Catastrophic insurance for all.

• Author: Hook, Janet
• Position: Health insurance for poor

CATASTROPHIC INSURANCE FOR ALL

In the current debate over providingcatastrophic health insurance, the loudest critics have been conservatives who think this would be an unnecessary expansion of government. Ironically, the last time Congress seriously considered giving the federal government a role in paying for catastrophic health costs, it was liberal Democrats who were on the front line of opposition.

In 1979, legislation to guarantee catastrophiccoverage for extraordinarily high medical bills was gathering steam in the Senate. But organized labor and other liberal forces objected to plans that provided only catastrophic coverage. They had long been pushing for a bigger prize, national health insurance, and feared any half-measure could take the impetus out of their drive. Senator Abraham Ribicoff pleaded with labor to drop its all-or-nothing strategy and support a politically achievable plan: "Isn't 50 percent of something better than 100 percent of nothing?' They got 100 percent of nothing.

Liberals may now conclude with regret thatthey missed a great opportunity to move in the direction of broader health insurance coverage. But they were on to something in 1979. The principle underlying their resistance was that it is hard to justify giving priority to expanding benefits for people who already have basic health insurance coverage when there are so many people who don't have even that.

That principle should not be forgotten as thecurrent revival of interest in catastrophic insurance gathers momentum. The plan urged by Otis Bowen, the secretary of Health and Human Services, would expand medicare to cover catastrophic hospital bills for the elderly. Such and expansion would not do anything for the 30 million or so young and middle aged who have no health insurance and for whom even a $2,000 medical bill could be catastrophic. And for the elderly, the plan wouldn't even cover nursing home costs, which are a more serious problem for them. With more imaginative funding ideas we could afford a wide-ranging catastrophic plan.

A letter from Danny Thomas

Most people know someone who has been hitby an illness that requires long, expensive care. Victims of a car accident, cancer, or Alzheimer's disease have in common the tremendous expense of extended care. At a House Ways and Means hearing on the subject last year, Rep. Hal Daub, a Nebraska Republican, told his colleagues that his 67-year-old father had incurred almost $300,000 in medical bills from seven months in the hospital, including four in intensive care. Daub's father was covered by Medicare, and had a supplemental private insurance policy, which meant he "only' had to spend about $20,000 of his own.

Our current health care system provides basiccoverage for 28 million elderly through Medicare. But there is now no ceiling on the out-of-pocket expenses they may face. Medicare beneficiaries have to pay at least 20 percent of their doctors' bills, a deductible for each hospitalization, and a hefty share of the tab for hospital stays longer than 60 days. After 150 days in the hospital, the elderly pay all their expenses.

Prodded by high-pressure sales techniqueswarning that...