Medicare

THE recent recommendations from Harvard's Kennedy School of Government for overhauling medicare deserve a careful hearing on Capitol Hill. For one thing, the Harvard report recommends expanding the system to cover long-term care for the elderly -- not only in nursing homes but day care, home care, respite care, and hospice care. For another, the report favors replacing some deductibles with higher premiums, which are easier to plan for.

The report also recommends charging the more affluent medicare beneficiaries higher premiums than the less well off pay. This proposal is sure to stir controversy. But the costs of the system are tremendous -- some $70 billion last year, for instance. It seems unreasonable that the affluent elderly pay less than 3 percent of their income for health care, while their less affluent counterparts pay up to a quarter of their income.

The recommendation to simplify the system by combining coverage for hospital and doctor bills is also welcome.

One suggestion not likely to go down well, however, is financing increased medicare costs by canceling the second income tax exemption granted all those over 65 and imposing a 5 percent surtax on those elderly deemed able to afford it. Long-term care is not just an ``elderly issue,'' but a family issue, and should be financed by a broad-based tax, not just a levy on the elderly.