First Lady Issues Warning on Health Care : Policy: Without change, cost increases will plague many Americans, she says. Her speech offers a look ahead at the White House’s campaign for reforms.

Unless the nation adopts sweeping changes in health care, many Americans face potentially ruinous cost increases and local and state governments risk bankruptcy, Hillary Rodham Clinton warned Friday in remarks that preview a major theme of the Administration’s campaign for its health care reform proposals.

“We have to be willing to strip away the years and years of papering over the problems in our health care system,” the First Lady said in a speech at a health care conference here.

“There is a lot that is right about our health care system,” she said, “but it is impossible to ignore the problems any longer.”

Her speech and a brief press conference that followed--one of the few such question-and-answer sessions she has conducted while heading the Administration’s effort to reform health care--offered few new details about White House plans for health care reform.

She did, however, reaffirm that the Administration’s proposals will include changes in both antitrust laws and the procedures that govern medical malpractice suits.

Health care planners and many hospital administrators have argued that antitrust laws, which prohibit competitors from making joint plans and decisions, have perverse effects in the health care field.

Among other things, they have argued, the laws drive up costs by prohibiting hospitals from sharing new technology or agreeing to specialize in certain procedures.

As for malpractice, doctors’ groups have long maintained that high premiums are driving up costs and leading many physicians to quit, particularly in areas such as obstetrics.

However, trial lawyers and some consumer advocates have urged the Administration to make no changes in existing malpractice systems, which until now have been governed almost entirely by the states, not the federal government. The system is needed to compensate individuals for damages done by incompetent doctors, according to its supporters.

Hillary Clinton offered no specifics on what malpractice changes the Administration may recommend but indicated that the White House probably would reject calls to leave the system as it is.

“There need to be changes” to reduce the “chilling effect” that malpractice has on the medical system, she said.

Most of the First Lady’s remarks were devoted to the effort to sell the reform program and, as the tone of the speech made clear, a central element will be reminding Americans of their worries.

Administration strategists concede that they face a fundamental problem: Although many Americans worry about rising health care costs, most still have insurance that provides relatively secure coverage.

As a result, polls indicate that many Americans worry simultaneously about the flaws in the current system and the potential risks of dramatic change.

Given that most Americans have insurance, Administration officials say, they cannot prevail if middle-class voters come to see health care reform as primarily directed at those who lack coverage, many of whom are poor.

To address that concern, White House officials and their allies in the health care debate have been emphasizing the flaws in the current system, reminding Americans of what it is that they do not like and what it is that they fear.

“It’s like in a political campaign. You have to remind people about what they don’t like about the other guy,” one senior strategist said in a recent interview.

Hillary Clinton, in her speech, did her best to remind Americans about those worries, citing statistics and anecdotes that Americans are likely to hear over and over in the months to come.

“If we do nothing,” she warned, health care costs will more than double in the next few years, and the average family will be paying some $14,000 per year in taxes, insurance premiums and out-of-pocket costs for health care.

The problem “is not only skyrocketing costs,” she said, noting that a growing number of employers have stopped providing insurance to workers. Each month, she said, about 100,000 Americans join the growing rolls of people who lack insurance.

“The security that many of us have come to take for granted,” she said, “can no longer be taken for granted.”

And even those who have insurance often find that they lack adequate coverage or can obtain coverage only at exorbitant costs. More and more Americans, she said, fall into the “there-but-for-the-grace-of-God-go-I group.”

After speaking here, the First Lady was to fly to Montana for a meeting with tribal leaders about American Indian health care issues. She is scheduled to attend a forum on rural health care issues in Montana today.