(MONEY Magazine) – Only all-out war could reshape Americans' lives more profoundly than the events that will begin to unfold in Washington, D.C. this month, when the Clinton Administration presents its health-reform plan to Congress. Sen. John D. Rockefeller IV (D-W.Va.) calls the coming health-care revolution ''the largest undertaking in our social history.'' If anything, that's an understatement. The Administration will attempt to: 1) harness runaway U.S. health-care spending, an estimated $940 billion this year; 2) guarantee full health care to everyone, thereby adding as much as $90 billion a year to Americans' tax bills; 3) revolutionize the practice and delivery of medical care; and 4) find common ground among the 400 different health-care interest groups, from doctors, drugmakers and hospitals to insurers, businesspeople and unions. The three months of public debate orchestrated by the President's wife, Hillary Rodham Clinton, which has already produced 60,000 documents, was merely an overture to the opera. In the coming months, a contentious cast of congressional staffers, lobbyists and witnesses will war over hundreds of the details, from what kind of coverage to include to how to pay for it all. When might the monumental struggle end? The answer: While changes in some unfair insurance practices may be enacted this year, a comprehensive reform law isn't likely until mid-1994. Even then, don't expect its provisions to be fully phased in for perhaps three to five years. This article will enable you to help yourself -- starting now -- before the possibly painful reality of reform is thrust upon you. Based on extensive MONEY reporting that included interviews with 50 health-care and public policy experts inside and outside the government, here in broad strokes is the plan that is most likely to emerge from Congress in stages, beginning this year: Every American will be covered by a package of basic benefits, which will likely include full physician and hospital care, hospice services for the dying and some assistance with prescription drug costs. Virtually all services will be delivered through some variant of the managed-competition system that the First Lady's 500-member task force will champion. Giant regional health insurance purchasing cooperatives (HIPCs, pronounced hip-picks) will be established by each state and will buy the services of doctors, hospitals and other health-care providers. Each HIPC will generally have 1 million or more members, mostly people who are self-employed or who work for small businesses. Corporations with more than 1,000 or so employees will likely act as their own HIPCs, buying coverage for their employees. Everyone will carry a health card guaranteeing them benefits no matter who or where they are. There will be little room in this new world for today's dominant health-care provider, the independent, fee-for-service, fatherly Dr. Welby. Instead, physicians will band together in health maintenance organizations (HMOs) or preferred provider organizations (PPOs) and sell their services at a discount to HIPCs. Ultimately, your choice about who cares for you will boil down to this: Either you'll accept the discounts available from HMOs or PPOs, where you'll have little say about who treats you, or you'll have to pay more for a doctor of your own choosing. This sea change will primarily affect middle- and upper-middle-income workers -- those neither rich enough to afford independent specialists nor old enough to qualify for Medicare nor poor enough for Medicaid. The 15 profiles of people like you on the following pages explain who figures to win under reform, who will lose and who will fall somewhere in between. In addition, you'll find specific advice about what these people can do to protect themselves in the year or more before reform takes hold. The profiles begin with consumers, followed by employers and health-care providers. Find yourself.

You have A+ insurance To Karen Long of Tacoma, Wash., health-care heaven is spelled Weyerhaeuser. As project manager for internal communications at the giant forest-products company, Long, 35, pays $30 a month to cover herself and her three children, ages 9, 12 and 14. Her plan requires her to pay a $500 yearly deductible before she's reimbursed for 80% of bills but caps her out-of-pocket costs at $3,000; last year, she paid only $1,300. And she has total freedom to choose her doctors. ''We have great preventive-care coverage for dental checkups and cleaning, screenings like mammograms and good prescription drug coverage,'' she says. PROGNOSIS: LOSER. ''Families with superior coverage and low premiums will either pay more or get less coverage,'' says Ed Howard, executive vice president of the Alliance for Health Reform, a nonpartisan advocacy group in Washington, D.C. If employers wind up losing their tax deduction for what they spend to provide coverage over a certain level, as expected, many might ''opt for the bare minimum package of benefits,'' says Bill Gradison, president of the Health Insurance Association of America in Washington, D.C. WHAT TO DO NOW: If your employer currently pays for, say, eye or hearing exams or routine physicals, make an appointment now. Such items are not likely to be fully covered by reform's basic benefit package. In the future, you may have to shell out for them yourself.

