Pick a Card, Any Card--for National Health Care : Identification: The potential market for cards ensuring medical treatment under Clinton’s reform plan has makers of optical, magnetic-stripe and smart cards vying for the contract.

President Clinton holds all the cards in the Administration’s campaign to give each American a uniform health insurance identifier.

His health reform agenda, which is bound to spawn a medical bureaucracy lasting into the next century, includes an obscure but important detail: the need for factories that can churn out plastic “health security” cards guaranteeing access to care.

The card, which will resemble a credit card, is likely to become a staple of every wallet, as common as a Social Security card and driver’s license. But who will make the card and what type of information it will convey aren’t clear yet.

The information question is particularly important because of the sensitive nature of personal medical histories and the potential for abuse by thieves, counterfeiters and other con artists.

The health card will provide access to databases that not only contain a person’s height and weight, but records of medications, substance abuse, mental health and family histories.

Still, the uncertainty about the cards hasn’t deterred an intense competition for this potentially lucrative government work. The battle lines have been drawn between producers of the magnetic-stripe card, which is the format for credit cards and automated banking cards, and two newer technologies--the smart card and the optical card.

The stripe card is the least expensive, costing 50 cents to $1.50 each and holding the equivalent of a few lines of type. Data is stored on magnetic tape on one side.

The smart card contains a silicon chip that is read by a computer and will hold three to four pages of typewritten data. Popular in Europe, the card’s U.S. use for the most part has been limited to military bases and colleges.

Smart cards cost about $1.50 each but can cost much more. A Wyoming food aid program, for example, paid $10.34 apiece for smart cards.

The harder-to-find optical cards cost about $4 each and are similar to smart cards but are read by expensive lasers. Optical cards hold the most information of any card. Just one, for example, can hold three copies of John Grisham’s “The Pelican Brief.”

The Clinton health security blueprint says the card will be a magnetic-stripe card that contains a personal identification number and the name of an individual’s health plan.

That doesn’t mean the smart card has been eliminated from consideration. Smart-card manufacturers have hired a congressional lobbyist.

Moreover, the Administration has shown interest in smart cards. A member of Clinton’s health task force inquired about a plan to issue smart cards for health insurance in North Dakota, Idaho, Montana, Wyoming and Nevada, said Tom Singer, research director for the Western Governors Assn.

Vice President Al Gore, the Administration’s lead proponent of the computerized information age, has said the smart card is the best way to deliver government benefits.

The International Card Manufacturers Assn., which represents stripe- and smart-card makers, is neutral on which card should be used, association President Robert Blum said.

But under his other hat, as president of stripe-card maker Colorado Plasticard Inc., he said that magnetic-stripe cards will be adequate.

“The job would have to be broken up among a number of manufacturers, and it would take them awhile,” he said in a telephone interview from Littleton, Colo. “I certainly couldn’t do it alone.”

If a magnetic-stripe card is used, a doctor’s office or hospital would obtain an account number from the card to tap into a computer medical file over a telephone line. The Clinton book said access to records will be limited to health professionals “who have a legitimate need to see them.”

Makers of the newer cards say the security of such a network is vulnerable to abuse and telephone-line disruptions.

“That system will be breached. No doubt about that,” said Stephen Price-Francis, North American marketing manager for Canon Inc.’s optical cards.

“What if a company doesn’t want to hire someone with AIDS? All they have to do is look at what medications that person has taken, and they will know right away,” said Janet Sayles-Falls, executive director of the Smart Card Industry Assn.

A security consultant to stripe-card makers said the claim that smart cards are safer than stripe cards is nonsense. He said the smart card can be copied easily.

“The simple, low-cost smart card is based on simple algorithms that can be broken by any hacker,” said Denise Jeffreys, president of XTEC Inc. of Miami. Jeffreys also acknowledged that many stripe cards can be compromised “with equipment you can buy at any Radio Shack.”

Patients with smart or optical cards would carry their medical life stories. But losing the card could mean rebuilding your story.

In Oklahoma City, smart cards are already sold as portable file cabinets for medical information. Eight pharmacies last year began selling the $10-a-year Medicard smart card.

Seven hospitals and an ambulance fleet installed Medicard readers so they can quickly obtain information such as histories of heart trouble or epilepsy, doctors’ phone numbers and names of relatives.

“It’s the coming thing. I’m telling all my friends about it,” said Ed Taylor, a retired Oklahoma City oil worker whose card lists his medications and allergies.

Oklahoma City pharmacist Jim Brakebill said his store performs about one transaction a day with the red Medicards. If customers visit another druggist while out of town, Jim’s Tower Pharmacy will perform a 30-second Medicard update at no charge when they return.

Brakebill said two dozen doctors he knows are installing smart-card readers to obtain patient information more quickly.

“Who among us hasn’t had to go to the doctor and sit down and fill out the same forms every time? What a pain,” said Sayles-Falls of the smart card group.

Talk of a national identification card also raises questions about government intrusions. One health care consultant said the key question is not which card will be used, but rather whether any card should be issued at all.

“Whenever you get any kind of card authorized by the government, people freak out, correctly or not,” said Grace-Marie Arnett, president of Arnett & Co. in Washington. “And the civil libertarians go nuts. Americans rebel against any type of state control.”