In the opening minutes of the debate, Kerry accused Bush of letting the health care system deteriorate on his watch, asserting that the jump in the number of uninsured and the soaring cost of health coverage showed the system was ''not working for the American family and it's gotten worse under Mr. Bush.''

Bush countered that Kerry's health plan was unrealistic and far too costly. ''A plan is not a litany of complaints, and it's not laying out programs you can't pay for,'' Bush said. ''It's an empty promise. It's called bait and switch.''

But even in a debate intended to be focused on domestic policy, the nation's security still loomed large. Kerry reiterated his charge that Bush had ''regrettably, rushed into war, pushed alliances away,'' and as a result ''we are not as safe as we ought to be.''

Bush countered, ''We can be safe and secure if we stay on the offense against terrorists,'' adding that under his watch, ''freedom is on the march.''

The confrontation Wednesday night in Tempe, Ariz., ushered in the endgame of this long, expensive and remarkably bitter race for the presidency. And it was sharp from the very start, ranging over domestic issues often overshadowed by the war in Iraq, including fiscal responsibility, the growth of the deficit, the fairness of American trade agreements.

Bush accused Kerry of being addicted to tax increases; Kerry noted that the deficit had exploded under Bush. Bush accused Kerry of being a liberal out of the mainstream of American politics; Kerry asserted that Bush had neglected a host of domestic needs.

Bush described the current shortage of the influenza vaccine as the result of contamination at the British manufacturer. ''We took the right action, we didn't allow contaminated medicine into our country,'' he said.

Kerry said the vaccine shortage around the country is symptomatic of the problems facing the health care system. ''This president has turned his back on the wellness of America,'' Kerry said, saying that 5 million people had lost health coverage under the current administration. ''It is falling apart not because of lawsuits,'' he said.

On taxes and spending, Kerry pledged to restore a ''pay as you go'' mentality to Washington.

''I'm going to stand up and fight for the American worker and I'm going to do it in a way that's fiscally sound,'' he said.

Bush said that Kerry's rhetoric did not match his record. He said that Kerry had voted to increase taxes 98 times in his 20 years in Congress, and ''when they tried to reduce taxes, he voted against that 127 times.''

The stakes were immense for this last of three presidential debates. In the view of most analysts, the first two sessions had hurt Bush, who began the autumn with a strong bounce from his convention in New York and a consistent lead in most of the polls. By this week, that lead had vanished.

Kerry and Bush were running dead even in a Washington Post-ABC News poll released Wednesday, which was conducted Sunday through Tuesday.

THE ECONOMY:

* KERRY said he would roll back Bush's tax cuts for Americans who make over $200,000 a year.

* BUSH said most of his tax cuts went to low- and middle-income Americans and put an end to recession.

GAY MARRIAGE:

* BUSH said adults can live the way they want to live, but the institution of marriage shouldn't change.

* KERRY shares Bush's belief on marriage, but would leave the laws to the states.

HEALTH CARE:

* BUSH said tax-sheltered health savings accounts would create competition and drive costs down.

* KERRY said the Bush administration has ''ignored ways to lower costs.''

Utah Quotes:

"I'm leaning toward Bush because I think he has done a good job the last four years despite the negativism. He's better qualified to fight terrorism. He's not to blame for all the economic troubles that started with Clinton and he has the best plan for education."

RICHARD ADAMS, 81

Independent, Provo

---

"Oh, I'll vote for Bush. He's not much of a debater. If I was judging on debate, I guess I would give it to Kerry. But Kerry has too many plans. He has a plan for everything, one that won't cost the taxpayers nothing but will give everyone health care and add military and fix immigration and we'll all be free. I don't buy it."

KEN OYLER, 56

Independent, Riverdale

---

"I just don't feel in my heart I would vote for Kerry . . . Anyone can stand up there and say the things that they are going to do. And, you know, everyone's destined to fail in some respect, but I think John Kerry is trying to blame everything on the president."

THOMAS FRANCIS, 35

Independent, Ogden

---

"Kerry's got a lot of promises and people can see what Bush has done. I think Kerry gives people something to look at what they have. But I'm going to have to do a lot of thinking because I don't know who to vote for."

FARRELL PARKER, 55

Independent, Wellsville

---

''I'm going to vote for Kerry. Right now, I think we're in a rut. We're just not going anywhere but further in debt. Kerry has ideas that make a lot of sense. I think he's won all the debates. I guess I'm ready for a change.''

TERRY LEAVITT, 57

Republican, Roy

---

"My son is back from Iraq and he wanted to take us to dinner, so I missed it. That was more important as far as I was concerned.

I'm leaning toward Bush. Kerry has a plan, but he doesn't have any details. I wish I would have seen tonight's debate. Maybe that would have changed things."

MELVIN VAN WAGONER, 61

Independent, Salt Lake City

---