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How to Insure? The problem is less one of providing care than of providing insurance—insurance that would let oldsters pay for their own minimum care without having to pass a means test or take the dreaded step of applying for charity (the mere name "state" or "county" hospital can be a psychic shock to many). All the Democratic proposals revolve around Forand's plan to graft health insurance onto the social security system. That plan has advantages: the social security system is nationwide and well administered, does a sound and economical job of distributing monthly pensions (range: $33 to $254) to 13.5 million people, mostly oldsters. A compulsory plan could probably offer lower premiums than a voluntary one, would avoid the onus of a handout because everyone would contribute toward his own ultimate benefits. But Forand's plan also has disadvantages. At the outset it would force today's wage earners (and employees) to carry the load for the oldsters. It would subsidize the rich along with the poor, yet do nothing for the 4.000,000 aged uncovered by social security. It would probably raise less in contributions than it would pay in benefits, and the Government would be stuck with the check for the difference, which health insurance officials say would run into billions.
Private enterprise's answer to the Forand plan is private insurance. The insurance industry claims that 49% of the aged have some coverage from private policies, and up to 90% will have some by 1970. But more important than the number over 65 who have limited or comprehensive coverage is the number who have none at all: at least 51%. Many private policies for the aged cost much, pay little, do not cover certain illnesses, can be canceled at any time. One popular policy sells for $78 a year, pays maximum annual benefits of $610—$10 a day for up to 31 days' hospitalization, plus $300 for surgery and related bills. A ward hospital bed usually costs $20 a day, and the bill for treating a malignancy, stroke or fracture—the most common major medical afflictions of the aged—can easily run to $3,000.
Supporters of a Forand-type bill hold that it is economically impossible for the private insurance firms to provide'comprehensive coverage for people in their last years of failing health. Searching for an alternative to the Forand plan, Arkansas' Democratic Congressman Wilbur Mills, chairman of the House Ways & Means Committee, told the private insurance companies to frame a model "group'' policy for 13 million aged persons; they returned with a rate schedule that would cost a thumping 1.8% of the nation's gross payroll. Mills argued that the social security system could provide the same coverage for one-sixth that amount.