center of the stage. The other candidates have not yet released comprehensive health plans. But many Americans still are unhappy with their health care, with insurance premiums soaring and prescription coverage lacking for most seniors. About 41 million Americans, including 8.5 million children, are uninsured.

Dean's national proposal includes elements of plans presented by liberals, such as Medicaid expansion, and conservatives, who favor tax credits. He wants the federal government to hold out a carrot to states: It would offer to pay prescription drug and hospital costs for older Americans who are enrolled in both the state-federal Medicaid and the solely federal Medicare programs, saving states more than $6 billion a year. States would not be required to participate, but if they want the money, they must certify that every child is covered either through private insurance or through expanded income eligibility for Medicaid.

Drew Altman, president of the Kaiser Family Foundation, said the plan is ''practical rather than ideological,'' because Dean ''wants to stitch together universal coverage by building on the existing system. ''

But others question whether it's practical enough. Even Vermont, which is among six states that have dramatically expanded Medicaid to cover even some middle-class residents, would not qualify immediately for federal money under Dean's plan, because not every child is insured. The most advanced state in the country for insuring children would need to work harder at it.

''It's extremely difficult, if not impossible, to get to 100 percent,'' said Leah Oliver, policy specialist for the National Governors' Association. ''States that have higher ethnic minorities have higher rates of uninsured. There's more poverty and fewer people who have access to employer-sponsored coverage. And our system of health insurance is voluntary. Unlike car insurance, there is no penalty that requires you to sign up.''

Dean's national plan could run into political problems, too. ''It's not politically feasible,'' said Nina Owachenko, a health care specialist with the Heritage Foundation, a conservative think tank. ''Middle-income people are actually reaping the benefits of these tax cuts. Now you're going to increase taxes so they have less money to buy the insurance we want them to keep?''

Families who qualify for Dr. Dynasaur and have access to health insurance at work can choose to enroll just in the Medicaid program. And many, like Sarah Evans's family in Brattleboro, do, because Dr. Dynasaur is far cheaper and the benefits usually are superior. Dr. Dynasaur goes beyond many private managed care plans, fully covering with no copayments dental care, mental health therapy, prescription medications, and vaccinations. The Evanses pay a small monthly premium: $20.

And many doctors believe Dr. Dynasaur has succeeded only because of their good will. All Vermont pediatricians still accept Medicaid patients, according to Vermont Medical Society executive vice president Paul Harrington, but he said he had heard reports that family practitioners are dropping out of the program. Still, he called Dr. Dynasaur an ''unqualified success.''

Moreau and colleague Valerie Rooney treat 1,000 children, 46 percent of whom are on Medicaid. Middle-class families such as the Evanses depend on the program, but also teenage mothers such as Robin Davis-Phillips, 18, who brought her 1-year-old daughter, Destiny, in for an ear infection. She works as a cashier at Fleming Oil Company, which has offered her health insurance. But she says she can't afford the extra cost, because she earns just $14,000 a year. Dr. Dynasaur is entirely free to her.

Even though Rooney and Moreau said they provide the same care to Medicaid and privately insured patients, Evans worries about whether other doctors limit care to Medicaid recipients because of the low fees. Her doctor gave her one ultrasound during her pregnancy, while some friends with private insurance received two or three.

''It's great insurance at covering what we need, but I don't think doctors see it as equal insurance,'' she said.

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