Controls on Medical Spending Needed, First Lady Says : Health: She also prescribes a need for changes in consumer lifestyles and lower profits for providers.

Campaigning for health care reform, a tough-talking Hillary Rodham Clinton said Thursday that controlling medical spending will be a “necessary first step” toward a revamped system that eventually will cover all Americans.

“We cannot go on the way we have been going,” the First Lady declared.

She suggested that consumers as well as health care providers must brace themselves for sacrifice--with the general public adopting healthier lifestyles, and doctors, hospitals, drug makers and insurers accepting lower profits.

“We have to recognize that there will need to be changes in our health care delivery and financing systems if we are going to control costs,” Mrs. Clinton said.

In a day of public appearances in Pennsylvania, the head of the White House Task Force on National Health Care Reform repeatedly returned to the theme of runaway health care costs, which comprise about 14% of the the nation’s gross domestic product.

“We have to have the courage to talk about that openly,” Mrs. Clinton said. “We can’t go on like this with this cost system.”

While short on specifics, she nevertheless began to sketch the probable outlines of an overhaul agenda that she said “will actually work” and start the nation on “the march toward facing reality.”

Mrs. Clinton also repeated an earlier pledge by President Clinton that the reform plan will be ready to submit to Congress before the end of May, adding that she expects its passage “sometime by the end of this year.”

Named just two weeks ago by her husband to chair the presidential task force, Mrs. Clinton called the current system “a patchwork, broken-down” network, and decried “our failure to face up to this health care crisis.”

Many details of a reform package must be worked out, but based on Mrs. Clinton’s comments at a statewide health reform forum here, that agenda seems likely to include childhood immunizations, simplified and standardized insurance claim forms and ways to encourage people to abandon unhealthy lifestyles. The Clintons have banned smoking in the White House.

Despite little previous experience with health care reform, Mrs. Clinton displayed an easy familiarity with the complexities of the issue, occasionally even lapsing into the arcane jargon used by health policy experts.

When one woman in the audience recounted her family’s inability to buy affordable medical insurance, as a result of various illnesses among family members, Mrs. Clinton seemed angered.

A revamped health care system, the First Lady replied, would tell insurance companies: “No, no. You have to take everybody. And you have to deal with everybody.”

At another point, when a conference participant mentioned the need to encourage people to curb their drinking and smoking, Mrs. Clinton wholeheartedly agreed.

“Personal responsibility and lifestyle decisions and changing behaviors will have to be a part of any national health care reform because we want people to be healthy,” she said.

“And if all we do is change the payment mechanism and the delivery system but don’t change behaviors, we’re not going to have the results that we would hope for.” She did not elaborate, although some task force members are reportedly talking about increasing the so-called sin taxes on liquor and tobacco usage.

Mrs. Clinton also said she is assigning “real emphasis” to the development of a standard insurance claim form that is “understandable to real folks.”

Accompanied by Mary Elizabeth (Tipper) Gore, wife of the vice president, Mrs. Clinton began the day by visiting the St. Agnes Medical Center in Philadelphia, where the women chatted with patients and hospital staff members alike.

Mrs. Clinton said later she agreed with a doctor who likened the health care system to a patient “in intensive care and we’re not seeing the vital signs that would lead us to believe it would recover.”

“If we do not face up to the cost problems that our health care system has inflicted on our institutions, a 108-year-old institution like St. Agnes might not be able to survive,” Mrs. Clinton said after spending about 90 minutes at the hospital.

Mrs. Clinton and Mrs. Gore then flew here on a military plane to join Sen. Harris Wofford (D-Pa.) and Democratic Gov. Robert P. Casey at a statewide health care conference.

Near the end of the day, Mrs. Clinton told the gathering of several hundred people that she has no illusions about how difficult the road toward reform will be. The effort, she said, will be strongly resisted by entrenched interest groups--”no matter how reasonable the kinds of changes that we are all talking about are.”

She cited as an example the government’s inability to broaden its childhood immunization programs--”which on the face of it is probably one of the clearest examples of progress on primary preventive care,” she said.

Saying that the cost of immunizing a child in public clinics has risen from $6.59 in 1981 to $90.43 in 1991, Mrs. Clinton looked around the conference room and added:

“Unless you are willing to take on those who profited from that kind of price increase and are continuing to do so, you cannot provide the kind of universal immunization system that this country needs to have. . . .”