A LID ON MEDICARE NEEDED TO KEEP COSTS FROM SOARING

Though doctors are sure to complain, a subcommittee in the U.S. House of Representatives took reasonable action this week in trying to curb the cost of Medicare by putting a ceiling on physician reimbursements.

The proposal would limit the national total that doctors can charge beyond the current level of Medicare-approved fees.Earlier attempts to limit increases in fees on a case-by-case approach have not worked. Doctors simply responded by performing more Medicare-paid services for the patient.

The $90-billion-a-year Medicare program includes $24.5 billion in payments to physicians. Those payments have been growing at an alarming 15 percent a year for most of the decade - twice the rate of inflation.

Under the House plan, Congress would set an "expenditure target" beginning in 1991 that would limit payments for physician services, based on total nationwide spending the previous year. Adjustments would be made for inflation and growth in the number of patients.

The American Medical Association has opposed setting spending targets as a form of health-care rationing. But something must be done to keep taxpayer-financed Medicare expenses from soaring out of sight.

In the days before Medicare and Medicaid, doctors frequently treated the elderly and poor at minimal cost or even for free. Since the advent of federal insurance programs, too many physicians charge all that the traffic will bear for such patients. If they feel that's not enough, some simply refuse to take Medicare patients.

A whole new generation of doctors is growing up that, in many cases, has much less experience with, and much less dedication to, the idea of donated service to the needy.

The enormous drain on the U.S. treasury by Medicare - far beyond what anyone envisioned when the program began - is reason to view with caution the proposals being made by some in Congress for a form of national health insurance to cover the 37 million people who do not have private insurance.

Unless Medicare expenses can be brought under control, the whole program will remain threatened from year to year with bankruptcy. That's no way to run a medical care plan.