On many questions but perhaps on health care more than on others the fundamental difference between John McCain and Barack Obama shone through during their second debate in Nashville Oct. 7.

During the debate which large majorities of viewers polled say Obama won, the candidates were asked by Tom Brokaw, the NBC moderator: “Is health care in America a privilege, a right, or a responsibility?”

“I think it’s a responsibility,” responded McCain who then rambled through a convoluted answer, complaining about how problematic the requirements would be for any universal program to provide health care for all.

Brokaw then turned to Obama.

“I think it should be a right for every American,” Obama declared. “In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills – for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this might be a pre-existing condition and they don’t have to pay for her treatment, there’s something fundamentally wrong about that.”

It was this type of answer that undoubtedly lifted the image of Obama as a candidate in the eyes of millions of viewers Tuesday night. Ordinary citizens understand that access to health care is not just about entering the market place to see what kind of deal you can get on check-ups or doctor visits. Access to health care determines the quality of our lives. Access to health care means the difference between life and death. For most folks it is a moral issue, therefore. John McCain showed he couldn’t relate to this. Barack Obama showed he recognized this fundamental reality.

McCain’s “free market” mentality led him to complain, when he discussed health insurance: “What is at stake here in this health care issue is the fundamental difference between myself and Senator Obama. As you notice, he starts talking about government. He starts saying, government will do this and government will do that, aand then government will, and he’ll impose mandates.” McCain blasted rules that curb the ability of insurance companies to sell policies across state lines.

Obama responded by strongly defending the government regulations on insurance companies. He explained how allowing them to hop from state to state would result in all of them setting up shop in a state like Arizona where there are no requirements that insurance companies pay for cancer screenings and where the definition of “pre-existing condition” is much broader than anywhere else.

“That is a fundamental difference that I have with Sen. McCain,” Obama declared. “He believes in deregulation in every circumstance. That’s what we’ve been through for the last eight years. It hasn’t worked, and we need fundamental change.”

The overwhelming majority of the public polled by NBC and CNN on debate night apparently agree.