Is Hillary good for the health of Americans?: Bill Clinton has given his wife the job of fighting the medical barons. Patrick Cockburn sees her first shots

ON HER first visit outside Washington as head of health care reform, Hillary Clinton was in full First Lady mode as she greeted patients in the physical therapy room of St Agnes Medical Center in Philadelphia. 'Hi, I'm Hillary Clinton,' she said breezily. 'I hope you don't mind our barging in on you like this. What are y'all doing?'

Most of her audience were trying to recover the use of their hands. Jimmy Howell of Philadelphia had fallen into a slag mill furnace and was burned all over his body. He showed her how he was painfully relearning how to put a nut on a bolt. Later she signed the cast on the leg of Lucy Mangieri with the words 'Lucy - best wishes to you', writing her full name Hillary Rodham Clinton. 'And your ankle]' added Tipper Gore, adviser on mental health to the health care reform task force and wife of the Vice- President Al Gore.

None of this was out of keeping with the traditional role of the president's wife, bringing good cheer to the sick and injured. But within the hour she flew 100 miles west to Harrisburg, capital of Pennsylvania, to attend a conference on health care in a grimly rectangular red-brick building belonging to the state university. Once there, she left nobody in any doubt that she was chairwoman of the President's Task Force on National Health Care Reform.

She told 300 doctors, nurses, health administrators, insurers, lawyers, politicians and advocates of reform that the United States spent dollars 940bn ( pounds 660bn) on health this year, more than any other country in the world. But the system did not work.

'There are people and interests who do not want change. It's not in their interest for this system to change.' These, though she did not name them, include the 600,000 American doctors, who are the highest paid group in the country, earning on average dollars 170,000 a year, and the drugs companies. 'In 1981, the cost to immunise a child in the public sector was dollars 6.69. By 1991, the cost was dollars 90.43, a rise of more than 1,250 per cent,' she said. 'Unless you are willing to take on those who profited from that kind of price increase and are continuing to do so, you cannot provide the kind of universal immunisation system that this country needs.'

One in seven dollars produced by the US economy (or 14 per cent of GDP compared to 6.1 per cent in the UK and 8 per cent in Germany, France and Sweden) are spent on health. If Hillary and the Bill Clinton are to achieve real health care reform, they will have to take on not only drugs companies but also doctors and insurance companies, two of the most powerful Washington lobbies. Just before Mrs Clinton arrived in Harrisburg, doctors, insurance companies and reform groups were all snarling at each other. Accusations of greed and incompetence were made.

Once Mrs Clinton had arrived, the exchanges became blander. The audience was at first unclear about whether to treat her as the President's wife or the chairwoman of the task force. But there was no doubt about how she regarded herself. References to her using her influence on the President received a tight smile or were disregarded. When an elderly balding advocate said he had had a full head of hair when he first called for health care reform and hoped she would still have her hair when reform was ultimately achieved, she patted her long blonde hair and laughed.

There was also a slight tightening of the lips when Senator Wofford twice referred to 'the political risk' the President had taken by appointing her. The Senator meant that, if anything goes wrong with health reform, it will be blamed squarely on the Clintons and may sink their re- election chances in 1996.

But Mrs Clinton's position is unique because in terms of influence she really is very close to being co-president. 'She is not in the loop. She is the loop,' said a White House official just after the inauguration, and his words were quoted across Washington. Some signs of her authority are trivial, such as the banning of Roger Clinton and Virginia Kelley, the President's brother and mother, from speaking to the press during the inauguration. Other indications are more important, notably her 90-minute interview with Kimba Wood, very nearly nominee to be attorney-general, which was twice as long as Ms Wood's interview with the President.

During last year's election the Republicans toyed with the idea of baiting Hillary as the radical hidden hand of a Clinton administration. Distorting her advocacy of legal rights for maltreated children, President Bush attacked her for calling on children to sue their parents. But the polls showed that Mrs Clinton was growing in popularity, and efforts to contrast her political activism with the homely virtues of Barbara Bush offended working women, whose numbers grew rapidly in the 1980s. In Arkansas, where she played a leading role in educational reform over that period, there was surprisingly little resentment at her prominence. John Robert Starr, former editor of the Arkansas Democrat Gazette, which opposed Bill Clinton as governor, says: 'She was tremendously effective, and a better speaker than Bill. He is more snake-like.' He says she was good at winning over legislators and local public opinion. Other Arkansans point out, however, that there is a world of difference between dealing with the director of Little Nob school in the back reaches of their state and fighting off Washington's medical and insurance lobbies.

There is a further point in her favour. Health care reform is immensely popular in the US. Among the middle class whom Bill Clinton claims to represent, polls show it to be the main concern - more important than jobs and the economy. Health is the issue which put him in the White House, and Mrs Clinton can therefore get away with using words such as 'egregious' when speaking of it, which a professional politician like her husband would not allow to appear in his public vocabulary for fear of damaging his populist credentials.

So far there are few signs that efforts by the Republican right to portray Mrs Clinton as the Evita of the Clinton presidency are damaging her. At the end of January, a poll showed that 74 per cent of Americans thought she was a positive role model for American women. Some 62 per cent also thought, however, that she should be called Hillary Clinton and not Hillary Rodham Clinton, using her maiden name.

Mrs Clinton's rise as a superstar is borne out by the circulation figures of People, the weekly magazine devoted to the doings of the famous, that is read by 29 million Americans. The biggest draw for readers used to be a picture of Princess Diana on the cover, but now Mrs Clinton is proving almost as beneficial to sales, reflecting the more earnest flavour of American political and social life in the Nineties.