When Republican Senate Leader Bob Dole threatened recently to filibuster any health-reform measure that required employers to contribute to their workers' insurance plans, he got everyone's attention.

Dole finally uttered the words that confirmed the underlying political reality that has dogged the health-care debate all along.If there's a filibuster, it won't matter that a majority of Americans want substantive health-care reform, that President Clinton has staked his presidency on such reform or that a majority in Congress has spent more than a year trying to reach a consensus on serious change in the present system.

All it takes to kill health-care reform is 41 senators willing to block legislative action for whatever reason they choose. A filibuster can be broken only by a vote of 60 senators, or three-fifths of that august body.

Even if the Democrats put up a united front-- which is far from certain-- the bill would die if the Republicans are uniformly unwilling to end a filibuster. The Democrats control the Senate, but they only have 56 votes, plus Vice President Al Gore as potential tie-breaker.

The insidious thing about the modern filibuster is that it has evolved into a sneaky process that kills a measure so quietly voters may never understand what hit them or who's to blame.

Originally, filibusters were monumental events that required all-night talkathons and attracted national publicity. The tactic was used relatively sparingly because public pressure could mount to silence the talkers, who often looked like cranky, selfish obstructionists. The classic test of wills was the Southerners' ultimately futile 83-day filibuster of the 1964 civil rights bill.

But for the past 20 years the filibuster has increasingly become virtualy an everyday occurence. In the past Congressional term, more than twice as many measures were filibustered as were filibustered in the entire 19th century, for a grand total of 35 in two years.

To avoid bringing all legislative business to a halt, the Senate accomodates these filibusters by moving on to other business until enouugh deals can be struck to win 60 botes for cloture or until the bill dies. The public is often not even aware why a particular measure is stymied.

That helps explain why there has been little political opposition to this archaic, anti-democratic practice.

And there has been no partisan motivation to clean up this particular act because both parties have found it useful. Although it currently benefits primarily the Republican minority, Democrats too employed the strategy during the 1980s when they were in the minority.

Many senators secretly like it most of the time, because it gives them more power and leverage individually than they might otherwise have. Former Majority Leader Robert Byrd, the Senate's unofficial historian, defends it as "a necessary evil."

Byrd contends that it protects the minority against the hasty and arbitrary action by the majority. "Delay, deliberation and debate-- though time-consuming-- may avoid mistakes that would be regretted in the long run," he says.

But the list of measures that have been blocked or watered down because of filibusters is now so long that the Senate seems to be barely functioning.

Filibusters have reshaped or killed bills dealing with crime, campaign finance reform, gun control, environmental protection, Head Start, National Service, family medical leave, voting rights, inoculation of children against diseases and dozens of other issues.

If health care is filibustered, public attention may finally be drawn to this tyranny of the minority. The 39 million Americans currently without health coverage are unlikely to view this penchant for foot-dragging tolerantly.