Modest health-care reforms would be like "putting lipstick on a pig," but it's doubtful Congress will have the appetite for sweeping changes in 1995 after the collapse of this year's effort, says the head of the Congressional Budget Office.

Looking back on a turbulent year, Robert D. Reischauer said that if Americans really want to expand coverage or slow medical inflation, "we're going to have to give something up. There's no free lunch here."President Clinton and Senate Minority Leader Bob Dole both have said health-care reform will be at the top of their agendas when Congress returns early next year.

But Reischauer said last week, "I would doubt if there's going to be substantial movement on health-care reform.

"We never got to some of the tough issues," said the 53-year-old economist, who has led Congress' in-house shop of budget experts since 1989.

"The political environment will probably be less conducive to health-care reform next year," he said.