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Hope for Chronically Ill

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The new secretary of health and human services, Dr. Otis R. Bowen, has proposed an extension of Medicare to provide protection from the costs of catastrophic illness and long-term nursing-home care. His constructive proposal was particularly useful at a time when many others in the Reagan Administration and many congressional leaders have focused on cutting the cost of Medicare rather than assuring the adequacy of its funding and services.

Bowen’s proposals came during his confirmation hearing. The hearing coincided with the publication of a new study confirming the appalling failure of the United States, through either private insurance or government program, to provide for long-term care of older citizens except those who are impoverished to the point of qualifying for Medicaid--known as Medi-Cal in California.

The inadequacy of present protection has forced hundreds of thousands of older citizens to exhaust their life savings before becoming eligible for the nursing-home care that they require. And, to make matters worse, the dependency on the Medicaid program has worked to push more and more persons into institutions at the expense of community alternatives, including less costly home care.

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There is vast ignorance of the problem. Many elderly people think that they are protected by Medicare, the universal medical- and hospital-protection plan for those 65 and over. But Medicare covers only about half the costs of acute hospital care and physicians’ services for those 65 and over. And its provisions for nursing-home care are extremely limited. In 1980, for example, Medicare was covering an average of 30 days of skilled nursing care when the average length of stay nationally was actually 456 days. Furthermore, after minimum periods, Medicare requires costly co-payments that can in themselves contribute to the exhaustion of life savings. And most supplementary private insurance policies that patients use to cover the so-called gaps in Medicare coverage do not make provision for long-term nursing care, according to the new study.

The need is enormous. An estimated 6.6 million Americans 65 and over require long-term care--a number that will reach 9.3 million at the end of this decade.

Bowen proposed a premium, estimated at $12 a month, to be paid by those under Medicare to provide long-term care protection. That would be in addition to the $15.50 monthly premium already charged. It would be optional. It would be a bargain, however, for that kind of protection. Nursing-home care now runs from $2,100 to $4,500 a month, according to the study. The expanded Medicare program would have the further advantage of taking some of the pressure off the Medicaid program. Long-term nursing is the fastest-growing element of Medicaid; it consumes almost half the entire Medicaid budget.

The new study was made by the Employee Benefit Research Institute. The research was partly funded by the Atlantic Richfield Foundation and the American Assn. of Retired Persons.

The study comes at a useful moment as the Administration and Congress sort out their budget priorities. Clearly this is a failure in the national health system that requires correction. It is not in the national interest to force senior citizens to become impoverished before they can have appropriate long-term care.

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