Remedy for Health Care

Significant initiatives to address shortcomings in the American health-care system are under way in Washington and Sacramento. Major obstacles lie ahead, but the prospects of some constructive action this year have improved.

In Washington the focus is on Medicare. The most promising initiative is developing in the Senate Labor and Human Resources Committee under the leadership of its new chairman, Sen. Edward M. Kennedy (D-Mass.), who is determined to implement a long-overdue protection against catastrophic medical costs.

In Sacramento the leaders of the Assembly and Senate today will convene a bipartisan task force to deal with two problems: the crisis in Medi-Cal, the health-insurance program for low-income people, and how to provide health-care insurance for 3 million Californians without any.

The legislative initiatives contrast with inaction and indecision at the executive level. President Reagan reportedly has not decided what to do about catastrophic health-care protection. And Gov. George Deukmejian, after underfunding the Medi-Cal program for the current year, has proposed further cuts for a program already crippled by earlier cuts.

The Reagan Administration’s indecision was reflected Monday by the refusal of Dr. Otis R. Bowen, secretary of health and human services, to testify before Kennedy’s committee. Bowen earlier supported a task-force report outlining a constructive way, at minimal cost, to provide catastrophic health-care protection through Medicare. The insurance industry, supported by right-wing critics of Medicare within the Reagan Administration, is waging war on that proposal because it would compete with Medigap insurance now sold by private companies to those on Medicare--ostensibly to help them cover expenses not paid by Medicare. The wastefulness and ineffectiveness of many of those Medigap policies were dramatized coincidentally on Monday in hearings by the California Insurance Department.

While the Senate hearing was under way, Bowen was at a meeting of health-maintenance organizations telling them that the Administration hoped to create new incentives to encourage more Medicare participants to join such organizations. Studies have shown that health-care costs can be reduced and quality preserved in well-run health-maintenance organizations. Bowen’s initiative makes sense if it is matched by oversight to assure quality maintenance. But if the Administration had its priorities right, Bowen would have been before the Senate committee advocating his excellent earlier proposal on catastrophic protection.

None of the proposals pending in Washington, unfortunately, address the most critical problem of all for older Americans on Medicare--the problem of long-term care that each year consumes lifetime savings of thousands of persons and reduces them to poverty. Bowen’s proposals for a government program on catastrophic protection do not cover long-term-care costs. His report suggested that the government offer tax incentives to encourage older Americans to seek private insurance for long-term care, but the costs of that insurance are out of sight for most Americans. Neglect of that issue is a national disgrace.

Willie Brown (D-San Francisco), Speaker of the California Assembly, and David A. Roberti (D-Los Angeles), president pro tem of the California Senate, have stepped in to fill the vacuum left by the governor in health-care finance. They have convened a bipartisan task force to seek solutions to the Medi-Cal funding crisis and to the broad problem of uncompensated care as increasing numbers, including many working people, are left without any health-care protection. They have invited the governor’s staff to join in the study. California can be grateful to the leaders of the Legislature. There is urgent need for improved health services to the poor. The importance of universal medical-insurance protection was cited in testimony in Washington on Monday by Joseph A. Califano Jr., the secretary of health, education and welfare under President Jimmy Carter, and earlier in Sacramento by Drs. Milton I. Roemer and E. Richard Brown of the UCLA School of Public Health.

The richest nation is best, as it should be, in the quality of its health care, but far from first in the equitable delivery of that care. All would benefit from a remedy for that discrepancy.