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I can think of only one reason to compel well-to-do senior citizens to pay Medicare premiums of up to $200 a month while their less-affluent neighbors pay only $70: It is morally right.

So I applaud President Clinton for mustering up the political courage to support a means test, knowing that this will earn him the wrath of a huge segment of the population that has above-average political clout. I hope that seeing the overriding fairness of the "ability to pay" proposal has motivated the president more than the fact that he cannot run for re-election.

Over the last three years, while undergoing an assortment of surgeries and medical procedures, I have learned more than I ever wanted to know about the costs of medical care and medicines. Quite honestly, I don't see how people with ordinary incomes can deal adequately with any illness of consequence, and that's why I favor most proposals that require the wealthy to bear a larger share of the health-care burden.

A therapist friend told me recently of an aged patient whose blood pressure was incredibly volatile, most often at dangerously high levels. The therapist found that this patient was supposed to take heart disease medicine three times a day but was taking the pills only three times a week because "that's all I can afford."

I recently left my post-knee-surgery medicines in a hotel in South Dakota. I wanted urgently a supply of anti-inflammatory pills and found at the pharmacy that I had used up the "co-pay" support of my insurance company on that drug as well as the others left in that hotel. So the anti-inflammatory pills that I would normally get for $9 I had to pay $81 for this time, even after the senior citizen's discount. Most elderly people take several different pills and make a lot of visits to medical care practitioners every month, and the costs are far beyond the reach of those who depend on Medicaid and Medicare.

I, like most well-off seniors, have deplored the idea of imposing a means test for Medicare, which turns it into another "welfare" program with the stigma the word brings to it.

I have read the objections of the American Association of Retired Persons (AARP) about the "bureaucratic nightmare" of enforcing a plan under which senior individuals with incomes above $50,000 a year and couples with more than $75,000 annually would pay up to $200 a month in Medicare premiums. Verification of what Medicare recipients claim they owe will be difficult and costly.

Many congressmen have run from this plan for a means test because it is a tax increase on the wealthy aged, and it would, as first proposed, have given the long-hated Internal Revenue Service wider authority to snoop inside the private financial affairs of seniors. Mr. Clinton's alternative proposal to have us seniors figure out our Medicare premiums and send a check to the "Medicare Trust Fund" at the Treasury Department seems more palatable, but would be so inefficient that the revenues raised would fall from about $9 billion over the next five years if collected by the IRS to just under $4 billion.

There are other objections that are logical enough to suggest that the idea of using a means test to determine Medicare premiums ought to be abandoned. But the fairness factor simply overrides all the objections. So let us hope that it is not too late for Congress to enact this plan that would give all seniors a reasonably fair chance to get the medical care they really need.

North America Syndicate

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