BY  Richard Wolf

        Americans have turned against major health care reform in a big way, and are increasingly upset with the prescriptions offered by President Clinton and Congress.
        Nearly four in five Americans want only minor changes in the health care system or none at all this year, according to a USA TODAY/CNN/Gallup Poll. Only 20% favor passing a major reform bill, as Clinton and congressional leaders have advocated.
        The public mood dovetails with efforts on Capitol Hill to end the year-old health reform debate by passing only minor reforms, such as new rules on insurers and subsidies for the poor or children.
        "As this has dragged on, people have gotten more gun-shy about big reform and worried that the cure will be worse than the disease," says Drew Altman, president of Kaiser Family Foundation, a non-partisan, private health philanthropy.
        The poll will be welcomed by Republicans and moderates who favor an incremental approach to changing the nation's health delivery system:
        -- Half of those questioned want minor reforms passed this year; 86% of that group want further action next year.
        -- More than one in four Americans want the health care system left alone.
        "It's another indication that if we do anything this year, it ought to be a package of targeted reforms," says Senate Minority Leader Robert Dole, R-Kan.
        From the poll:
        -- 6 in 10 disapprove of Clinton's handling of health policy, a new high; 36% approve.
        -- 52% say Congress has moved in the wrong direction on health reform - 20 points higher than a month ago.
        -- Democrats are still trusted more than Republicans on health policy, but by the narrowest margin yet, 43% to 40%.
        "The country really has no confidence in the government to solve this problem without making it worse," says former GOP congressman Vin Weber, vice chairman of Empower America, a conservative think tank.
        Yet two-thirds of Americans still support guaranteeing insurance for all - cornerstone of Clinton's failed reform plan.
        With Congress scheduled to take up the issue again next week, lawmakers who once favored universal coverage are splitting into separate camps - a sign any compromise plan will have trouble passing:
        -- The chief advocate of a Canadian-style, government-financed system, Rep. Jim McDermott, D-Wash., now says Congress should reject all lesser reforms and try next year to cover everyone and cut costs.
        "None of the proposals now viewed as the framework for some kind of nominal health care reform will deliver even one element of that vision," he says. "In fact, they won't even bring us close."
        -- Moderates in both parties are working with Senate Majority Leader George Mitchell, D-Maine, on a package of insurance market reforms and low-income subsidies.
        "I think there's still hope, I really do," says Sen. John Chafee, R-R.I. "I think a lot of people can be helped."
        -- A group of liberal Democrats has a fallback plan to cover all children and give states money for long-term home care, to be paid for with cuts in Medicare and tobacco taxes.

Few want major health bill A USA TODAY/CNN/Gallup Poll shows almost half of the public wants gradual health care reform. Many want minor bill passed What people would like to see done this year: 

Pass minor reform, continue work           43% 
Leave system as is                                      27% 
Pass comprehensive bill                            20% 
Pass minor reform, don't continue work     7%

Fewer support guaranteed private health insurance 
Jan. 30    79% 
June 28   77%
Aug. 9     69% 
Sept. 7    66%

More say Congress moving in wrong direction on reform
             Right     Wrong   No opinion 
Aug. 9     47%      32%          21% 
Aug. 16   41%      45%          14% 
Sept. 7    38%      52%          10%