Catastrophic Illness Coverage

There is something terribly troubling about the reaction of American conservatives to the announcement that President Ronald Reagan had decided to support a new program for reducing the costs to seniors of catastrophic illness. Their cries of anguish were louder than anything heard after the revelation of the Iran- contra mess or the debacle of the recent negotiations in Iceland .

One complaint was: “He was supposed to be leading us toward less government and here he is proposing an expansion of the Medicare program. We had expected that he would be moving toward eliminating such things and here he is caving in to a proposal that does just the opposite.”

The source of the distress was a decision by the President to support a proposal that the cost of care for catastrophic illness for those on Medicare be limited to a maximum of $2,000 a year. The suggestion, which was developed by Secretary of Health and Human Services Bowen was to impose an additional charge of $4.92 per month on seniors to pay for the extra cost of the program. It would be self-financing. It would not cost the federal budget a single cent, nor add a single penny to the deficit.

Actually, the proposal was a very modest one, long, long overdue. More than half the people entitled to Medicare benefits receive more than half of their incomes in the form of their monthly Social Security checks. Most of them cannot even afford the $520 payment for the first day of hospital care that is required by Medicare regulations and the record of the last several years since the first day charge inflated so sharply is that seniors are postponing hospital care until their condition becomes so serious that they are forced to enter sicker at greater expense to treat.

Is the cause of the anger among conservatives the fact that these people might be able to get hospital treatment at a maximum of $2,000 a year? Are they concerned that health care might come to be considered an American right? Are they afraid that the senior community might be enabled by such legislation to approach the end of their days wallowing in affluence?

Actually, far less than half the catastrophic financial burdens that are faced by the elderly are addressed by this proposal and this had led Rep. Claude Pepper (D-Fla.) to characterize the program as a “pygmy step” instead of the “giant step” characterization used by the President.

Nursing home care is not covered. Custodial care is not covered. A patient who is a victim of crippling stroke or Alzheimer’s disease may require nursing home care at a cost of more than $2,000 dollars a month and such care is not covered by Medicare or any affordable Medigap insurance policy.

Even if the family is able, at heroic sacrifice, to care for the patient at home, the costs are not limited or reimbursable or even tax deductable as a legitimate expense for the care of the ill. Only when these people spend themselves down to poverty (under $1,700) are they entitled to Medi-Cal.

DANIEL COHEN

Santa Monica