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Health care America's health care system is unsustainable. It's not one problem, but three: cost, quality and coverage. The U.S. has world-class hospitals and doctors. But it spends far more than other advanced countries and people aren't much healthier. And in an aging society, there's no reliable system for long-term care. Obama's expansion of coverage for the uninsured hits high gear in 2014. Obama keeps today's Medicare while trying to slow costs. He also extends Medicaid. Romney would repeal Obama's health care law but hasn't spelled out what he'd do instead. On Medicare, he favors the option of a government payment to help future retirees get private coverage. The risk of expanding coverage: Health costs consume a growing share of the stressed economy. The risk of not: Millions continue uninsured or saddled with heavy coverage costs as the population grows older. Immigration An estimated 11.5 million illegal immigrants are living and often working in the United States. Figuring out what to do with them has confounded Washington for years. Lax enforcement could mean more illegal immigrants competing with citizens for jobs and some social services, without necessarily paying income taxes. A too-tight policy could mean farmers and others in industries that rely on the cheaper labor of illegal immigrants are left begging for workers, passing higher costs on to everyone else or going out of business. Obama backed the DREAM Act, a failed bill that would have provided a path to legal status for many young illegal immigrants. In June, Obama decided to allow as many as 1.7 million of them to stay for up to two years. Romney supports completing a fence at the Mexican border and other tough security measures while pledging to veto the DREAM Act. Income inequality The income gap between the rich and everyone else is getting larger, while middle incomes stagnate. That's raised concerns that the middle class isn't sharing in economic growth as it used to. Obama would raise taxes on households earning more than $250,000 a year, plus set a minimum tax rate of 30 percent for those earning $1 million or more. He also wants to spend more on education, "a gateway to the middle class." Romney would cut taxes more broadly and says that will generate enough growth to raise all incomes. Income inequality has risen for three decades and worsened since the recession ended. The Census Bureau found the highest-earning 20 percent earned 51.1 percent of all income last year. That was the biggest share on records dating to 1967. The share earned by households in the middle 20 percent fell to 14.3 percent, a record low. Iran With the Iraq war over and Afghanistan winding down, Iran is the most likely place for a new U.S. military conflict. Obama says he'll prevent Iran from acquiring nuclear weapons. He hopes sanctions alongside negotiations can get Iran to halt uranium enrichment. But the strategy hasn't worked yet. Obama holds out the threat of military action as a last resort. Romney accuses Obama of being weak on Iran. He says the U.S. needs to present a greater military threat. Attacking Iran is no light matter, however. That is why neither candidate clearly calls for military action. Tehran can disrupt global fuel supplies, hit U.S. allies in the Gulf or support proxies such as Hezbollah in acts of terrorism. It could also draw the U.S. into an unwanted new war in the Muslim world. Supreme Court appointments With four justices in their 70s, odds are good that whoever wins in November will fill at least one Supreme Court seat. The next justice could dramatically alter the direction of a court split between conservatives and liberals. One new face could mean a sea change in how millions get health care, shape gay rights and much more. Obama already has put his stamp on the court by selecting liberal-leaning Justices Elena Kagan and Sonia Sotomayor, 50-somethings who could serve a quarter-century or more. Romney has promised to name justices in the mold of the court's conservatives. Since the New Deal, Supreme Court decisions have made huge differences in American lives, from rulings to uphold Social Security, minimum wage laws and other Depression-era reforms to ringing endorsements of equal rights. Big decisions on health care, gun rights and abortion have turned on 5-4 votes. Social Security Unless Congress acts, the trust funds that support Social Security are on pace to run out of money in 2033, triggering an automatic 25 percent cut in benefits that millions of older Americans rely on for most of their income. That may seem far off. But the sooner Congress acts, the more time to phase in changes slowly. Social Security could be preserved for generations with modest but politically difficult changes to benefits or taxes, or some of both. Obama hasn't laid out a detailed plan for addressing Social Security. Romney proposes a gradual increase in the retirement age and, for future beneficiaries, slower growth in benefits for the wealthy. But nothing will happen without White House leadership. For millions of retired and disabled workers, Social Security is almost all they have to live on. Monthly retirement benefits are $1,237; average disability benefits, $1,111. Syria Syria's conflict is the most violent to emerge from last year's Arab Spring. Activists say at least 23,000 people have died over the last 18 months. Obama wants Syrian President Bashar Assad to leave power. But he won't use U.S. military force to make that happen. Romney says "more assertive" U.S. tactics are needed, without fully spelling them out. The future of Arab democracy could hinge on the crisis. After dictatorships fell in Tunisia, Egypt, Libya and Yemen, critics say Assad's government has resorted to torture and mass killings to stay in power. Its success would deny the U.S. a major strategic victory. Assad long has helped Iran aid Hamas and Hezbollah, destabilizing Lebanon while threatening Israel's security and U.S. interests in the Middle East. But extremists among the opposition, Assad's weapons of mass destruction and worries about Israel's border security have policymakers wary about deeper involvement. Taxes Almost every U.S. taxpayer faces a significant tax increase next year, unless Congress and the White House agree on a plan to extend a huge collection of tax cuts expiring at the end of the year. And there's a huge debate over how to overhaul the tax code to make it simpler, with lower rates balanced by fewer deductions. Obama wants to extend Bush-era tax cuts again, but only for individuals making less than $200,000 and married couples making less than $250,000. Romney wants to extend all those tax cuts and enact new ones, dropping all income tax rates by 20 percent. Romney says he would pay for that by eliminating or reducing tax credits, deductions and exemptions. But he won't say which ones would go. Most lawmakers want a simpler tax code, but millions count on the mortgage interest deduction, child tax credit and more, making progress all but impossible. Wall Street regulation The debate over banking rules is, at its core, a dispute about how to prevent another economic cataclysm. The financial crisis that peaked in 2008 touched off a global economic slowdown. Four years later, the recovery remains painfully slow. After the crisis, Congress passed a sprawling overhaul of banking rules and oversight. The law gives regulators new tools to shutter banks without resorting to emergency bailouts. It restricts risky lending and establishes a new agency to protect consumers from misleading marketing and other traps. The new rules also boost companies' costs, according to Romney and many in the business community. Romney believes the law is prolonging the nation's economic agony by making it harder for companies to invest and grow. He has pledged to repeal it. Obama fought for and supports the law.
Associated Press writers Nancy Benac, David Crary, Tom Raum, Seth Borenstein, Robert Burns, Jack Gillum, Paul Wiseman, Carole Feldman, Mark Sherman, Matthew Pennington, Bradley Klapper, Ricardo Alonso-Zaldivar, Daniel Wagner, Stephen Ohlemacher, Alicia A. Caldwell and Christopher S. Rugaber contributed to this report.
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