You buy your family's coverage Debbie Brown, 38, the San Diego Chamber of Commerce's special-events coordinator, hands back to her employer $245 a month -- 8% of her salary -- for her husband's and kids' insurance; the Chamber puts up $196 a month for hers. ''We're in an HMO, so we don't have deductibles,'' says Debbie, ''but we don't get coverage for vision and dental care.'' Last year she paid $400 for eyeglasses, but she and her husband Phillip, 40, a real estate developer, decided they couldn't afford $1,500 for braces for one of the kids. These expenses will be more affordable in 1994, when Debbie opens an employee flexible spending account (FSA), which will allow her to pay $5,000 a year of medical bills with pretax money. PROGNOSIS: WINNERS. ''Everyone buying their own health insurance now -- whether employed or self-employed -- will be able to get the same type of policy for 15% to 20% less after reform,'' says Robert Blendon, a professor of health policy at Harvard University. ''And many people will get more comprehensive coverage for what they pay now for a bare-bones policy.'' That's because HIPCs -- those giant buying cooperatives -- will bid for low-cost coverage for individuals as well as employees of small businesses, which often don't provide company-paid insurance. Some experts estimate that under reform, individuals buying for themselves will probably pay around $150 a month for coverage, while the government will pay for people who can't afford it and employers will generally have to pick up 75% of the tab for full-time employees and 50% for part-timers. WHAT TO DO NOW: Make as much use as you can of FSAs, which will disappear after reform, but probably not before 1995. This could save you as much as $1,400 in federal income taxes if you're in the 28% tax bracket.

You gave up raises for coverage ''Health-care reform has already come to my house,'' complains Vince Mula, 38, a stock clerk at USAir in Miami and a 16-year member of the International Association of Machinists. Last November the union and the financially strapped airline agreed to cut wages 3.5% and offer employees new health insurance choices. Under the old plan, Mula and his wife Tracy, 33, a Winn- Dixie bookkeeper, had to cover only a $200 family deductible and 20% of their doctor and prescription drug bills. Vince could have kept essentially the same coverage under the new contract for $120 a month, but he chose a $40- a-month managed-care plan. It requires no deductible and a flat $15 per doctor visit and $10 per prescription. Vince now must choose doctors from a list and go to a primary-care physician -- called the gatekeeper -- for permission to see a specialist. In all, between the higher health-care costs and the salary cut, Mula says, ''I'll be down about $1,500 this year.'' PROGNOSIS: MIXED. Mula has already absorbed the wallop that reform will deliver to people who have generous plans today: less coverage at more cost. Other union members who voted for fatter benefits in lieu of raises will get hit too. ''In the future if you want coverage where the sky is the limit, you'll pay for it with after-tax dollars,'' says Uwe Reinhardt, a health-care economist at Princeton University. WHAT TO DO NOW: Begin shopping for your area's best HMO. As Vince Mula can attest, quality of service can vary widely from one to another. Seek advice from friends who are HMO patients. They may be your most reliable source of information, since HMOs themselves are not required to give you any cost or performance data.

You're young and can't afford coverage Vida Petronis, 26, a freelance copy editor in New York City, thinks she doesn't need health coverage -- and, what's more, she can't afford it. She rejected a bare-bones Blue Cross/Blue Shield policy with no deductible that would have cost her $1,200 a year, or 6% of her just-over-$20,000 income. Her fear is that reform will force her to buy unnecessary coverage. ''I'm young and healthy and take very good care of myself,'' she says. ''The standard package is likely to have more benefits than I need or want. Putting everybody in the same risk pool means that I'll have to subsidize people with bad health habits, and I don't think that's fair.'' PROGNOSIS: LOSER. Like it or not, Petronis and other healthy young people will have to pay for coverage. Princeton's Reinhardt estimates that people at Petronis' income level or above could end up paying a mandatory $1,800 a year, making the $1,200 policy she rejected seem like a bargain. One small consolation: Premiums would almost certainly be tax deductible for the self- employed, trimming Petronis' cost by $270. WHAT TO DO NOW: You have no choice but to start saving for the premiums you'll have to pay by 1995.

You're solidly self-employed, but your insurance costs are soaring Pat and David Coggins, 50 and 57, who own an antiques store in Marblehead, Mass., have watched their annual Blue Cross/Blue Shield premiums jump 173% in 10 years, to $3,000. And they're due to rise another 22%, to $3,660, this year. Had the couple not accepted a $2,500-per-person deductible, they'd be paying $6,000. Says Pat: ''Heaven help us if something happens to both of us at once.'' PROGNOSIS: WINNERS. When health reform is in place, around 1995, the Cogginses' bill will probably plateau at around $4,000 a year for a much broader policy with possibly no deductible. The couple will be covered for visits to doctors, prescription drugs, annual checkups and other preventive care -- items they currently pay for themselves.

