When Bush ran for president in 2000, he said that he was entirely against the notion of "nation building". The one place where he has lived up to those promises has been in "nation building" at home.
Bush/Cheney chose foreign affairs as the subject of the first debate in hopes that it would be a knock-out punch, since that's where they felt their campaign was stronger. A lot of attention has been focused there. For one, because what now looks to be about a $215 billion and counting war in Iraq is going to influence a lot of what's possible domestically. For another, a question of national security. And another take is that foreign affairs can be a smokescreen for failed policies at home.
Domestic issues abound, but they are not in as brilliant a focus as a war can give you.
Health care is a frigging mess in this country -- for all the chest-beating people here do about how we have the best care in the world, it's ironic that we're running to Canada for prescription drugs (Bush basically didn't want to create conflict with American pharmas) and we're in a sort of dark ages compared to, say, Europe for what appears on formularies. (As a Type I diabetic, I can't access convenient meds that Europeans have had for years.) Fact is that we're drinking our own Kool Aid if we think our health care system is superior to other nations out there ... it no longer is.
But more important are the economics of health care -- the pay-by-proxy system is falling apart, costs are skyrocketing, the insured are subsidizing the uninsured more and more as they fall off the ranks of the covered, and every labor strike in this country over the past couple of years has almost exclusively dealt with health care costs. Bush talks about OB/GYN's getting massacred by malpractice lawsuits, and in that specific field he's right. But that represents about 1% of health care expenditures. Most of the rising costs can be attributed to an aging population, prescription costs, new mandatory minimums for nurse-patient ratios, and a system that encourages innovations but not efficiencies. About the only candidate I saw that comprehensively "got it" in this area with a health care policy was Howard Dean, but then he was a doctor (and a nut case of sorts, but that's another story). The rest are fumbling around.
As for the Patriot Act, who was going to vote against something with a name like that right after 9/11? There's always an us-versus-them mentality though ... it's easy to sign away rights when you think you can comfortably say you're never subject to those laws. And then your name shows up accidentally on a no-fly list, or your brother wants to marry an Arab-American, etc. There has to be a balance.
As for economics, the budget deficit will do probably what Reagan's did in the 1980s to Bush Sr.: whatever presidential administration inherits it in the future, it will kick them out of office when the economics catch up. My theory is that Bush is probably trying to run up a massive deficit to justify cutting entitlement programs like Social Security and Medicare in the future, but it's politically unpopular to say so. In the meantime, the U.S. dollar is trading at some all-time lows against other currencies because of all the mounting debt.