Will It Work?

Rolls closed on Medicare registration last week. Some 17.3 million people over 65 (an incredible 91% of those eligible) had signed up for the voluntary $3-a-month insurance plan that entitles them to bargain-rate doctors' care beginning July 1. On that day, a total of 19.1 million elderly people who are drawing social security benefits automatically become eligible for low-cost, Medicare-financed hospital and nursing-home care. A very automated data system stands ready in Baltimore to handle the record-keeping end of the intricate program that Health, Education and Welfare Secretary John Gardner understates as "an extraordinarily interesting partnership between the Federal Government, the hospitals and nursing homes, state health agencies, private insurance companies and the medical profession."

Nevertheless, plenty of people are wondering whether Medicare might not need something far, far more than extraordinary management to make it work. No one will know for certain how complicated its ailments will be until after the program goes into effect next month, but there are plenty of symptoms to worry about. To wit: sbCROWDED FACILITIES. No one in the Administration or in the American Medical Association can be really certain as to how many aged eligibles will jam into hospitals for long-delayed, noncritical "elective" operations or other "nonessential" treatment. It would not take too many to cause a serious problem, for there are not many beds available; some 25% of the nation's hospitals are already filled to capacity. Beyond that, the Medicare bill prescribes medical standards that hospitals must meet before they can qualify as Medicare institutions; only 3,000 of the U.S.'s 8,200 hospitals had been approved as of last week. Another 3,000 may be approved this month, but the extra strain put on those that do qualify is bound to be enormous. The Government has no way to even out the increased patient load, for Medicare registrants are free to choose their own doctor or hospital. Even if there were enough beds available, the nurse shortage is rapidly worsening; the nation has vacancies for 75,000 registered nurses and 25,000 practical nurses. Insofar as Medicare-backed nursing-home treatment is concerned, less than one-third of the U.S.'s 700,000 nursing-home beds are in institutions that have the medical staff and facilities to qualify for Government payments, sbSEGREGATION. Under Title 6 of the 1964 Civil Rights Act, federal money cannot be appropriated for public institutions that practice racial discrimination. A last-minute campaign by Social Security Commissioner Robert Ball, who is the overall Medicare administrator, has convinced some Dixie hospital administrators that the financial benefits offered by guaranteed Medicare payments outweigh outmoded habits of bigotry. Yet right now, only one-fourth of the hospitals in the South can qualify for Medicare coverage on grounds of desegregation--a fact that will cause critical pressures on the few integrated institutions that will have to carry the entire Medicare load.

sbEXTRA INDIGENTS. And then there is Title 19, a little-publicized section contained in the Medicare act. It, too, will add to the U.S.'s new-patient load, for it extends existent federal programs--offering free health care to children under 21 of impoverished families and to adults between 21 and 65 who are blind or "disabled." Title 19 requires individual states to assume part of the cost, but seven states and Puerto Rico have already passed the necessary legislation.

sbDOCTORS' FEES. One of the prickliest problems involves the system of paying doctors, already angered by the specter of bureaucrats interfering in their practices. Dr. Philip Randolph Lee, Assistant HEW Secretary for Health and Scientific Affairs, said last week: "We have heard from some sources that physicians have raised their fees in anticipation of Medicare." A guidebook went out last week to some 230,000 physicians reminding them that the Government will pay "reasonable" fees--meaning an amount close to what the doctor usually charges non-Medicare patients in his area.

The Administration is not unaware that potential chaos lies ahead. President Johnson announced last week that 200 doctors and hospital executives had been invited to Washington for a June 15 conference on the program, and he ordered that social security headquarters in Baltimore mount a round-the-clock Medicare information service.

The President, at least, was sanguine about Medicare's future. "I do not believe the few of little faith who say it will fail," he said to a White House ' delegation from the National Council of Senior Citizens. "I see it as a blessing; I say it will succeed. I see it as a beginning, not an end. I say it is another battle in the larger struggle to ennoble man's life. And I ask--I expect--every man's hand to join with mine in that."

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