Harkin, Clinton Focus on Health Care : Democrats: Both candidates call for federal action on what many feel will be a key issue of ’92 presidential campaign.

DES MOINES —  Two Democratic presidential candidates, Iowa Sen. Tom Harkin and Arkansas Gov. Bill Clinton, Saturday called for federal action to deal with the nation’s health care problems.

But Harkin was more specific and Clinton more cautious in describing their own approaches to the issue, which many Democrats believe could be their most potent weapon in their 1992 challenge to President Bush’s reelection.

In a 30-minute talk to a health policy forum here in his home state, Harkin, regarded as the most liberal member of the current field of Democratic candidates, said he would emphasize the need for preventive medicine in establishing a comprehensive national health insurance plan.

“Everyone is running around trying to figure out how to pay the bills” for health care, he complained. “Let’s quit focusing on how we patch and fix and mend and just pay bills and let’s make our guiding principle to prevent illness and disability and keep people healthy in the first place.”

Citing a package of legislation he has introduced in the Senate under the rubric “prevention first,” Harkin contended: “We’re spending over $700 billion a year on health care--and we’re not getting our money’s worth. We don’t need to spend a nickel more. We just have to spend it smarter.”

As examples of preventive care, he mentioned prenatal care, mammograms to detect breast cancer, childhood immunizations and biomedical research.

By contrast, Clinton, a spokesman for the centrist or conservative wing of his party, stressed the complexities of the health care problem in his remarks.

And he made plain that health care would be on his list of priorities if he were to win the White House next year. “I believe that after the next election the President should get all the players together, give them 60 days to get a plan and get on with it.”

But he did not say which plan, of the variety under discussion, he himself would favor. And he said that he did not support any of the various plans offered by other Democrats because he did not regard their cost-control provisions as adequate.

Much of Clinton’s talk here Saturday stressed the economic and political obstacles facing any attempt to create a national health insurance system.

“No country has solved this problem without national action,” he said. “But we live in a time where people have all but given up faith in the government having a positive impact on their lives.”

Clinton said that health care was “more complicated” than any other issue now facing the nation. “If you attack it piece by piece, it springs another leak,” he said, adding that attempts at incremental solutions create new problems.

Clinton did list what he said should be the major objectives of any proposal to reform the nation’s health care system--mainly controlling costs, maintaining quality of care and preserving the patient’s right of choice. And he referred to the Canadian and German health care systems, which some see as models for this country, citing the pros and cons of each.

For his part, Harkin painted the problem in simpler terms. “People are always saying that the Canadian system’s got this problem and the British system’s got that problem,” he said. But he added: “I’ve done a quick check and in no country in the world are there any bills to adopt the American health care system, Now that ought to tell you something.”

Even if Democrats cannot agree among themselves on a solution, their strategists feel that just by debating the issue, they call attention to the fact that President Bush has yet to propose a plan for dealing with the problem.

Sen. John D. (Jay) Rockefeller IV (D-W. Va.), who moderated the discussion attended by health care professionals that was sponsored by the state Democratic Party, said this would be the first in a series of similar forums.