WHAT TO DO NOW: You could stabilize your costs while waiting for reform by ( joining an HMO and seeing specialists on your own only if you need them.

A family member is disabled -- and the rest of you are uninsured Presiliano and Joan Munaton, 38 and 33, of Denver live each day with the arbitrariness of the present health-care system. The second oldest of their six children, Socorro, 12, was born with cerebral palsy and qualifies for Medicaid only if the family's income stays below $3,297 a month. The unfortunate consequences: 1) Joan, who is trained as a licensed practical nurse, is afraid to take a job, and 2) the rest of the family must go without health insurance. The Mexican restaurant where Presiliano cooks doesn't offer it, and he can't afford it on his $16,800 income. So Joan takes the other kids to a clinic at Denver General Hospital that charges about 20% of the actual costs. Last year the couple's out-of-pocket medical expenses came to $2,000. ''Medicaid is very good to us,'' says Joan. When Socorro needs a new $3,500 wheelchair, for example, Medicaid gets it for her. ''It's best for Socorro that we qualify for Medicaid,'' says Joan. ''But it's hard on the other kids.'' PROGNOSIS: WINNERS. While adults who currently aren't insured might have to wait four or five years for coverage under reform, children will be enrolled immediately. ''If there is anything Mrs. Clinton wants to do, it's to get children covered,'' says Harvard's Blendon. ''If their parents can't pay, the kids will be subsidized; the parents might be asked to pay 20% or 25% of the cost.'' As for Socorro, she would stay in Medicaid until it's folded into the new national system, most likely by 1998. WHAT TO DO NOW: For lower-cost or free care, call the U.S. Department of Health and Human Services (800-638-0742) to find out which hospitals in your area have received funds through the Hill Burton Act. Under this law the feds pay for a hospital's capital improvements only if it provides a certain amount of subsidized care to the needy.

You're out of work and in poor health ''I'm in that white-male, unemployed, over-50 category,'' says Robert Ruggles, 53, who was a customer service manager at Tandem Computers in Santa Ana, Calif. for 14 years until his job was eliminated in late 1990. Since then, he and his wife Edith, 52, have been unable to find insurance they can afford, largely because of pre-existing conditions -- Robert's lupus, a skin disorder that is in remission, plus his and Edith's high blood pressure. They have been % told by an agent for Blue Cross of California that they might be accepted into a high-risk plan with premiums of as much as $800 a month. But that's out of the question. The couple rely primarily on investment income of $2,000 a month. In addition, Edith makes $800 a month as a part-time food service worker for the Huntington Beach School District. In April, Robert started working part time in the district's warehouse, also for about $800 a month. PROGNOSIS: WINNERS. ''The rules on pre-existing conditions are going to change quickly,'' says Ed Howard of the Alliance for Health Reform. ''Insurers won't be allowed to turn you down.'' The Ruggleses might then be able to find a less costly policy. ''Help is on the way,'' says Howard. WHAT TO DO NOW: Ask your senator and U.S. representative to vote for legislation prohibiting insurance companies from withholding coverage from people suffering from pre-existing conditions. Word from Capitol Hill is that this ban could pass this year.

You're not exactly treating your body like a temple Pat Meldrum, 38, a $70,000-a-year agency manager for Allstate Insurance in Phoenix, thinks financing health care with new taxes on tobacco, alcohol and guns would be unfair. As you might suspect, he smokes (an occasional cigar), drinks (two cases of Australian beer a month) and loves his four handguns (so much, in fact, that he may join the National Rifle Association). ''The government should increase income taxes on people who pay a little and make a lot,'' he says. ''That way you don't penalize people with less money.'' PROGNOSIS: LOSER. Of all the revenue sources the Clinton health-care reform task force is considering, so-called sin taxes will be the easiest to impose politically. New taxes on smokes, drinks and guns will likely be stiff; the price of a pack of cigarettes could easily climb by $1 to $3.50 or so. WHAT TO DO NOW: Break your unhealthy habits, perhaps by joining a support group at your local HMO or hospital.

