MEDICARE: Expensive, Successful MEDICAID: Chaotic, Irrevocable

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Demand for Dentists. In a fully participating state like New York, the impact of Medicaid is immense. Under the $6,000 family-income ceiling, about 6,000,000 of New York's 18 million people would probably be eligible; 2,700,000 have already qualified, despite forbidding red tape and Double-Crostic forms; 1,700,000 of these are in New York City—half of those believed to be eligible. The U.S. pays half the medical bills for most patients, the state pays one-fourth and local governments onefourth.

So far, Medicaid has cost $350 million in New York City. The current fiscal year's total is expected to rise to $420 million, and $600 million the following year. The system in the city is so snarled and complaints are so loud that Mayor John Lindsay last week asked for a prompt report.

A major complaint in the state, and especially in the city, is that only a minority of doctors, dentists and druggists are participating in the plan and accepting Medicaid patients. Some doctors say that they cannot be bothered with the paper work and would rather treat patients free. Some are suspected of holding out (though there can be no proof) because Medicaid pays by check, whereas now they can pocket unreported cash fees. Some doctors who do participate are enjoying hugely increased incomes because now they are sought out by patients formerly kept away by pride and poverty. The biggest boom has been in dental services, for which there was a huge and largely unrecognized backlog demand. When Medicaid started, New York paid out less than $1,000,000 in a three-month period for welfare recipients' dental care. Now the quarterly bite is almost $10 million.

Sympathy from Romney. California embraced Medicaid early and enthusiastically but changed its name to Medi-Cal. Now it threatens to become Medi-Lo-Cal. In mid-August, California Health and Welfare Administrator Spencer Williams ordered a $210 million cut in Medi-Cal outlays to keep them within the state budget. Biggest cuts would have been in non-emergency surgery, length of hospital stay, drug bills and dental care. But a superior court judge declared the cutbacks illegal. Governor Reagan appealed, and the State Supreme Court is expected to hear the case in about a month. Meanwhile, Reagan has threatened those who provide care that if they ignore the cuts and he wins his appeal, they will not be paid by the state for the disputed expenditures.

Against this backdrop, Reagan invited eight Governors to confer with him in San Francisco on Medicaid. Only Michigan's George Romney found it politic to attend, briefly, for the final session. Reagan told assembled health and welfare officials: "Unless Medi-Cal is revised and revamped, it not only can but most assuredly will bankrupt our state." California has a higher proportion of its population on welfare—though not necessarily of the medically needy—than New York State.