Did somebody say . . . patients' rights?

The complex Senate debate over health care reform seems to have boiled -- charbroiled? -- down to an unlikely nutritional symbol: the Big Mac.

The 560-calorie bundle of beef was first hauled into the partisan squabble over managed care by Sen. Edward M. Kennedy (D-Mass.), co-sponsor of the Patients Bill of Rights. Kennedy trotted out nonpartisan Congressional Budget Office numbers projecting that his plan to rein in HMOs would increase insurance premiums by only 4.8 percent over five years. For the average worker, Kennedy said, that comes out to less than $2 a month, which is less than the cost ($2.19 plus tax) of one Big Mac.

A Big Mac a month, Kennedy thundered, is a small price to pay for "protections to guarantee that the health insurance benefits they have paid for will be there when they need them."

But like Hamburglars in the night, Republicans have tried to steal the Big Mac issue from the Democrats. They say the $2-a-month figure is just a political Whopper.

Assistant Senate Majority Leader Don Nickles (R-Okla.) began the counterspin Tuesday with a posterboard featuring a supersized pile of Big Macs. He argued that the CBO premium hike estimates -- which he put at 6.1 percent over five years -- only tell part of the story. In many cases, he said, employers may respond to the higher premiums by cutting wages -- perhaps as much as $64 billion over 10 years. That comes out to nearly $30 per family per month.

"That's a lot of Big Macs," Nickles said. "That's a real hit." Sen. Phil Gramm (R-Tex.) then chimed in that for $64 billion, you could buy a lot of McDonald's franchises.

Republicans have also argued that the sweeping Democratic measure would encourage many employers to drop their health coverage altogether, swelling the ranks of the uninsured by 1.9 million. And sure enough, Sen. Larry E. Craig (R-Idaho) took the Senate floor yesterday with a design of the familiar golden arches above the slogan: Over 1.9 Million Uninsured.

"Our Democratic colleagues have a mantra when it comes to their bill. Over and over, they say it would cost less than a Big Mac," Craig said. "Well, if you look at the CBO report, it says nothing about Big Macs. . . . This is a Big Mac attack that Americans can do without!"

This is the crux of the showdown over managed care. Democrats are pushing for broad protections for all patients with health coverage; they basically believe that if you're in an HMO, you deserve a break today. Republicans have proposed more modest protections for fewer patients; they essentially argue that the government cannot do it all for you.

So where's the beef? The CBO analysis does back up the Republican accusation that if the Democratic bill passes, some employers may drop health insurance plans entirely, scale back their benefit packages or increase cost-sharing by beneficiaries. But a congressional budget source said that Kennedy's burger-a-month estimate is still probably on target.

"It's in the ballpark," the source said. "Maybe an upscale Big Mac."

CAPTION: The display that Sen. Don Nickles (R-Okla.) used in arguments against the Democratic patients' rights plan.