First Lady Defends Health Care for All : Medicine: Hillary Clinton cites added cost of treatment the uninsured get in emergency rooms. She also calls for more general practitioners.

Hillary Rodham Clinton on Thursday defended the President’s plan to provide health coverage for about 40 million Americans who have none, saying there has been a “gross distortion” about just who is uninsured.

Mrs. Clinton, speaking at a women’s health care seminar sponsored by several women’s groups, including the Congressional Caucus for Women’s Issues, said some recent articles had described the uninsured as “healthy 25-year-olds who don’t want insurance . . . self-sufficient people who understand that they can take care of their health needs.”

“It is not only a gross distortion of who the uninsured are, but it totally misunderstands one of the critical reasons we have a health care crisis,” she said.

Mrs. Clinton said the uninsured do get health care but only at the last minute when it is most expensive. The rest of America pays, she said, and that is why people are charged high rates by hospitals for small items.

“So the $50 Tylenol enables the emergency room to keep taking the people who show up, rather than turning them away. Then you and I compensate the hospital for that care,” she said.

Mrs. Clinton also said the nation needs to change its mix of doctors. About 70% are specialists and 30% are general practitioners, she said, but the country needs more general practitioners to help people with preventive care.

Meanwhile, Tipper Gore, a member of President Clinton’s health care task force, told members of a Senate committee on Thursday that mental illness should be treated just like any other disease.

Mrs. Gore said the group wants to end mental health discrimination and do away with a system that costs mental patients more than those with physical ailments. The vice president’s wife was making her first appearance on Capitol Hill as head of the mental health segment of the task force.

For instance, she told the Senate Labor and Human Resources Committee that patients often must pay 50% of the bill for mental health treatment rather than the 20% they are charged for physical ailments. Insurance covers the remainder in each case.

In addition, many policies have lifetime limits of $50,000 for mental health treatment, whereas cancer patients have no such limits, Mrs. Gore said.

“That’s what we’re fighting against,” she said.

In a related development, the Congressional Budget Office issued a report Thursday that said managed competition in health care would probably mean less choice of doctors and fewer medical services for most Americans.

The Clinton Administration is building its health reform proposals around the largely untested concept, combined with spending limits.

The CBO study did not pass judgment on Clinton’s unfinished plan but explored the theory of unleashing market forces to make consumers and providers more cost-conscious.

Most people would be encouraged to sign up with health maintenance organizations, which are paid set rates whether a person stays well or gets sick. If everyone with insurance enrolled in the most efficient health maintenance organizations, the CBO said, “national health expenditures could decline by up to 10%.”