THE HEALTH BILL

THE health of our people is, inescapably, the foundation for fulfillment of all our aspirations," declared President Johnson in his special message to the Congress outlining a broad health-care program that he termed "practical, prudent and patient." Its goal, he said, was to lay a firm foundation for "the healthiest, happiest and most hopeful society in the history of man."

At the top of the list was the most controversial and most publicized item in the package: medical insurance for the aged. Johnson's medicare plan is similar to one that failed to pass last year,* except for one important difference: while the old plan would have been financed by a simple increase in social security taxes, the new plan sets up a separate trust fund to be administered under the social security program. The change precludes the possibility that unexpectedly high medical costs could endanger the solvency of the regular social security fund. It also means that workers will know just what medicare is costing them. As proposed, that cost will be a payroll tax of no more than .45 of 1% of each worker's annual earnings up to $5,600, with a matching contribution by his employer. This is in addition to the present social security tax of 3.625% from employer and employee, which is already scheduled to rise to 4.62% by 1971.

Medicare would cover some 16 million persons aged 65 or over. Another 2,000,000 persons (many self-employed) not previously eligible for social security would receive similar benefits from the Government's administrative budget. Those benefits include up to 60 days of hospital care paid entirely out of the fund except for the first day, up to 60 days of post-hospital care in approved facilities such as nursing homes, up to 240 home-nursing visits a year, and certain outpatient diagnostic services.

Newest concept in the package is a proposal to set up 32 multipurpose regional centers in a massive attack against heart disease, cancer and strokes, as recommended by a special presidential commission (TIME, Dec. 18). A prime function of the centers would be to diagnose these illnesses early and, in serious cases, help patients take advantage of such new lifesaving techniques as open-heart surgery and high-voltage radiation therapy. The centers would be federally financed extensions of existing medical schools, teaching hospitals and other medical centers. Staff personnel would be chosen by the institutions involved and would work directly for them. A five-year program is planned. Total cost: $1.2 billion, to be financed from general revenues, not out of the medicare tax.

A third major proposal is to permit the Federal Government to contribute to the costs of medical and dental care for needy children in states that are ready to share the expense. Federal aid also would be increased for children who are crippled, mentally retarded, or disabled. Health clinics for migratory workers and their children would be extended, as would community vaccination services. Such increased aid to children would cost $125 million the first year, $320 million the next.

Other items include scholarships for medical and dental students "who would otherwise not be able to enter or complete such training," grants to help cover the operating costs of medical and dental schools and improve their teaching, funds to modernize existing hospitals, loans to build and equip group-practice clinics, and new federal controls over the production and distribution of habit-forming drugs.

No one, of course, knows the cost of this breath-taking proposal. Since it would start slowly, it is estimated that it would merely take an extra $262 million out of general revenue, which would rise to $800 million the following year. This is probably conservative, and is on top of employee and employer contributions.

* The Senate passed medicare as an amendment to a bill increasing social security benefits. In Senate-House conference, House conferees refused to accept medicare, and the bill died.

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