Also worth fearing

September 13, 2004

IT'S ALL VERY well for presidential candidates to be squawking over potential terrorist attacks. But there is a real danger looming that isn't getting nearly as much attention, though its impact is likely to be far broader - the soaring cost of health care.

The Bush administration deftly buried the news on Labor Day weekend that Medicare premiums will rise next year by 17 percent to $78.20 a month.

That's a lot of money for retirees on fixed incomes - often elderly widows living exclusively on Social Security - and it doesn't even buy drugs.

What's more, those premiums only cover 25 percent of so-called Part B Medicare coverage - mostly doctor bills and outpatient hospital visits. Taxpayers foot the rest.

Younger folks still in the work force aren't getting off any cheaper. Their insurance premiums increased this year by more than 10 percent for the fourth consecutive year, rising five times faster than wage growth and inflation since 2001, according to a survey by the Kaiser Family Foundation. Employers typically shoulder most of the load, but fewer can afford to offer coverage, resulting in a net loss of 5 million jobs, the survey found.

As the quality of care continues to advance, the ability to afford it lags further and further behind. Few issues are more crucial to individuals and society as a whole. Voters should be demanding that it be front and center in the presidential campaign.

Medicare, in particular, is a ticking time bomb. Republicans have been trying for years to cut costs by moving beneficiaries into private insurance plans, where their care could be more efficiently managed. But private insurers aren't eager to take on the elderly population because they can't make money on them. Older people are the heaviest users of medical services, especially in the last year or two of their lives.

The Medicare law Mr. Bush signed last year includes sweeteners to induce private insurance companies to offer coverage beginning in 2006. But insurers are balking at the law's requirement that plans cover large regions instead of single states.

Simply swelling the ranks of the traditional fee-for-service Medicare that has no limits on access to specialists or expensive medical tests - as most Democrats advocate - is not an acceptable alternative, though.

Democratic challenger John Kerry has a few good ideas for health care reform: allowing Medicare to negotiate for pharmaceutical discounts, and easing the premium burden for younger workers by creating a new federal program to underwrite catastrophic coverage.

Mr. Bush proposes to expand the use of health care savings accounts, which build restraint into the process because health consumers feel like they are spending their own money.

Both are nickel-and-diming, though, in contrast to the size of the problem. Exploding health costs pose a threat about which there can be no doubt.

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