Although Congress is finally nearing approval on a catastrophic health insurance plan for Medicare, coverage for the high costs of long-term care in a nursing home is not included in the bill.

Yes. It certainly is for those who can pay now for their own future care.

A year in a nursing home costs about $22,000. Americans pay for it out of pocket and need an alternative.

Insurance spreads risk so people can trade the possibility of unpredictable catastrophic expenses for a predictable, affordable premium.

Coverage for long-term care is especially workable through employer-sponsored plans that can encourage people to set aside money during their working careers. It may be hard to put another expense on employers now, but appropriate tax incentives would surely encourage this process.

Those who think people won't look far enough ahead to buy such coverage may be wrong. Tens of millions now use today's funds to buy tomorrow's choices every time they pay a premium for life, health or disability insurance.

Some people won't be able to buy the insurance. Financing their care is an appropriate public responsibility.

The nation's current annual $38.1-billion nursing-home bill cannot be handled by the public or private sector alone. Demographic projections suggest these costs will escalate.

We face an enormous budget deficit and many social needs. Our society must make just decisions in allocating scarce resources. I believe those who can afford to pay for their care should be encouraged to do so.

But insurers will not invest a lot of money to develop coverage for long-term care if they believe the government will eventually push them out of the business.

Bruce L. Boyd

chairman, Task Force on Long-Term Care, Health Insurance Association of America; vice president, Teachers Insurance and Annuity Association, College Retirement Equities Fund, New York

No. The Medicare catastrophic coverage that's expected to become law would cover only 20 percent of costs that impoverish the elderly. Long-term care accounts for the rest. It's the biggest hole in our society's safety net. Nursing-home care's cost averages $22,000 a year, but in high-cost areas it can go over $50,000. Older retired persons' median income is only $11,500 a year, so they quickly spend all savings.

The House Committee on Aging reports that nearly 50 percent of elderly persons living alone are impoverished within 13 weeks of entering a nursing home -- and couples within a year after either spouse enters.

Private insurance policies have a basic flaw. They're indemnity policies, paying a fixed amount. You buy a policy because the indemnity payment will meet the current nursing-home costs in your community. But if you enter a nursing home 10 or 12 years later, our history of inflation says the payment will cover only a portion of the cost.

Americans are optimistic. If insurance is optional, only those aware of an incipient condition or those with family members under long-term care are likely to buy. That might not create a sizable enough risk pool.

Group policies through employers would be better, but employers are holding the line on benefits. The answer is the mechanism that has worked for Social Security and Medicare -- a payroll tax that covers the whole population.

Six out of seven Americans want a government long-term-care program, a 1987 survey showed. And by a margin of five to two, they're willing to pay more taxes to get it.

Donald Reilly

senior vice president, National Council on the Aging, Washington