No Time to Tinker

The balanced and promising extension of Medicare, including expanded coverage of acute-care hospital expenses, is coming under attack from some senior citizens even before the process of implementing it commences on Jan. 1. That is as regrettable as it is shortsighted.

Much of the complaining is coming from higher-income persons who, under the provisions of the Medicare extension, will pay a substantial increase in premiums based on their incomes. What some of these dissidents apparently do not understand is that the program, despite its increased cost, is a bargain.

There is a broader risk in this criticism. It could divert the effort to provide insurance against an even more pervasive risk, the cost of long-term care that now is impoverishing thousands of older Americans. It is inconceivable that a solution can be found to the long-term-care problem that is not based, at least in part, on income-related fees.

The campaign against the new Medicare Catastrophic Extension Act is being led by the National Committee to Preserve Social Security. The committee has been conspicuous in the past for conducting, over the signature of James Roosevelt, a deceptive fund-raising campaign that succeeded in stirring false fears about the integrity of the Social Security system. The committee opposed the new legislation when it was adopted earlier this year, and now is at the center of the protest seeking to change the law just as it starts.

To its credit, the American Assn. of Retired Persons, which worked hard for the passage of the catastrophic-health-care bill, is now working equally hard to educate older Americans on its generous provisions and on the fact--so trenchantly expressed by a prime sponsor, Rep. Pete Stark (D-Oakland)--that it is “a hell of a bargain.”

The premiums for Medicare will remain nominal for most older Americans next year--$27.90 a month for basic doctor coverage, a $4 base charge for the catastrophic coverage, plus an income-tax surcharge that will average $285 for the year. Basic hospital care will continue to be funded from the federal budget and from payroll contributions. The new element will require those who pay income taxes to pay a surcharge ranging next year from $22 to a maximum of $800 a year for those with an income of $50,000 or more. In 1993 the average premium will be $506. Medicare will provide unlimited hospital coverage after individuals pay for the first day of care--$564 next year. In subsequent years other benefits will be implemented--including a cap of $1,370 a year on the 20% co-payment on doctors’ bills, an extension of home and nursing-home care, and a provision for the first time to help pay for prescription drugs.

Paradoxically, much of the criticism of the premiums based on income is coming from retired persons with substantial incomes who normally oppose government intervention but who now want the federal government to pick up all of the costs of the new program. That argument seems to us to be particularly hollow at a time when 38 million Americans, most of them younger working persons and their dependents, are without any health insurance.

The decision in Congress to impose income-related premiums for the expansion of Medicare reflected a recognition that federal budget funding was not politically possible. So the Medicare expansion was made self-funding, with the costs to be borne by the beneficiaries on the basis of their ability to pay. This innovative approach, with its inherent economies of scale growing out of the universality of the program, may very well be adapted to filling other major gaps in the national health-care system. The legislation won well-deserved praise for Dr. Otis R. Bowen, secretary of health and human services, for President Reagan and for the Democratic and Republican leaders of Congress.

This is not the time to tinker with this vital legislation. The priority for Congress is to address the other great gaps in health care--notably the lack of health insurance for millions of citizens and the need for coverage for long-term care at home and in nursing facilities.