Vice President Gore yesterday promised to guarantee access to health insurance for all children by 2005 as part of a campaign proposal that could extend coverage to as many as one-third of the 43 million Americans who are now uninsured.

In a major speech that laid out his vision of how to shape the nation's health care system, Gore also said that, if elected president, he would help parents and people over the age of 55 obtain coverage for the first time through the country's public insurance programs.

The vice president called for a new system of financial bonuses and penalties to help motivate states do a better job of locating the millions of children who qualify for--but are not enrolled in--Medicaid and the government's relatively new Children's Health Insurance Program. And he proposed a system of 25 percent tax breaks to make insurance more affordable to small businesses and people who need to buy it on their own.

"We must and we can move toward access to affordable, quality health care for every American family," Gore said at Children's Hospital of Los Angeles in the latest in a series of speeches aimed at burnishing a reputation for substantive policy proposals.

While he offered several new ideas, large parts of Gore's plan amount to a continuation of President Clinton's proposals, including initiatives to help disabled people keep their coverage if they return to work and to give tax breaks to Americans for long-term care.

Gore said he favors the administration's proposal to use the expected budget surpluses to keep Medicare from running out of money early in the next century, adding that he opposes the politically unpopular idea of making people wait longer before they can join the nation's health insurance program for the elderly. But, otherwise, he was remarkably silent on the health care issue vexing much of Washington: how to restructure Medicare so that it remains financially solvent well into the future.

In laying out his vision of the future of health care, Gore put the issue of access back on the political front-burner at a time when the ranks of the uninsured have been swelling by about 1 million each year. But he did so in a far more cautious manner than the health-care-for-all pitch that was a key theme of Bill Clinton's 1992 presidential campaign.

Indeed, Gore almost bragged about the limits of his proposal, though officials familiar with the details of the plan predicted that it would provide coverage to perhaps 15 million children and adults currently without health insurance.

"We have all learned that we cannot overhaul the system in one fell swoop," Gore said, borrowing a line used recently by first lady Hillary Rodham Clinton, whose ambitious health reform plan faltered in 1994. "Experience has taught us that there is a way to keep what is right, while fixing what is wrong with American health care."

Generally, liberal and conservative health care advocates reacted favorably to the proposal. "In a period of incrementalism, this is a big deal and very practical," said Ron Pollack, executive director of Families USA, a health care advocacy group.

The ideas he described yesterday put Gore squarely in the middle of the leading presidential contenders. Bill Bradley, the only other Democrat in the race, says he will soon release a bolder and--almost certainly--more expensive plan that will call for universal access to insurance. "Millions of Americans have serious concerns about the availability of health care coverage and the quality of their care," Bradley said. "I'm glad to see that the vice president shares my belief that these concerns should be a top priority."

Texas Gov. George W. Bush and other Republicans have not offered detailed views on health care but in general have opposed the broad expansion of government programs. "The governor doesn't believe a large government solution is the answer to every problem," said spokeswoman Mindy Tucker, adding that Bush wants to increase enrollment by people who are already eligible for government health programs.

In his speech, Gore singled out Texas for its large number of uninsured children, noting that one-quarter of them "are still out in the cold."

In a no-nonsense delivery that rarely deviated from the prepared text scrolling on his TelePrompTer, Gore methodically made his case for "visionary but practical change." The vice president gave no clue as to how much his plan would cost, and aides said simply that all of Gore's campaign promises would be paid for within the context of a balanced budget.

As he has done with issues such as education, Gore is attempting to expand on the health care foundation laid by Clinton without radically departing from it. He reiterated his support for a "patients' bill of rights" that the administration wants Congress to adopt to protect people in managed-care plans.

"I am not satisfied when life-or-death medical decisions are made by HMO bureaucrats at the other end of a telephone line," he said to applause from about 100 hospital officials and union members. "They don't have a license to practice medicine or a right to play God."

The newest ideas in Gore's plan are the constellation of proposals to extend health coverage to more of the nation's uninsured children and parents. He said the government should expand eligibility in the Children's Health Insurance Program by about 1 million youngsters, by raising the eligibility ceiling to about $41,000 a year in income for a family of four. Families with higher incomes would be allowed to buy insurance through the program for about $1,200 a year.

Created under a 1997 budget agreement between Congress and the White House, the $24 billion program was intended to cover about half of the nation's 11 million uninsured children. But according to the most recent count, only 1.3 million are taking part.

Connolly reported from Los Angeles, Goldstein from Washington.

CAPTION: At Children's Hospital of Los Angeles, Vice President Gore presents a proposal for improving U.S. health care.