Sharing the Medicare Burden

The Department of Health and Human Services has agreed, if reluctantly, to implement a mandate of Congress calling for higher Medicare payments to hospitals serving “a significantly disproportionate number” of low-income people. So it should.

Congress had called for the special compensation three times over the last three years. But the Reagan Administration conformed to the congressional action only when the 40-bed Redbud Community Hospital in Clearlake went to court and won an order. Now Margaret M. Heckler, secretary of health and human services, is pursuing an appeal in the District Court, hoping for a reversal before the new regulations take effect Aug. 1.

This sort of defiant, insensitive administration has been all too commonplace in dealing with the poor and the disadvantaged. Heckler’s assertion that she “strongly disagrees” with the appropriateness of the regulations is unfortunate. There are few who agree with her view disputing that there are exceptional costs inherent in caring for the poor. Her insensitivity to the Constitution’s separation of powers is also to be regretted--stalling for three years before implementing the congressional mandate, and then only under a court order.

The determination to slow the rate of increase in health care is a welcome development, and the shift of Medicare to a prospective payment system, based on standardized payments for particular treatments, has played a constructive part in achieving a cost slowdown. But that does not justify bureaucratic maneuvers that merely shift the burden from the federal government, the responsible agency in this case, to the already overburdened hospitals.