A Dose of Stronger Medicine

By Ted Gup/Washington

For Anna Price of Washington, catastrophic health care means looking after her husband James, 78, a retired federal worker who has suffered for ten years from Alzheimer's disease. He can neither bathe nor dress himself. She frets about him constantly, and about how she will pay the doctor and the sitter who comes twice a week so she can go out to buy groceries. Even the $25 a month she pays for diaper-like underpants for her incontinent husband is a drain on ( their dwindling life savings, now less than $10,000.

Last week the Senate took a sizable step to ease the burden on the Prices and millions of other Americans by passing the Medicare Catastrophic Coverage Act, the most dramatic expansion of federal health insurance since its enactment in 1965. That same day the House derailed a bill that would have provided home health care for the chronically ill. It was a reminder that the Federal Government, too, has difficulty paying rising medical costs.

The Medicare extension breezed through the Senate (86 to 11) as it had through the House (328 to 72) the week before, largely because of its self- financing mechanism. The program is to be paid for by Medicare's 32 million beneficiaries, who will be charged an additional $4 monthly premium plus an income-based surtax. Among the provisions to be phased in during the next three years is the cost of respite care for up to 80 hours a year, which will allow many like Anna Price to hire occasional help. But the bill has little effect on the big-ticket item for 1.5 million elderly Americans: nursing-home costs, which average $22,000 a year.

Nor does it cover long-term home care -- a gap that Claude Pepper, the 87- year-old champion of the elderly, tried to fill with his complementary bill. At $4.5 billion by 1990, the Pepper proposal appealed more to the heart than to reason. "This is a day for which I've waited and worked and I might say prayed for 50 years," Pepper declared in an impassioned plea to his colleagues on the day of the vote. "Think about the human values."

Congress was more inclined to think about the cost, which Pepper proposed to cover by lifting the $45,000 cap on income subject to the 1.45% Medicare payroll tax. Projections showed that this tax hike would cost $9 billion by 1993, a prospect that brought out thousands of small businesses and the U.S. Chamber of Commerce in opposition. They were joined by the health-insurance industry, looking to protect its lucrative stake in private medigap insurance.

The day before the vote, 2,000 delegates at the National Council of Senior Citizens convention in Las Vegas took turns manning phones to remind Congressmen that the council's 4.5 million members were watching. The 28 million-member American Association of Retired Persons also supported the bill. Far more effective, however, was a letter-writing campaign by one of the House's mightiest chairmen, burly Dan Rostenkowski of the tax-writing Ways and Means Committee. He and Chairman John Dingell of the Energy and Commerce Committee were incensed that Pepper had struck a deal to bypass their committees and take the bill directly to the floor. Rostenkowski sent out a barrage of "Dear Colleague" letters attacking the measure, and it was killed on a procedural vote, 243 to 169.

It is not the last Congress will hear of long-term health care. Already the elderly absorb $258 billion in federal spending, two-thirds of the Health and Human Services budget. Yet at present there are only 25,000 Americans over the age of 100. By the end of the century, there will be 100,000.

CHART: NOT AVAILABLE

CREDIT: TIME Chart by Joe Lertola

CAPTION: MEDICARE'S BOOSTER SHOT

DESCRIPTION: Medicare coverage in several areas under current law and under Medicare Catastrophic Coverage Act.