Clinton Wraps Up California Swing, Again Pledges Health Care Reform : Democrats: He attacks rivals on abortion stand during appeals to two key constituencies: blue-collar suburbanites and Latinos.

Democratic presidential nominee Bill Clinton wrapped up a three-day swing through California Saturday with appearances before two key constituencies. He emphasized health care to blue-collar suburbanites in Contra Costa County and then spoke to an audience with a large Latino contingent in National City, near San Diego.

At the National City rally, Clinton blasted the Republican ticket on the eve of its convention in Houston, portraying President Bush as a do-nothing chief executive interested only in power for its own sake.

“I think the American people are tired of being told why we can’t do something; they need to know how we can do something,” he said.

The choice in November, he added, “will be an election of hope against fear, of new ideas against the same old ways.”

And in sharper terms than previously, Clinton criticized recent comments by Bush and Vice President Dan Quayle on abortion, in which they said they would support a family member who opted to have an abortion. “They’re pro-choice for their families, but they want a constitutional amendment for everyone else to ban abortion--another double standard.”

The two audiences Clinton addressed illustrate the scope of the coalition he must hold together to maintain in November the lead he currently holds in the polls over Bush. And health care is a prime example of the sort of issue the Democrats hope will make that coalition gel.

Northern California’s Contra Costa County is home to the sort of middle-class and working-class white voters who once formed the Democrats’ central constituency but who have abandoned the party’s presidential choices in most elections since 1968. Clinton has tried--with considerable success so far--to appeal to such voters by portraying himself as a new kind of Democrat, one with the interests and values of the middle class in his heart.

But at the same time, no Democrat can win without receiving large majorities from minority groups, among whom doubts have grown about Clinton’s commitment to their interests because of his heavy emphasis on wooing white voters in the nation’s suburbs and small towns.

Clinton strategists hope to blunt those suspicions in part by using prominent black and Latino politicians as surrogates to help promote the Democratic ticket in minority communities. At the San Diego rally, for example, Clinton was introduced by Henry G. Cisneros, the former mayor of San Antonio, Tex. Clinton strategists hope to use Cisneros extensively as a spokesman in several states with large Latino populations.

More crucially, Clinton and his advisers hope issues like health care, education and economic growth can knit together both wings of their putative coalition.

Health care has become a steadily more important issue for Clinton as the campaign has evolved. Early in the year, he said little about the subject, which was a key issue for some of his rivals in the Democratic primaries.

But as Clinton has honed his positions for the general election battle against President Bush, he increasingly has seized on health care as a key issue defining the differences between his political philosophy and that of the Republicans: the question of whether government programs are capable of improving the lives of average Americans.

“Ladies and gentlemen, you must decide in this election whether you have the courage to try new ideas,” Clinton told a crowd of several thousand gathered outside a hospital in Pittsburg, in eastern Contra Costa County, where he received the endorsement of the American Nurses Assn.

Clinton repeated his pledge to send Congress a comprehensive package of health care reform measures within the first 100 days of his Administration if he is elected. And as he often does, he urged Americans to look at examples of other major industrial nations for proof that such an effort can succeed.

Clinton cited Germany, which offers universal health care coverage and has average factory wages substantially above the U.S. norm.

Another reason for Clinton’s heightened emphasis on health care is that the candidate, who prides himself on his mastery of diverse public policy issues, became increasingly concerned about the issue this spring as he studied options for the economic and budget plan he released in June. Since that time, he has talked far more about the impossibility of balancing the federal budget unless the growth in health care costs can be controlled.

“The more I study these budget numbers, and the more I listen to stories” from families who have lost health coverage and business people struggling with health costs, “the more convinced I am that it is one of the central problems of America’s economy,” he said after his Pittsburg speech, when asked about how his views on the issue have evolved.

“Avoiding it for four more years, piddling around with it, putting Band-Aids on it is simply not an option.”

Bush Administration budget analysts, led by Richard G. Darman, director of the Office of Management and Budget, have made similar statements, saying that rising costs for the government’s two huge health insurance programs, Medicare and Medicaid, threaten deficits that would dwarf even the current huge level of federal red ink.

But Bush has shied away from making any specific proposals for handling the health cost crisis, proposing to place a cap on overall federal spending for such programs but not saying what spending he would cut to enforce the cap.

Clinton’s central argument is that the costs of the health care system cannot be controlled without providing universal health coverage. And universal coverage, he argues, can be afforded only if the country eliminates what he describes as hundreds of billions of dollars in health care spending that currently go to waste because of the way the country’s insurance market works.

Many health economists--both liberals and conservatives--agree with that premise, pointing out that America spends far more of its health care dollar on administrative overhead and bureaucracy than most other countries.

But health care experts also say that eliminating the waste is a daunting task, and they differ widely about how best to approach the problem.