Both the Democrat and Republican presidential candidate fields have narrowed. Soon we will know who will lead their respective parties into the November election. Health care accounts for 18 percent of the U.S. economy.  Where the candidates stand on health care reform is critical, so here is a rundown of their positions.

The two remaining Democratic candidates are Senator Bernie Sanders and Secretary Hillary Clinton. Senator Sanders’ position is straight-forward – he supports expanding Medicare for everyone. He advocates a single-payer, government-controlled plan that separates health insurance from employment.

He estimates his plan would cost $1.4 trillion per year and would be paid for by substantially increasing taxes on employers and families. Under his plan income and estate taxes would be increased, loop-holes would be closed, and dividends and capital gains would be treated as income. He estimates a net savings of $600 billion per year based on simplifying the payment system and a healthier population.

Secretary Clinton, although sympathetic to a single-payer system, says she wants to build on the existing Affordable Care Act (ACA), or Obamacare. She advocates lower premiums and lower out-of-pocket costs in the insurance plans sold in the state and federal exchanges. She favors adding a “public option”, or total government plan, in the exchanges. She wants to expand Medicaid and expand health care in rural areas. Her campaign offers no specific payment plan, but obviously taxes would need to be raised to pay for it.

Both Senator Sanders and Secretary Clinton advocate price controls on pharmaceuticals.

All of the Republican candidates support repealing the Obamacare law.

Businessman Donald Trump says he wants to remove state borders for health insurance purchases and “cover everyone.” He states, “the government is going to pay for it, but we’re going to save so much money on the other side.”

Mr. Trump recently announced a comprehensive reform platform that includes block grants for Medicaid, giving individuals the same tax deductions as employers, increasing the use of health savings accounts (HSA), and encouraging transparency in provider pricing. He also advocates the importation of prescription drugs to hopefully increase competition and lower costs.

Senator Ted Cruz says he wants to decouple health insurance from employment and make it individual and portable. He favors letting people buy health insurance across state lines, expanding the use of HSAs, and gradually increasing the age of eligibility for Medicare.

Senator Marco Rubio has the most robust health care reform platform. He is very clear about replacing the present system with market-driven solutions.

He advocates Medicare and Medicaid reform to make these entitlement programs sustainable for future generations. He wants to use refundable tax credits to help people buy affordable health insurance, protect people with pre-existing conditions, and reform insurance regulations.

Governor John Kasich also wants to use market competition to give people more choices. His plan focuses on the provider side of health care. He favors eliminating fee-for-service billing, keeping people healthy with more primary care, and rewarding healthy outcomes rather than the number of patient seen. As governor, he supported expanding Medicaid in Ohio as allowed under the ACA.

The policy difference between the Democrats and Republicans is very simple, but important. The Democrat candidates want to expand government control over the U.S. health care system. Senator Sanders is an avowed socialist and is unwavering in support of a single-payer, government-run system.

Secretary Clinton is more nuanced, but the end result under her plan would be more government and less patient control of health care in the U.S.

Paying for the Democrat plans would require much higher taxes. Yet health care dollars are limited and demand for care will always be greater than supply. Ultimately, under the two Democrat plans, health care would need to be rationed, which would limit access and quality of care for patients.

The Republican candidates have their differences, but they all support less government micromanaging and more patient control. Their approach of de-coupling health insurance from employment and making it portable, allowing more insurance choices, expanding HSAs, providing consumer price transparency, and adopting sustainable reforms to Medicare and Medicaid would give patients, not  government regulators, the power to access the best health care possible. The Republican presidential candidates would use normal market competition to reduce costs and put patients in charge of their own health care dollars.

Dr. Roger Stark is the Health Care Policy Analyst at Washington Policy Center, an independent, non-profit organization. For additional information, please visit www.washingtonpolicy.org.