Railroads and Congress

ONE of the great things about the United States Congress is that once a bill rolls through, it has a lot of people aboard, like a great train rumbling out of the station. But the legislative trains of Congress do not always stay on track. They don't derail so much as gather momentum in another direction altogether.

A better metaphor might be one of those wayward grocery carts; it's hard to point all four wheels in the same direction and then get them to move where they should.

So it has proved with the so-called ``catastrophic health insurance'' bills now passed by both House and Senate. Basically, they address the need for additional medicare insurance to cover long hospital stays for the elderly. But there is broad consensus among health-care experts that the real ``catastrophe'' against which the elderly need protection is a possible long stay in a nursing home. This is what bankrupts families and often leaves spouses in dire straits as family assets are ``spent down'' so that the partner in need of care qualifies for medicaid.

Long-term nursing-home care should not be seen as a daunting problem, but it will take a lot of time, energy, thought, and money to work out the kind of program the country needs. The program for long-term hospital stays is much easier, much cheaper - and will help far fewer people. No wonder the train took off along this downhill grade.

The White House has favored action on long-term hospital stays all along, and looks likely to approve the conference bill expected to be worked out sometime during this session. Since the new programs will be financed by premiums rather than general revenues, it should at least be noted that this is a ``budget neutral'' bill - for now, anyway.

But as for meeting the more serious need, we'll have to wait for another train.

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