On the one hand, expansion of health coverage to millions more Americans and preservation of the federal consumer protections for health insurance that customers enacted a decade ago.
On the other, more obstacles to healthcare and continued withdrawal of the federal government from oversight of the healthcare system.
Those are nutshell descriptions of the approach to healthcare reform touted by the Biden and Trump presidential campaigns.
There may be no more important issue for voters to ponder in the election. Healthcare has ranked high among the topics of interest for voters for years.
This year, attention on the issue is heightened by the COVID-19 pandemic, which has sickened more than 8 million Americans and killed about 220,000, cratered the U.S. economy and opened deep rifts in the country's social fabric.
Direct comparison between the Biden and Trump platforms is almost impossible - just as it is impossible to directly juxtapose their economic programs - because Biden has produced detailed proposals bristling with numbers and legislative options, while Trump has offered vague promises devoid of specifics.
But neither has Biden proposed a comprehensive measure on the scale of the "Medicare for all" plan offered by Sens. Bernie Sanders and Elizabeth Warren during their campaigns for the Democratic presidential nomination.
Rather, Biden would build on the Affordable Care Act, enacted in 2010 during the Obama-Biden administration, by expanding its tax subsidies and adding a "public option," which would offer publicly funded coverage to low-income residents of states that haven't expanded Medicaid under the ACA, and to employed persons who can't afford their employer-sponsored coverage.
The most pressing imperative for a Biden administration would be heading off the challenge to the ACA's constitutionality due to be heard by the Supreme Court on Nov. 10, one week after election day.
The case, brought by Texas and several other red states, is based on the premise that when Congress reduced the ACA's individual mandate penalty to zero as part of the GOP tax cut act in 2017, that action rendered the entire law unconstitutional. Most legal experts consider the argument absurd, but they're also amazed that the case has reached the high court.