Health-Care Catastrophe

For the victim, there is little choice between cruelty that is deliberate and cruelty that results from common political callousness. Last year’s attempt to shelter older Americans from the financial panic often created by a long illness is a case in point.

Nothing in the program dealt with the most common medical crisis among the elderly, the long-term confinement to a nursing home that can devour the most carefully assembled nest egg. But it did extend coverage for longer-term hospital stays, promised relief from major doctor and drug bills and was better than what Medicare offered at the time. We supported it as a good first step toward something even better.

It is now clear that the Medicare Catastrophic Insurance Act was doomed from the start by two factors. It was conceived as a political gesture, not a medical program. And former President Reagan insisted that the elderly pay the entire cost of insurance to cover bills for long-term illness rather than having the burden shared with the nation’s working population. That led to a revolt of “haves” against “have-nots,” stirred up by a mail campaign that strayed occasionally from the truth.

Campaign or no, 5% of the people for whom Social Security is only one source of their income were to pay an income surtax that could have reached $800 each this year. That was necessary to make the plan work for the 60% of pensioners whose incomes were so low that they paid only pennies a day. On top of that, the 5% with relatively high incomes usually had private pension plans to support them through long illnesses and did not need any help from Medicare. It doesn’t take being wealthy to balk at a financial proposal that gives you nothing for something, but Congress did not have to cave in as fast as it did to pressure from the more affluent and vocal pensioners.

The House of Representatives voted last week to repeal the catastrophic act entirely. In today’s Washington, it seems appropriate that the senator who got a bill through his chamber that stripped out many benefits but did not actually kill the act is something of a hero. The odds are that the House will prevail over the Senate and that Congress, which in consort with President Bush gave 33 million older Americans less in the way of protection than they needed, will snatch even that much away from them. Because Congress cannot stop long-term illness, costs will be met in other ways with higher private insurance premiums, from savings and from state programs for the elderly poor.

Rep. Anthony C. Beilenson (D-Los Angeles) voted against the act in the first place because “it covered the wrong catastrophic needs” and cost so much that Congress would never extend it to nursing homes. Beilenson would go back to square one and design a new and balanced federal health program.

The ultimate goal should be a national health plan that would cover the important needs of the elderly, extend medical coverage to some 38 million Americans who now pay their own bills or get along without either doctors or hospitals, and sharply curtail the cost of health care that now approaches 12% of the gross national product.

The cost to Washington of expanding health care along those lines is estimated at between$50 billion and $70 billion a year. Congress has some, but not much, time to find ways to pay for it. Otherwise, it will have to sit by while its plan for a catastrophic health-care program disintegrates into a health-care catastrophe.