By Mark Reutter Seven months after President Clinton unveiled his health-care plan, scare tactics and dire predictions have obscured the merits of national health- care reform, a UI expert argues. "Up to this point the tone and content of the debate have been truly unfortunate," says Robert F. Rich, the director of the UI Institute of Government and Public Affairs and a co-editor of a book on health care. Writing in the Policy Forum, published by the UI, Rich faults the ad campaign that predicts that 40 percent of Americans will pay more for health care under Clinton's plan. In truth, Rich argues, health-care costs will go up whether or not Congress adopts the Clinton plan. "The relevant question is not whether costs will increase; instead, how will these costs be distributed? And what role will savings from cuts in other areas play in paying the bills?" Similarly, the "choice" question is bogus, he writes. Choice of physicians and health plans are increasingly limited under private insurance - and the trend will only accelerate as more companies respond to the escalating costs of medical insurance for employees. "Traditional fee-for-service arrangements are capturing less and less of the market," Rich notes. "Such arrangements accounted for 89 percent of the national market in 1984, 44 percent in 1987, and will account for only 10 percent in 2000. At the same time, 40 percent of the market will be captured by HMOs [health maintenance organizations] and 35 percent by PPOs [preferred provider organizations]." The criticism that a national program would ration health care and overwhelm citizens with bureaucratic red tape also is based on false assumptions. "The current system is heavily involved in rationing. Those who can afford to pay receive all the care they want, and those who can't are much more limited in their options," Rich writes. It is important for Congress, private industry and the media to focus on the core questions facing America, Rich notes. One such question is whether the nation should alter the basis of its medical delivery from a market system, where the payer determines his or her level of care, to one where care is based on medical and therapeutic principles. Clinton's principle of equality - that all Americans are entitled to equal health care - marks a major departure from most public policy and should be vigorously debated. "In elementary and secondary education," Rich writes, "we guarantee each child access to a publicly financed education; we do not guarantee the same education or a high-quality education for everyone. By mandating health insurance for everyone at an equal level of care, we would be fundamentally changing the way we organize, finance and deliver health-care services in this country." Rich is a co-editor of "Competitive Approaches to Health Care Reform," published last fall by the Urban Institute Press in Washington, D.C.