You have a catastrophic illness Jane Hawley, 39, of Phoenix is dying of AIDS. ''I discovered I had it in 1990 when it was full-blown,'' she says. ''I think I got it in 1979 or 1980 from a lover.'' With perhaps a year to live, she is too weak to work. She spends most of her days trying to cadge prescribed drugs that normally cost a prohibitive $1,400 a month. She is not eligible for Medicaid under Arizona's unusually strict rules; her $484 monthly Social Security disability income exceeds the state's $267 maximum. But her Social Security disability status does qualify her for Medicare, which pays 80% of her doctor bills. And under the federal Ryan White Act, her income is low enough to qualify her for free antiviral drugs like AZT and DDC. But for the six other medicines she needs, she taps the AIDS underground, which retrieves drugs left by the deceased and distributes them illegally to the needy. ''I've stockpiled as many drugs as I can find, maybe four months' worth, because I know I'm getting weaker by the day,'' she says. ''I'll have to move in with my parents pretty soon, and they can't go looking for drugs for me.'' PROGNOSIS: MIXED. While reform will almost certainly come too late to help Jane Hawley, it will be a boon to AIDS patients, as well as to many others made dependent on costly drugs by various illnesses. That's because there's a strong chance Congress will put some prescription-drug coverage into the basic package of benefits it passes. And every benefit in that package will go to Medicaid recipients as well, no matter what their states' rules may be, even before those two health programs are combined. WHAT TO DO NOW: Ask your doctor to consult the Pharmaceutical Manufacturers Association (1100 15th St. N.W., Washington, D.C. 20005; 202-835-3400) to see whether you qualify for the Prescription Drug Indigent Program, advises Matthew Lesko, the author of What to Do When You Can't Afford Health Care (Information U.S.A., $24.95). Under this program, drug companies provide some products free of charge to doctors for patients who cannot afford medication that they need.

You're a senior citizen who has Medicare and Medigap Agnes Ranseen, 79, is unhappy with the state of her health-care coverage, and she doesn't believe reform will make it any better. The retired social studies teacher lives comfortably in Evanston, Ill. on annual pension and Social Security income of $13,237. Every month she pays $17.05 for Medicare (after a rebate from her pension fund) and $44.60 for a Blue Cross/Blue Shield hospitalization policy with a $500 deductible. ''Hardly any of my bills are covered,'' she complains. For example, she paid $350 last year for dental care, and she now faces a $650 bill for root canal work. ''I'll use the doctor only if I'm critically ill,'' she says. ''I think that's a foolish way to take care of yourself, but I have no choice.'' Even so, she opposes managed competition: ''I hate the idea of not being able to choose my own doctor.'' % PROGNOSIS: WINNER. With prescription drugs likely to be covered early in reform and some long-term-care coverage phased in later, the twin terrors of the elderly will be tamed. Most other retiree medical expenses would be covered too, with the probable exception of dental care. Eventually, perhaps by the year 2000, Medicare will be folded into the reformed system and recipients will join HIPCs. Upshot: lower cost but, as Ranseen suspects, less choice.

WHAT TO DO NOW: Don't drop your Medigap insurance, which costs from $300 to $3,000 a year. Medigap pays Medicare's deductibles and co-payments, which will otherwise come out of your pocket.

A family member needs long-term care Jack McClenaghan, 63, a retired corporate controller in Portland, Ore., was diagnosed with Alzheimer's in 1984. The disease has progressed to the point where Jack ''walks, breathes, feeds himself -- and that's about it,'' says his wife Mary Lou, 65, a retired teacher. He has not been able to talk for three years and generally recognizes no one but his wife, not even his three children or five grandchildren. Medicare covers 80% of Jack's doctor bills but none of his living expenses. He is now in foster care, which costs Mary Lou $1,650 a month -- more than half of the couple's $3,000-a-month income from family savings, Jack's small pension and Social Security. The family kitty is running out, while Jack's otherwise robust health (''He has the blood pressure of a 12-year-old,'' says Mary Lou) indicates that he will live for many more years. Although his wife hopes that reform will bring her some relief, she says: ''I'm worried that we may have too much income to be eligible for any kind of long-term-care benefit.'' PROGNOSIS: MIXED. Ask almost any health-care expert about the chances of at least some long-term care being included in the basic reform package, and the answer will almost certainly be yes -- perhaps by 1998. However, some of Jack McClenaghan's foster-home-care costs stand a good chance of being covered in earlier stages of reform, regardless of the couple's income. WHAT TO DO NOW: Hang on to your long-term-care policy if you have one; otherwise, you should weigh the need to buy one now. The government might wind up deciding that fully covering nursing-home care -- estimated alone to cost $60 billion a year -- is too expensive to deal with.

