The Numbers May Not Count in Reform Debate : Statistics: Both supporters and foes of the Clinton plan say the figures are on their side. Ultimately, human nature may be the key factor.

The struggle over health care reform is rapidly turning into a battle of dueling computers.

Firing up the government’s mainframes, Administration number crunchers produce statistics supporting their claim that President Clinton’s plan will deliver benefits to every American and control runaway costs, all with only a negligible increase in taxes.

Small-business leaders fire back with printouts supporting their claim that mandating insurance for all workers will end up costing millions of jobs.

And so it goes on almost every element in the President’s complex blueprint for reforming the nation’s health care system. Jockeying for advantage in the coming struggle, partisans on all sides are spewing out studies and statistics--many of them directly contradicting one another.

Who is right? Who can be believed? Where can anxious voters go for “real numbers?”

While particular numbers may be more or less distorted than their rivals, the overarching fact is that “real numbers” do not exist. No one--Democrat or Republican, doctor, lawyer, economist or bureaucrat--can know for sure what Clinton’s or anyone else’s plan will cost, or how they will work out in every detail.

Like other major policy decisions in the past, from the creation of the Social Security system to construction of the interstate highway system, health care reform is a leap into the unknown.

The debate will be loud and fierce in coming months, each side summoning economists and pouring forth statistic-laden studies. But neither the most fervent backers of the Administration nor its most determined opponents can provide anything other than guesstimates.

An enormous chunk of the economy--$800 billion a year, one dollar in every seven--is spent for medical care. Tinker with one segment and you drastically alter everything else. No one can predict for certain either the economic consequences of specific decisions or how millions of individuals will behave in a new system.

What happens, for instance:

* When 37 million people without insurance are given a card guaranteeing immediate access to doctors? Will they, freed from worry, use the system only when needed? Or will they flood into doctors’ offices in search of treatment that they previously did without? The answer will have enormous consequences in terms of cost, but no one can know ahead of time what will happen.

* When 3 million or 4 million small firms that now provide no health insurance must begin paying 80% of the cost of coverage for all their workers? Will such firms find ways to cover the new costs while remaining profitable? Or will they go broke or lay off workers?

* When the new Clinton-designed health alliances trim the fees doctors are permitted to charge? Will doctors cut back affluent lifestyles and maintain present quality standards? Or will they defend the financial bottom line by turning to assembly-line medicine?

“There is a great uncertainty as to who will bear the costs, particularly in a plan as complex as this one,” said William Custer, research director for the Employee Benefits Research Institute. “It redistributes massive amounts of money in the economy.”

The Administration is promising subsidies to poor people, small business and those who take early retirement, all financed without any big tax increases. The only higher taxes would be paid by the tobacco industry and big corporations that choose to stay out of the new regional health alliances.

The President says that under his plan, Americans will enjoy quality care and pay the same or less than they now pay for health insurance. “That can’t be true for everybody--it’s just not believable,” Custer said.

Administration officials, however, defend their figures.

“The numbers are credible and real, and we can defend them,” said Leon E. Panetta, director of the White House Office of Management and Budget. Federal experts “did a line-by-line analysis of each of the policies,” he said.

But the proposal will not work, according to Terry Hill, spokesman for the National Federation of Independent Business, one of the groups leading the fight against the Clinton program. “We expect consumer price hikes, layoffs, wage cuts or freezes,” he said.

For the most part, all sides have used legitimate computer models to generate their numbers.

The computer models are supposed to replicate the real world and the behavior of real people: patients, doctors, workers, managers. If it turns out people don’t behave the way a model predicts, however, the computer printouts are just another pile of waste paper.

Clinton’s plan is based on the belief that managed competition--a new concept never tried on a large scale--will squeeze out billions of dollars in savings.

All Americans would enroll in regional health alliances whose monopoly on purchasing would give them the power to squeeze concessions from doctors and hospitals, according to the Administration.

But no one can say how much waste there is to be wiped out. And it may be impossible to define waste to everyone’s satisfaction.

An insurance company, for example, may have a department of doctors and nurses who provide second opinions on the need for surgery and review the number of tests a doctor orders or the number of days the doctor keeps patients in the hospital.

Is this good administration or dangerous interference in the professional judgments of your doctor or hospital? Will it save money or only add another layer of bureaucracy?

“Winners and losers will depend on individual situations,” Custer said. “People will have to sit down, go over this proposal and decide if they would be better off or worse off. That’s what the debate will be.”

As they go through that process, voters will not be able to rely on the computer gurus of either side.

In the end, they will have to decide whether the overall goal is something they want and whether the general approach of a particular plan seems acceptable.

Then, as at every such juncture when the country has made major policy decisions, it will have to trust largely to the future and to trial-and-error to work out the details and correct the mistakes.