First Lady Pushes Major Health Reforms : Medicine: Her speech to doctors indicates that the White House will only accept a comprehensive plan. She says costs are only part of the problem.

First Lady Hillary Rodham Clinton sent a strong public signal Thursday that the White House will settle for nothing less than comprehensive health care reform--even if most Americans are willing to settle for a quick fix.

“We cannot attack just one part of the problem,” she said in a speech to several hundred physicians at Johns Hopkins University. “What we have to do is look comprehensively at all of the problems . . . that confront us in the health care system today. We are facing a crisis.”

In expressing her frustration--and fear--that the public does not see a need for major health care reform, the First Lady reflected the Administration’s anxiety over the task of selling a massive and costly social program that will change the way most Americans receive and pay for health care.

As elements of the President’s reform agenda have gradually emerged, even his supporters in Congress have expressed concern that it appears so complicated as to defy easy explanation.

If that proves to be so, they fear, the debate will be won by those opposing reform.

The First Lady’s talk also seemed intended to counter a growing perception that the White House is too quick to compromise when faced with strong opposition, whether it is on budget negotiations, presidential appointments or other matters.

Since the President named her to chair the White House Task Force on National Health Care Reform in late January, the First Lady has traveled throughout the country, conducting well-publicized town hall meetings and consulting with experts as well as citizens from all walks of life.

Yet, she lamented Thursday, “one of the sad and perhaps unfair tasks that we confront in the health care reform debate is that most Americans believe there is a very simple answer: ‘Don’t charge as much for what you do.’ That, to them, is the answer.

“All the rest of the issues that we have looked at and worried about in the last five months pale in significance against the overwhelming public perception that the real problem is that doctors charge too much, hospitals charge too much, insurance companies charge too much, everybody charges too much, so we should just cut everybody’s prices and everything will be fine.”

She complimented Johns Hopkins for its pioneering role in medical education and scientific research. And she urged the institution, and others like it, to produce more primary care doctors and fewer specialists.

She said that the White House is studying a variety of programs for repayment or forgiveness of school loans to encourage medical students to become primary care physicians--and then to begin practicing in areas with too few doctors.

The White House task force is preparing its recommendations and options for the President. His aides said they expect him to introduce a health care reform plan in July, although some are privately saying that he may delay it until September--after Congress has passed his budget and returned from summer recess.

Also Thursday, Administration officials said the White House is likely to scale back plans to cover mental health services in a standard package of benefits that will be a part of the reforms.

Rather than open-ended coverage, as initially discussed, the latest range of proposals generally would limit coverage for psychotherapy sessions and hospitalization, sources said.

One leading proposal would limit hospital coverage to 30 days “per episode” while imposing an annual cap of 90 days. In addition, the first 10 or 15 outpatient visits to a therapist would require an out-of-pocket co-payment of 20%, the same proportion as for most physical treatments, going up to 50% for subsequent visits as a way to deter excess use, sources said.

“We’re still in the process of costing this out,” said Dr. Bernard S. Arons, head of the task force’s mental health working group. “There may be disappointment in that we haven’t gone as far as we could,” he said.

Among the disappointed is Tipper Gore, wife of Vice President Al Gore and an ardent champion of mental health coverage. “I know I’m not going to be happy,” she said in an interview. But she added that she is nevertheless “very pleased” and “very excited” at the possibility that mental health services will be covered. That such coverage is even being debated in the same breath as physical illness, she said, is “revolutionary.”