PITTSBURGH — STATE Auditor General Barbara Hafer was in for a surprise last week when she toured western Pennsylvania's depressed river towns on election day.She had come to turn out Republican votes. Instead, she found many Republicans voting for the Democratic Senate candidate, Harris Wofford. The reason? Health care. "The people who talked to me were very concerned," Ms. Hafer says. "They are afraid the little meager amounts of money that they've saved could be wiped out" by a catastrophic illness or unexpected medical bills. That day, Senator Wofford went on to upset a heavily favored Republican in Pennsylvania's special Senate election. Since then, politicians of all stripes have been taking a close look at Wofford's call for national health insurance, a cornerstone of his campaign. Some political and health-care analysts believe last week's Pennsylvania election could be the catalyst for a new debate about health-care policy in the United States. It's "a very powerful message that health care is important," says Henry Simmons, president of the National Leadership Coalition for Health Care Reform. "I think there's going to be movement toward very significant reform in the system." There's no denying that the US health-care system is in trouble. It is the most expensive, least universal system of any major industrial country. When the Gallup Organization asked if there was a crisis in health care this summer, 91 percent of the adults surveyed said there was. "Never before in the 17 years that Roper has been tracking Americans' attitudes toward health care have sentiments been so universally negative," the Roper Organization reported in its February newsletter. When Roper surveyed Americans about health-care in the 1970s and early '80s, it found most people were at least somewhat satisfied with their medical care. The major dissatisfaction? Costs. "You're getting a major confrontation there," says Donald Ratajczak, director of the Economic Forecasting Center at Georgia State University. "Our country revolted when we had 20 percent of GNP taken for taxes," he says, referring to the anti-tax revolt that surfaced in California and Massachusetts more than a decade ago. A similar revolt could occur over the medical-cost issue, he says, when health care hits 20 percent of gross national product. "If current trends continue we could hit the 20 percent mark by the first decade of the next century." While most people can point out the problems, they can't agree on solutions. "Congress doesn't know what the people want. The people in many cases aren't sure what they want," says Tom Smith, director of the General Social Survey of the National Opinion Research Center. "The alternatives have not been articulated well enough to the people." In June, the Gallup Organization found that 40 percent of those surveyed wanted a national health-care plan run by the federal government and financed by taxpayers, which would cover all Americans. That fits several Democratic plans now in Congress. Another 34 percent preferred a plan requiring businesses to provide health-care coverage to all employees or, as an alternative, pay into a federal fund that would cover all uninsured Americans. This tack is closer to Republican proposals. Some 22 percent wanted to leave the system as is, Gallup found. The trick for Democrats and Republicans will be to capitalize on voters' dissatisfaction and come up with a plan that can win majority support. Democrats believe they have the best chance at turning health care to their advantage. "As a party we are better on health care," says Jeff Eller, a spokesman for the Democratic Senatorial Campaign Committee. "We're on the offensive. They [Republicans] are on the defensive." But Republican strategists do not believe the Wofford election provides a clear-cut case for national health insurance. "It was less a referendum on any one issue than a referendum on Washington," says Wendy Burnley, press secretary of the National Republican Senatorial Committee. "The anti-incumbent mood was very strong." Although Wofford was technically the incumbent, appointed last spring, he successfully portrayed himself as the outsider and his challenger, former governor and US Attorney General Dick Thornburgh, as the insider. Indeed, Republican polling here showed that health care was not a big issue as late as September, when voters ranked it as only the fourth most-important issue. But by late October, after a barrage of Wofford advertising and publicity, polls showed health care had moved into the No. 2 spot behind the economy. "This is really the pre-game," says Patrick Stroh, a political scientist at Carnegie Mellon University. Next year, Democrats will push for national health insurance and Republicans will focus on the costs. Their message will be much like Mr. Thornburgh's, he says: "If you vote for national health care, then you're voting for higher taxes."