MEDICARE: Expensive, Successful MEDICAID: Chaotic, Irrevocable

When Congress approved Medicare and Medicaid, both proponents and opponents turned prophet. Advocates were sure that the measures would bring enormous health benefits to millions over 65, covered by Medicare, and to more millions in low-income brackets who would be covered (the states permitting) by Medicaid. Doomsayers saw in both programs socialized medicine and the welfare state at its worst; they foresaw hordes of oldsters jamming the hospitals under Medicare and greater hordes of ne'er-do-wells chiseling on Medicaid.

Medicaid has now been extended to 35 states, and has been operating for 21 months in some of them. Medicare, which blankets the 50 states, is 15 months old. Partly—although not entirely—because of the plans, hospital costs are soaring at the rate of 15% a year, double the previous rate. Doctors' fees are edging up, a dollar here and a couple of dollars there. Many physicians are doubling their incomes, while staying within the law. The overall costs of both Medicaid and Medicare are running astronomically higher than pre-enactment forecasts.

Does this mean that the plans are misguided failures? Far from it. Medicare can be rated as a marked success both for the aged treated under it and for the hospitals treating them. Medicaid is suffering from all kinds of inflammatory ills, plus massive financial hemorrhaging, and is headed for drastic surgery before Congress quits for Christmas. But its benefits, in terms of medical treatment for those who could not afford it before, are certainly manifest.

Wilbur Cohen, Under Secretary of Health, Education and Welfare and chief architect of both Medicare and Medicaid, concedes that the Administration is a long way from its goal of making the best health care available to all Americans. But in a recent series of 64 exhausting closed sessions with Congressman Wilbur Mills's Ways and Means Committee, he was confident that the two plans could be improved to accelerate progress toward that goal.

MEDICARE, PART A

Medicare has two parts, each with a separate financing mechanism. Part A provides that anyone over 65 may have his hospital bills paid out of Social Security Administration funds after the first $40 and for up to 60 days at a time. In Medicare's first few months, hospitals complained that they were kept waiting so long for payment that they were being bankrupted. Now all parties have learned to process the masses of paper more expeditiously, and SSA asserts that it gets a check out in ten days, on the average.

Medicare has enrolled 19.1 million elderly Americans under Part A, and on any one day 200,000 of them are in a hospital—roughly, one out of 20. In all, 6,000,000 patients have piled up 7,500,000 hospital admissions at a total cost to the SSA of $3 billion. In a few hospitals, this means twice as many over-65 patients as there were before Medicare, with a national average of 20% more; they stay an average of two days longer than before.