The Applause Is Deserved

An excellent piece of legislation to expand Medicare benefits has emerged from the Senate-House conference committee. Its passage by the House on Thursday is expected to be followed by Senate approval next week. President Reagan’s signature seems assured by the constructive role played in the negotiations by Dr. Otis R. Bowen, secretary of health and human services.

It was Bowen’s strong support for providing better protection of older Americans against the high cost of health care that set the stage for this legislation. He won the support of the President. And he has worked with Congress to help sort out a variety of benefits that have been added. The final product is a job well done.

The legislation has come to be known as the catastrophic-care bill, which it is not. It would protect against catastrophic costs for in-hospital care and doctors’ services, and that is important. But it does not address the greatest health-finance catastrophe facing older Americans--the cost of long-term nursing-home care that each year consumes the life savings of thousands of senior citizens. That is being left for separate action--a wise decision. The very complexity of long-term care suggests that it should be put over as the first priority of the new Congress next year.

In expanding the benefits of Medicare, Congress has for the first time introduced payments based on income beyond the fixed premiums that have always been part of supplementary coverage. But for those with incomes below the poverty line, the government will pick up all costs, including the premiums and co-payments for doctors and hospital services.

In another innovation, coverage for prescription drugs will be phased in so that by 1993 Medicare will cover 80% of the cost after a person has spent an annual deductible, which initially will be $600.

For the first time there will be an annual cap on the out-of-pocket fees paid by a person for doctor services. Persons will be required, as now, to pay 20% of approved doctor fees, but the cumulative total of these co-payments will be capped at about $1,400. Under present law, there is no limit to the out-of-pocket co-payments for medical services.

There will be two supplementary premiums. One will be a flat charge, beginning at about $4 a month, that will be added to the present Part B premium of $24.80 a month. The other will be income-based, rising over the years from 15% to 28% of income tax, with an initial maximum of $800 a person or $1,600 a couple per year. Those are bargain prices, made possible by spreading the risk among all who are 65 or older.

The work of the conference committee was guided by Rep. Dan Rostenkowski (D-Ill.), chairman of the House Ways and Means Committee, and Sen. Lloyd Bentsen (D-Tex.), chairman of the Senate Finance Committee. But they recognized the crucial role played by Bowen in the process. So it was no surprise that the conference committee, on reaching a final compromise agreement, honored Bowen with a burst of spontaneous applause.