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ANOTHER PIECE OF THE HEALTH-CARE PUZZLE

When President Clinton unveils his 1999 priorities after the first of the year, one group that merits budgetary attention is what demographers are calling the "near elderly."

They are the 55-to-64-year-olds who are increasingly becoming the victims of a downsizing, outsourcing economy in which job-based health care is one of the first casualties. Their age bracket will soon be crowded with aging baby boomers.

This group isn't old enough yet for Medicare. Many of its members are struggling but not poor enough to qualify for Medicaid. And they are beginning to contract expensive, chronic ailments like kidney or bladder problems, ulcers and high blood pressure.

While insurance for children is relatively cheap, for these adults policies can run $5,000 a year -- even if they're healthy. For those who already have afflictions, the coverage simply is unavailable at any cost unless they've had it through a current or former employer.

Those who were self-employed or who've been laid off and can't afford premiums are simply out of luck if they fall ill, despite a reform last year that made health care portable. And advocates contend that this age group is losing benefits at a faster pace than any other.

Already, an estimated 3 million near-elderly lack health coverage, out of 21 million in that age range.

But as the baby-boom generation continues to age, the number of near-elderly is expected to balloon to 30 million by 2005. And with that increase, the number of 55- to 64-year-olds without health insurance will increase, too.

And if Congress raises the age of eligibility for Medicare -- as it should to keep that program healthy despite growth of the over-65 population -- even more of the near-elderly may find themselves without coverage.

Solutions obviously will cost, and a Congress intent on balancing the budget while also cutting taxes is not likely to embrace new spending. One possibility being considered in the White House is to let the near-elderly, in effect, cash their Social Security checks early. They would be admitted into the Medicare program early in return for smaller pension checks from the government once they turn 65.

What impact smaller Social Security checks might have on some of the poor after they turn 65 is one question that needs some serious consideration. But at least that proposal puts the issue on the public agenda and can start a discussion of it.

Of course, we've heard the tale of health-care deprivation before. We heard it from workers before Congress passed a reform in 1996 that let workers pay to continue coverage after they leave a job -- if they can afford it.

And we heard it from advocates for children of the working poor. That was before Congress earlier this year approved coverage for kids in families that earn too much to qualify for Medicaid, but not enough to be able to afford private health insurance.

Now we're hearing it again.

We hear it over and over because Congress rejected Clinton's 1994 bid to deal with this nation's health-care problems in a comprehensive manner by guaranteeing basic coverage for all Americans.

Years ago, country singer Johnny Cash scored with a song about building a car "one piece at a time." That seems to be how this nation is building a health-care system.

If we keep it up, Americans might eventually enjoy the kind of cradle-to-grave coverage that citizens in virtually every other industrialized nation take for granted. But surely there's a better and faster way to do it.

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