AP WHITE HOUSE CORRESPONDENT

TERENCE HUNT

WASHINGTON (AP)—President Clinton proposed a top-to-bottom makeover of the nation’s health care system Wednesday night, calling upon Congress to enact ambitious reforms that guarantee every American comprehensive medical benefits ‘‘that can never be taken away.’‘

In a speech to a nationally broadcast session of Congress, he said his plan would reform ‘‘the costliest and most wasteful health care system on Earth without any new broad-based taxes.’‘

He sprinkled his 53-minute address with anecdotes of nightmares from the current health system, laying out his rationale for the biggest social initiative since the New Deal. The president said the current system is ‘‘too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed.’‘

Pointing to his own proposal, which would require all employers to provide health insurance to their workers, and pay most of the expense, the president said, ‘‘Let us guarantee every American comprehensive health benefits that can never be taken away.’‘

Clinton spoke to a House chamber packed with lawmakers and dignitaries who interrupted him 32 times with applause.

The dramatic scope of Clinton’s proposal could not be overstated. It would literally touch everyone in the health delivery system and change the way it operates. Patients, nurses, doctors, hospitals, pharmaceutical companies, insurers—all would be affected.

The president signaled a willingness to compromise over the course of what is sure to be many months of debate. ‘‘On this journey, as on all others of consequence, there will be rough stretches in the road and honest disagreements’‘ about how to proceed. ‘‘After all, this is a complicated journey.’‘

Senate GOP leader Bob Dole said Republicans would work with Clinton to fashion a new health care system, but warned of disagreements ahead. ‘‘In the complex debate that will come in the months ahead, let’s keep in mind four key issues: choice, quality, jobs and cost,’‘ Dole said.

To help pay for it, Clinton said he would impose new taxes on tobacco but he dropped the idea of increases for beer, wine or hard liquor. Clinton also said he would seek a ‘‘modest’‘ tax on corporations that opt out of the health alliances and set up their own programs, and seek billions in cuts in Medicare and Medicaid.

He deliberately left vague the financing details, one of the thorniest issues to come. After the speech, a White House official said cigarette taxes would likely increase 75 to 80 cents a pack.

The product of eight months of work, the administration’s plan is based on the premise it can extend health coverage to the 37 million uninsured and at the same time shrink the nation’s $900 billion medical bill.

Health care costs are rising at more than twice the rate of other prices and represent one-seventh of all U.S. spending.

Clinton said that under his plan, some Americans would be asked to pay more but that the vast majority would pay the same or less for health care coverage that would be the same or better than they currently have.

Clinton saluted his wife, Hillary, as ‘‘a talented navigator’‘ for the controversial, complicated plan. From her perch in the gallery, Mrs. Clinton acknowledged a brief standing ovation. Beside her were C. Everett Koop, the former surgeon general who has endorsed the administration’s approach, Surgeon General Joycelyn Elders, known for her liberal views on abortion and birth control, and T. Berry Brazelton, a pediatrician and author of books on child development.

In a direct overture to lawmakers, Clinton said, ‘‘Let us pledge tonight: before this Congress adjourns next year, you will pass and I will sign legislation to guarantee health security to every citizen of this country.’‘

Clinton came equipped with a prototype of the health care card that every American would get under his plan. Emblazoned with the seal of the United States, it resembles a credit card.

‘‘This card will guarantee you a comprehensive package of benefits that can never be taken away,’‘ the president said.

Clinton’s speech set out six principles that he said were essential for any health plan: security, simplicity, quality, affordability, choice, and responsibility.

Mrs. Clinton said later those principles ‘‘are non-negotiable. The details as to how we fulfill each of those principles, we are open to discuss.’‘

Polls show most Americans believe the system needs to be fixed but uncertain about ways to change it. A half-dozen rival plans already have sprung up.

Clinton’s plan for the first time would require all employers to pay 80 percent of the average health premium for their workers. Employees would pay the rest. Small businesses and low-income workers would get subsidies.

Giant insurance-purchasing pools called health alliances would be created in each state to negotiate with doctors, hospitals and insurers. Consumers would buy their coverage through the alliances.

The plan would vastly expand the government’s power to control health costs if competition alone doesn’t work. But critics question whether the controls would squeeze out quality, too.

Growth in the government’s two biggest health programs, Medicare and Medicaid, would be slowed by $238 billion over five years, though many in Congress say it’s politically unrealistic to cut that deeply on care for the elderly and the poor.

There was a torrent of response to Clinton’s speech—much of it praising his goals but questioning his approach.

In the official Republican response, South Carolina Gov. Carroll Campbell questioned how many jobs would be lost if small businesses were required to cover all workers. ‘‘Do you really want the federal government to control your health care?’‘ Campbell asked.

Dr. Lonnie R. Bristow, chair of the 300,000-member American Medical Association’s board of trustees, said ‘‘the means to finance reform are unclear and the timetable too aggressive. … The president may be creating expectations that cannot be met.’‘

A health reform coalition chaired by former Presidents Carter and Ford praised the ‘‘comprehensiveness and strength’‘ of Clinton’s plan and said it was encouraged by bipartisan support for changing the system.

There’s formidable opposition to Clinton’s plan from powerful groups representing small businesses, insurance companies, drug manufacturers, hospitals and doctors—as well as tobacco growers.

Clinton said Congress would be bombarded with advice in the months ahead.

‘‘There will be some who will stoutly disagee with what I have proposed and with all other plans in the Congress for that matter. And some of the arguments will be genuinely sincere and enlightening. Others may simply be scare tactics by those who are motivated by the self interest they have in the waste the system now generates. ..

‘‘I ask you only to think of this when you hear all of these arguments, ask yourself whether the cost of staying on this same course will be greater than the cost of change.

He said members of Congress ‘‘have a special duty to look beyond such arguments.’‘

‘‘Let us write that new chapter in America’s story and guarantee every American comprehensive health benefits that can never be taken away.’‘

Health care reform is issue No. 1 in Clinton’s agenda. More than anything else, it’s the issue by which Clinton’s administration will be judged.

Since 1912 when Theodore Roosevelt called for national health insurance, many attempts have been made to enact universal coverage. All of them failed.

This time, prospects appear better because Clinton is staking his presidency on the issue and taking a high-profile lead.