MICHAEL DUKAKIS proposes a number of programs to help America's poor with problems of health, housing, and other safety-net issues. As the candidate, or his aides, discuss the programs, however, it is clear that they are aware of the liabilities that large new federal expenditures pose. For example, the governor's program to provide all Americans with certain health-care services in their homes would be financed primarily through a lifting of the cap on social security taxes collected from working Americans. He would finance new construction of low-income housing through some federal funds, but also with additional state and local money. And he insists that no new taxes would be required to provide health insurance to some 15 million Americans who would fall through the cracks between other health-care programs.
In health care, Mr. Dukakis would pay all medical costs for pregnant women from families whose annual incomes are no more than twice the poverty level. He would also make free vaccines available to all children in the United States.
The prevailing estimate is that 37 million Americans now lack basic health insurance. Dukakis proposes to require that US businesses provide such insurance to their employees - which, he says, would cover 22 million of these. After taking office, he says, he would appoint a commission to figure out how to provide health insurance to the remaining 15 million.
Between them, these programs would furnish basic health care for children as well as adults. By contrast, George Bush would provide care for poor young children through his maternal health plan.
Dukakis backs the home health care proposal of Rep. Claude Pepper (D) of Florida, which the House of Representatives this year turned down. It would provide a full array of home-care services - skilled nursing, homemaker assistance, rehabilitation training, and custodial care. The governor has not yet decided whether, to save funds, he would have persons requiring home-care pay some of the cost, depending on their income; the Pepper proposal would not.
Under current law Americans who are paying nursing-home or other heavy medical expenses must spend most of their assets before medicaid, the government's program to aid the poor, will pick up the costs. This year Congress loosened those rules. But Dukakis, aides say, would like to ease this ``spend-down'' concept still further, and eventually to get rid of it.
The governor would encourage working Americans to purchase good private health insurance that would finance long-term care, should it ever be required.
Dukakis feels that health professionals ought to accept as full payment the amount that medicare reimburses them for caring for the elderly, and not bill patients for additional charges. But he says that each state should decide whether to make such an approach state law.
On social security, Dukakis has pledged not to cut payments, and to provide cost-of-living increases based on the inflation rate, as long as he is president.
On homelessness, Dukakis supports the newly enacted McKinney Act, which provides an assortment of services for the homeless. But truly to help many of the homeless, he says, it is critical that more low-income rental housing be built. He wants to provide additional federal funds to get construction of low-income housing going again; but he wants states and localities to commit their funds, too.