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SHOE'S ON THE OTHER FOOT AS GOP TACKLES HEALTH CARE

It is Alice-through-the-looking-glass time on Capitol Hill. The Republicans - yes, the Republicans - are desperately trying to convince the public that there is a crisis looming in the nation's health-care system.

"It's a huge thing," complains Haley Barbour, chairman of the Republican National Committee. "It's amazing to me that people think this isn't news."Arguing that the status quo is simply too expensive to sustain, congressional Republicans are considering proposals that could substantially alter the way millions of Americans - specifically, the 37 million older Americans covered by the Medicare program - get their medical care.

The debate is oddly familiar to anyone who lived through the Great Health Care War of 1993-94, but it is also oddly scrambled. Then it was the Democrats making the case that a crisis was at hand because of the rising cost of health care, while conservative Republicans extolled the virtues of the status quo - traditional, fee-for-service medicine.

Moreover, in the last health war, it was the Democrats who were accused of trying to put Americans on a forced march into health maintenance organizations and other forms of managed care. Today, that charge is increasingly lodged against Republicans.

Republicans hate these comparisons, particularly the suggestion that they are about to embark on a massive exercise in social engineering by trying to bring millions of elderly people - with longstanding attachments, habits and patterns in the way they get their health care - into the HMO era.

Republicans say they are simply trying to do the right thing and insure the long-term solvency of a troubled program, while giving Medicare's beneficiaries access to the same cost-efficient managed care available to everyone else. In contrast, they say, the Democrats last year were trying to re-con-figure the entire private health-care marketplace.

But some Republican strategists acknowledge that there are some echoes from past debate. Bill Kristol, the conservative strategist who led the argument that there was no health-care crisis last year, said: "There is a risk, obviously. I'm sure the Democrats are sitting back, thinking, `We can do to them on Medicare and Medicaid what they did to us on the Clinton health-care proposal.' "

Indeed, health policy analysts say they worry that the very real problems in health care will again get subsumed into a bitterly partisan struggle. Looking ahead to the debate over Medicare, Uwe Reinhardt, a health policy expert at Princeton University, said:

"I'm sure the Democrats will demagogue it, and in a way you can't blame them. They were demagogued for two years. Let's face it - the Republicans left a certain legacy, and now they'll get demagogued back."

"But in a way, it's a shame," Reinhardt added. "Something has to be done. The fact of the matter is, the trust fund is going broke."

Reinhardt was referring to the Medicare trust fund that covers beneficiaries' hospital costs. It is financed by payroll taxes, and its trustees recently reported that given current revenue and rate of expenditures, it will run out of money in the year 2002.

The Clinton administration's position is that Medicare's problems ought to be dealt with as part of a broader health-care overhaul, like the one the administration pro-posed.

Administration officials maintain that the Medicare program is simply too big, too complicated and too interconnected with crucial parts of the health-care system, like medical education and rural health delivery systems, to be revamped in isolation.

The debate is expected to escalate in the coming weeks as the Republican leadership in Congress begins to produce a budget. And as Republicans try to redeem their promises of massive tax cuts and a balanced budget by the year 2002, the Medicare program is an inevitable target for savings.