Salvage Catastrophic Health Plan

An unfortunate stalemate between the House of Representatives and the Senate is jeopardizing efforts to salvage at least some benefits from the so-called catastrophic health care law that expands Medicare.

We continue to think that the best solution would be to keep the law in place for at least another year while weighing ways to correct some of its inequities. The inequities that repeal will bring to a majority of Medicare beneficiaries are certainly graver than the inequities affecting some of the more affluent seniors. The cost of repeal to most seniors is already evident in new estimates of the rapidly rising cost of the private Medi-Gap insurance that would help cover expenses if the catastrophic law is repealed.

Many of the additional benefits under the catastrophic law are funded by the income tax surtax charged to 40% of those on Medicare--those with higher incomes. The law also provides for an increasing Part B premium to be paid by all beneficiaries. Congress, panicked by the national campaign by those seniors who pay the surtax, made clear its unwillingness to preserve it.

Without the surtax, the options and benefits will be limited. But there are some desirable elements that can be preserved by maintaining the Part B premiums. Those premiums will range from $4.90 a month now to $11.20 in 1994. That is enough to buy expanded hospital protection, covering everything except a single, first-day payment in a given year, as well as some home-care benefits and access to mammograms, an important breast cancer detection tool of special value to senior women. Because of its low overhead, Medicare is a better bargain than private Medi-Gap insurance. But even the relatively modest Part B premiums are a burden to low-income seniors, which makes it especially important that the legislation continue subsidies to cover their costs.

The Senate conferees continue to support maintaining some benefits from catastrophic under an additional Part B premium, but the House conferees, riven with disagreements, have once again been able to agree only on a call for repeal of the entire bill. The stalemate might have been easier to resolve had the Bush Administration been willing to provide leadership. Dr. Louis Sullivan, secretary of health and human services, endorsed the Senate effort to rescue some of the benefits of the legislation only to have Richard G. Darman, director of the Office of Management and Budget, assert that Sullivan was not speaking for the Administration. So who is?

Even as the wrangle over the legislation continues, a more fundamental review of national health care in under way in the U.S. Bi-Partisan Commission on Comprehensive Health Care, composed of a dozen members of Congress and three appointments made by former President Ronald Reagan.

The commission is charged with developing by March 1 a legislative program to address the need for comprehensive health care at a time when 37 million Americans are without coverage and a long-term health-care program at a time when thousands of seniors face loss of their life savings to provide nursing-home care.

It was led by Rep. Claude Pepper (D-Fla.) until his death and now is chaired by Sen. John D. Rockefeller IV (D-W.Va.). Its mandate reflects the concern of Congress that piecemeal responses, including catastrophic care legislation, are not adequate. At the same time, however, it is evident that bits and pieces of protection are better than nothing while the complex process of developing comprehensive protection is undertaken.