Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, February 27, 1991                   TAG: 9102270492
SECTION: EDITORIAL                    PAGE: A-10   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

PREMIUM PLAN/ MEANS TESTS FOR MEDICARE COVERAGE?

With costs spiraling in the taxpayer-financed entitlement program, and the boom in the elderly population raising demands for benefits, there should be, as AARP legislative director John Rother says, an "ability-to-pay principle" written into the program.

If budget realities require entitlement cutbacks, surely these should be targeted at people who would be hurt the least. The principle of entitlement thereby loses value - not an inconsequential loss. But the alternative, significantly reduced benefits for everybody, is worse.

It makes no sense for the federal government to pay annually for the hospital care of an estimated 10,000 millionaires aged 65 or older - the same as if they were penniless.

It's unseemly, if not outrageous, that the government is subsidizing doctor bills for those earning $125,000 or more a year in interest on their investments, and paying for costly medical devices for people with personal income of $500,000 a year.

The AARP, while open to the idea of means-testing, opposes President Bush's proposal for introducing a hint of means testing in the $112-billion-a-year Medicare program. An income-related premium was a key feature of the Medicare catastrophic-benefits law that Congress recently enacted, then repealed under pressure from seniors.

That was a good law. The new proposal also is reasonable. It would triple premiums for the doctor-insurance portion of Medicare coverage paid by those with taxable income above $125,000. Instead of paying $31.80 a month for so-called Part B coverage next year, about 600,000 of the wealthiest seniors under Bush's plan would pay $95 for this insurance that is heavily subsidized by the Treasury. To continue offering benefits for those who It's unseemly, if not outrageous, that the government is subsidizing doctor bills for those earning $125,000 or more a year in interest on their investments. cannot do without them, the government has to renege on automatic benefits for the well-to-do.

Granted, the plan, part of the Bush administration's 1991 budget recommendations, is not a full means-test. High-income people would only pay higher premiums; they wouldn't be excluded from coverage altogether. Nor would the proposal make much of a dent in the federal deficit, saving only about $1.2 billion over five years.

Certainly, the proposal does not qualify as a comprehensive reform of the nation's health-care system. It's a piddling aside next to health-care costs, which have reached an astounding $600 billion annually and continue to rise. It won't address the problems of the uninsured or underinsured, or the spiraling expense for businesses.

Even so, the minor means test is worth enacting - if only as an opening to debate about entitlement programs generally. Why should age rather than income entitle someone to government benefits?

Critics say the president's proposal is a cynical maneuver to blunt Democratic efforts to portray Republicans as coddlers of the rich. Maybe so. On the other hand, as long as Bush keeps pushing for a capital-gains tax cut, Democrats needn't worry that the coddlers-of-the-rich issue has been wrested away.