MEDICARE: Expensive, Successful MEDICAID: Chaotic, Irrevocable

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Reagan got some sympathy from Romney, who had just cut Michigan's Medicaid this year from an expected outlay of $180 million or more to $130 million. Then Romney wept for the good old days: "I regret that doctors who for generations gave freely of their help now expect payment for what they gave before." With this, hardly anyone in welfare or medicine, let alone doctors or a patient on the receiving end, would agree. The A.M.A.'s Dr. John R. Kernodle points out that today's physicians cannot give free or cut-rate care as readily as their fathers did. The reasons are many: they have to use and pay for costly equipment, run efficient offices, keep elaborate records, and pay for help and laboratory services.

Medi-Cal and other Medicaid programs may well have been overambitious. New York's certainly was. Most are shot through with manifold abuses and inefficiencies. Wilbur Cohen, being a realist, is backing legislation to set the income limit at 150% of subsistence. While this would vary from state to state, it would average at about $3,000 per family of four. Such a ceiling should cut federal outlays by $600 million a year, while retaining the treasured principle of aiding the medically needy. As with Britain's National Health Service, repeal is unthinkable, though Medicaid may have to suffer some amputations in order to survive.