More Care, What Costs?

Although the U.S. Government has increased its annual investment in health from $6 billion to almost $14 billion in a mere three years, that is still not enough, President Johnson said last week. He sent Congress a health message that calls for an estimated increase to $15.6 billion in fiscal 1969, at the same time declaring, "It is appropriate that the Government--which pays more than 20% of the nation's medical bill--take the lead in stem ming soaring medical costs."

In explaining that paradox, Johnson noted that health costs may zoom by 140% in the decade that began in 1965. While the overall cost of living is expected to rise a mere 20% in that span, drug payments are expected to rise by 65%, dental-care bills by 100%, doctors' bills by 160% and general hospital costs by no less than 250%. The President contended that much of the projected increase is unnecessary, and results from an insurance setup that encourages both doctors and patients to choose hospitalization even when less costly forms of care would be equally effective. Also, health professionals are paid in proportion to services rendered, and hospitals charge on a cost basis. In neither case is there any incentive to economize or any penalty for inefficiency. The President urged the Department of Health, Education and Welfare to explore ways of preventing unnecessary hospitalization and of controlling hospital costs.

What really galled the President was "exorbitant prices for drugs" bought with federal funds. Noting that twelve drugs of the same type (prednisone) range from $1.25 to $11 for 30 tablets, he declared: "The taxpayer should not be forced to pay $11 if the $1.25 drug is equally effective. To do this would permit robbery of private citizens with public approval." He asked Congress to let HEW enforce a reasonable price scale for drugs used under Medicare and Medicaid.

How Many & When. Among major goals on which more money must be spent, said Johnson, the first is "to reduce sharply the inexcusably high rate of infant mortality in the U.S." (TIME, Dec. 29). In 1965, said the President, "the rate among poor families was nearly double the national average. In certain city ghettos and pockets of rural poverty the rate was seven times that in surrounding suburban areas." To correct this: We must now provide "essential medical care to the 700,000 needy mothers who now give birth each year and to their infants." So the President recommended a $58 million increase in funds for maternal and child care in fis cal '69.

Equally vital to children's welfare is the parents' ability to decide how many they will have, and when. While he conceded that more research (at $12 million a year) into family planning is needed, the President declared that present knowledge of contraceptives must be made available to many more women who want it. As against $25 million currently available, which has financed family-planning counsel for 500,000 women, Johnson asked for $61 million so that 3,000,000 women can get advice and help. Always, of course, on a strictly voluntary basis.

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