Debate Over Plans to Change Medicare

The Times was correct in stating that President Clinton’s “kinder-and-gentler” approach to shoring up Medicare Part A was based more on political savvy than substantive answers (editorial, June 7). Shifting home health care funding from Part A to Part B is more sleight of hand than it is good policy.

California’s home care providers are solidly opposed to the proposed shift because it may actually increase costs. By limiting Part A coverage to “post-hospital” services, the administration’s proposal completely ignores the fact that millions of elderly Americans use home care to prevent the need for hospitalization. This proposal will also force many home care patients who need extensive care into expensive institutions, which will surely increase Medi-Cal costs. This plan could ultimately lead to co-payments that will prevent the very elderly from receiving the cost-efficient, quality home care they need.

The California Assn. for Health Services at Home (CAHSAH), whose members serve over a half-million home care patients, has worked extensively with other states to find a better answer. The industry has proposed a new reimbursement system called “prospective pay” that would save an estimated $20 billion over seven years by capping costs and eliminating much of the complexity that leads to waste in the Medicare system. The plan is now before Congress.

JOSEPH H. HAFKENSCHIEL

President, California Assn.

for Health Services at Home

Sacramento

* Truth in billing is the basic level that must be corrected. Cost-transferring is a well-known practice. Your bill may get a 300% markup to pay for someone else. This is a social tax that must be identified on the billing. Until this fraud is corrected no Medicare solution is possible.

ALLEN C. HAGELBERG

Upland

* Re “Investing in Research Will Rescue Medicare,” Commentary, June 7: I imagine the ones who will be against it are those people who are in such a hurry to get to tomorrow, they don’t stop to finish today’s work.

Warning: If Medicare goes, younger people will still be stuck. Or will they turn their backs on sick parents?

Edward Schneider’s article is a simple idea, a sensible one and will give a far greater return sooner than later. Let’s not worry so much about voyages to other planets. Let’s concentrate on making people here healthy enough to enjoy this one.

JUDITH JACOVITZ

Laguna Hills