Where I Stand — Classic Hank: Medicare struggles to meet health needs

Friday, Aug. 24, 2001 | 4:47 a.m.

Note to readers: Sun Publisher Hank Greenspun, wo died in 1989, was a prophetic, hard-hitting columnist who butted heads with world giants and demagogues and zealously defended the rights of the little guy.

Every week the Sun will run one of Hank's Where I Stand columns, recalling his finer momentsas a chronicler of the late 20th century. We call this feature "Classic Hank."

TODAY: Recently announced plans call for cuts in Medicare payments for some outpatient procedures, forecasting more gloom and doom for a program that takes care of 35 million senior citizens and 5 million disabled Americans. In this Nov. 13, 1964, column, Hank looks at struggling Medicare as it prepares to meet health needs for aging Americans. Some issues, it seems, never change:

The Golden Years ... but not for some.

Some lie ill and neglected in a nation that boasts of the greatest medical advances in mankind's history.

And what about those who take the oath of Hippocrates? Have these men met their responsibilities to the society they have sworn to serve, or have they permitted their devotion to the private enterprise system to outweigh their dedication to the framed credo you can find on the wall of any doctor's office?

These are the questions of conscience involved in the present struggle in the Congress of the United States over medical care programs for the aged.

On the one hand is the belief of progressive and liberal lawmakers that a nation as rich as the United States could not turn its back on aged residents who meet medical crises at that time of life when they are least able to do so financially.

On the other hand are those who believe that no third party or political entity should be exerted in the relationship between the physician and the patient. There was also consideration of the costs involved in any health program financed wholly or in part by the federal government. Both sides agreed that the various "medicare" proposals would mean increases in taxes for all who contribute to the Social Security fund.

Many will agree with the idea that should a budget squeeze strike, there are many programs that the federal government now finances that are of less importance than the well being of the nation's aged residents.

Or, to put it another way, the nation should not allow its aged to languish and die without medical care or hospitalization when needed.

The fact must also be considered that many of those now in poor health and of advanced years have been wage earners and taxpayers during their more productive and active times in life.

Many also have found the real worth of savings, insurance and pensions reduced by spiraling costs of the necessities of life, including medical care.

Does a nation meet its responsibilities if it ignores the plight of such as these?

On the other hand, there are some basic considerations. We cannot support government medical plans which dictate to a sick person, whatever his age, that he must go to a certain doctor, be confined in a specific hospital or allow for any regulation that interferes with the vital relationship between the physician and those in his care.

There has been on the federal statute books for four years a law known as the Kerr-Mills Bill which provides medical assistance to needy and near-needy aged residents.

The federal government provides to the states, in a matching basis, funds that help pay for the costs of medical care.

The services offered under this bill vary from state to state because the legislatures decide what kind of a program is to be offered and appropriate the money for it.

Available in all 50 states is a medical assistance program for residents on the old age assistance program which also is financed on a federal-state and sometimes county basis.

The Kerr-Mills Bill also covers those on old age assistance, but it also provides benefits for aged residents who can meet ordinary living costs but have no room in the budget for medical problems.

The American Medical Association supported Kerr-Mills while it was under consideration and has made many recommendations for expansion or improvement since its passage in 1960.

As evidence that medical men generally support this program, it is actually administered in Nevada by the State Medical Association, under a contract signed with the State Department of Health and Welfare.

There is no question that the Kerr-Mills program has improved medical care for the aged, especially in those states in which the legislature has provided adequate funds for physicians' care, dental services, and for periods of confinement in nursing homes and hospitals.

Under programs such as that in effect in Nevada, there is no interference with the physician-patient relationship and the bill provides for flexibility in the services with each state the judge of what it can afford.

There are some gaps in it, however, and in some jurisdictions only the bare essentials ... certainly not a program that could be called adequate ... are provided.