President-elect Bill Clinton should use his mandate to reform the nation's health care system to create a "single-payer" insurance program that controls overall costs and guarantees access to all citizens, Sen. Paul Wellstone told a Kennedy School of Government audience yesterday.

Wellstone, a Minnesota Democrat elected in a populist campaign two years ago, argues that a single-payer system offers the only means for making health care available to all Americans without reducing consumer choice.

Under the plan Wellstone described, Congress would establish a National Health Care Trust Fund to finance health insurance for every American citizen. By setting an overall budget each year and streamlining administrative procedures, Congress could establish "by far the most effective health care [cost] control," Wellstone said.

The program would preserve a role for insurance companies, which would provide plans with minimum benefits packages set by the government, Wellstone said. Consumers would choose among the plans, he said.

But because the government would set an overall cost ceiling each year, Wellstone said, the plan would break the grip insurance companies now have on the American health care system. That grip denies many citizens access and increases overall costs, he said.

"I think it's unconscionable the extent to which insurance companies rule the game," he said. "My biggest fear of all is that there would be choice for companies but not for consumers."

Wellstone said Clinton's election, which was buoyed by a promise to reform the health care system, offers Americans an opportunity they never had under the Bush administration, which frowned upon any government involvement in the health care industry.

"With the election of Bill Clinton, we move into the politics of rising expectations," he said.

Wellstone said he wanted the public to become more active in support- ing a single-payer plan and fighting thegovernment's bureaucracy and corruption. Hepointed to the Single Payer Health Care CoveragePlan, a piece of pending legislation, as a modelprogram.

"I only wish there was a grassrootsconstituency that was ready to fight for [theplan]," Wellstone said. "Government to the highestbidder...I think that's what we have."

Wellstone said he was particularly concernedabout the plight of Americans too poor to affordhealth insurance but too well-off to qualify forentitlements such as Medicaid.

During a question-and-answer period, Wellstonesaid that while the single-payer system mightinflate the federal budget, it was a worthwhileexpense--particularly since it could fosterlong-term savings.

"Any national health insurance plan runs intothe difficulty that it's going to cost money,"Wellstone said. "But that doesn't mean weshouldn't do it. That's what leadership is al