You own a business and don't cover your employees Last year Laurie Neuse and her two partners at Spaghettini, a 200-seat restaurant in Seal Beach, Calif., dropped HMO coverage for their 80 employees, including a number of parents who had worked for them since 1988. ''We could no longer afford it,'' says Neuse, 37. Over the 3 1/2 years the insurance was in force, costs jumped from $3,500 to $5,000 a month. To open the restaurant, the partners had borrowed $350,000, and the loan still has more than a year to run. Recently they promised their employees that they would restore health benefits the day the loan is paid off. ''If we're mandated by the government to provide insurance before we are in a position to do so, it would be tough to manage both that and the debt,'' says Neuse. PROGNOSIS: MIXED. Good for the workers, but not so good for the owners. Many small businesses struggle financially, which partly accounts for the fact that one-third offer no health plans to employees. ''Some softener for small companies will be included'' in reform, says one plugged-in congressional health-care specialist. Princeton's Uwe Reinhardt predicts that small employers, those with 100 or fewer employees, will be awarded government subsidies, probably when their health-care expenses exceed 8% of payroll. And HMO fees will be lower than they are now. WHAT TO DO NOW: Nothing. Given the shaky economy, especially in California, the workers and the owners should probably hang in there until reform.

Your livelihood partly depends on today's health-care system Frank Shooster, 39, and Gerry Abrams, 40, a married couple with two-year-old twins in Fort Lauderdale, like the health-care world as it is. Shooster's law practice draws 10% of its business from medical malpractice cases. But such suits are expected to shrink by at least a third if tort reform, as expected, is reined in as part of the health-care overhaul. Moreover, Abrams may lose as much as 70% of her marriage-and-family psychotherapy income, because the new system may not cover such therapy. In addition, their twins may have inherited Shooster's genetic problem of growing too few teeth, which could eventually cost the couple as much as $100,000 if dental care isn't covered. PROGNOSIS: MIXED. While Shooster and Abrams stand to lose professionally, there may be a happy outcome on the twins' teeth. Although routine dental care seems destined to be left out of the package, the Shooster-Abrams family could win if childhood preventive dental care is covered, as one health-care task force member predicts it will. WHAT TO DO NOW: If you earn any income from the present health-care system, keep close tabs on the reform legislation as it moves through Congress. The Association of Trial Lawyers of America, for instance, will offer members who call updates on changes that will affect them most.

You are a big-city medical specialist in private practice As a New Orleans radiologist, Dr. Edward Soll, 49, fears that reform will severely squeeze physicians' incomes. But as director of Diagnostic Imaging Services, an outpatient radiology business, he believes he and his two co- owners, another radiologist and a business partner, will do just fine. DIS has 87 employees and a payroll of $3.5 million and serves about 100,000 patients a year at fees ranging from $95 for mammograms to $895 for magnetic resonance imaging. About two-thirds of Soll's business comes from Medicare, Medicaid and contract services like HMOs. Under reform, that figure will push inexorably toward 100% by the end of the decade, making it impossible to shift costs onto private patients any longer. Still, he says, ''I'm not worried. Under reform, we'll get more business, but at lower fees.'' While radiologists' median annual income in 1991 was $254,000, professional sources estimated that Soll's is higher. PROGNOSIS: LOSER. Although some specialists like Soll may be able to pump up their patient volume under health-care reform, most will see their fees contract and their incomes fall. Ed Howard of Alliance for Health Reform even predicts a federal effort to retrain specialists as primary-care physicians. WHAT TO DO NOW: Cultivate relationships with your best sources of referrals. Once reform is in place, a reputation for efficiency, cost-effectiveness and good customer relations will be essential.

You are a country doctor Dr. Catherine McGinnis, 36, and her husband Dr. James Allen, 47, work in a 14- physician group practice in Hutchinson, Minn. (pop. 11,500). McGinnis, Allen and 10 of their colleagues are family practitioners. That's typical; there's little demand for specialists in rural areas. Like most country doctors, McGinnis worries most about how so-called managed competition would work in an area where competition is impractical and the nearest rival clinic is 45 minutes away in Waconia. ''Rural doctors and hospitals are already reimbursed at lower rates than those in urban areas, so it's hard to think we'll have further cuts,'' she says. PROGNOSIS: WINNER. Harvard's Robert Blendon points out that, as the Clintons of Arkansas well know, pure cutthroat managed competition won't work in isolated rural areas. For this reason, reform will bring less change there -- including fewer HMOs, for instance -- than anywhere else. Moreover, he says, ''there will be an effort to pay rural doctors more to attract practitioners to the country.'' WHAT TO DO NOW: Smile. The future is yours.