Gov. Gerald L. Baliles of Virginia has proposed soaking the sick to care for the poor.

He might not regard it that way. But that would have been the result of a plan he suggested to rescue the state's hard-pressed -- and notoriously inadequate -- Medicaid program for the needy and uninsured.

He proposed to charge every Virginia hospital $5 a day and every nursing home $1 for each of their beds to bolster the Medicaid fund.

The idea sounded good to some people. Hospitals aren't popular, nursing homes less so. Many hospitals try to turn away or transfer patients who can't pay. Why not make them cough up?

"This is a very innovative and forward-looking idea," said Del. Dorothy McDiarmid (D-Fairfax), Virginia House Appropriations Committee chairwoman.

But who would really pay the $5 or $1 a day?

The hospitals' and nursing homes' patients and/or their health insurers, that's who.

Hospitals and nursing homes would inevitably have to increase their charges to come up with an estimated $58 million a year -- $640,000, for example, for Arlington Hospital.

Health insurance premiums would go up even further after a year in which they have typically shot up from 12 to 38 percent or more.

Patients, "covered" or not, would have to shell out more cash, since insurers are paying less and less of their bills.

In short, the sick would be charged to care for the poor sick.

Many of the sick, in fact, are already being charged -- soaked, I would say -- to pay for other patients in the same hospital. This is because neither Medicare nor Medicaid pays the average hospital's full costs. Every hospital also winds up with some unpaid bills. Hospitals have to charge paying patients more to make up these losses, a long-essential system of internal cost-shifting.

Who should pay for the care of the poor?

The question is one that needs to be addressed everywhere, not just in Virginia. The answer, it seems to me, is that the burden should be shared by all of us who pay taxes, not by those on their backs in hospital beds.

No legislator or official, of course, likes to raise taxes. In polls, people commonly say they are willing to pay "more" for this cause or that. They then vote against politicians who ask them to do so.

Virginia's Medicaid problem is especially acute, to be sure.

The Public Citizen Health Research Group ranked state Medicaid programs by coverage and other characteristics. Virginia's ranked 42nd, after Texas' and Oklahoma's. Virginia Medicaid covers only 21 hospital days a year. Limits on well-child, mental, home, dental and many other services are "disastrous," the Health Group said.

Only 54 percent of those below the poverty level are eligible. In 1986, a family of three with an annual income of $5,300 would have been ineligible for either Medicaid or a small plan for the "medically needy."

The program has nonetheless increased in cost by more than 330 percent in 12 years. It will cost $1.55 billion in the 1988-90 two-year period, with the state paying half and the federal government half. Virginia's 1988-90 budget includes a $145.9 million boost to keep services at the current level.

Starting in 1990, Baliles warned, an even larger increase will be needed or the next governor and General Assembly will face "rather Draconian choices."

Hence he proposed the $5 a bed daily hospital tax and $1 nursing home tax plus a licensing fee of $250,000 per 100 beds for new facilities -- to yield $116 million for Medicaid, plus $18 million to $20 million to help compensate hospitals with big unpaid bills for indigent care. Virginia hospitals gave an estimated $330 million worth of unpaid care in 1986, some far more than others.

Chairman Fortney (Pete) Stark (D-Calif.) of the U.S. House Ways and Means health subcommittee recently said, "I'll give you a buck for any person at a hospital admissions desk who comes forward and says to a patient, 'If you're short of money, we have this program to help you get free medical care.' " Nationally, 5 percent of all hospitals, mainly public hospitals, give 37 percent of all unpaid care.

But if some hospitals deserve compensation, it should come from all taxpayers, not just hospital patients. Dr. Gail Wilensky, Project Hope health economist, spoke for many colleagues when she recently urged that new health insurance or Medicaid expansion be financed via the broadest possible tax base, possibly by an income tax surcharge or a part of sales taxes.

Bitter but perhaps necessary medicine.

Many people are trying to figure out how to pay for medical care for the needy and uninsured.

There are obviously huge holes in the health safety net. From 35 million to 37 million Americans -- about one out of six under age 65 -- lack health insurance. Millions more have skimpy coverage. Medicaid coverage of the poverty population has fallen from nearly 70 percent in the mid-'60s to less than 40 percent.

Some quite unsocialistic observers think a complete revamping of the health system -- say, enacting government-paid care by government-paid physicians and government-funded hospitals for virtually everyone -- is inevitable.

Dr. Alan Einthoven, Stanford economist, proposes a less drastic system of government vouchers entitling the poor to health insurance and the non-poor (or the non-poor and their employers) to either a tax credit or cash compensation for adequate coverage.

Others suggest a mix of many measures. Perhaps completely federalizing Medicaid with adequate standards. Or increasing the federal contribution to states and requiring higher standards. Or letting those with modest incomes buy Medicaid coverage with the federal government paying part of the cost.

Ten states have created risk pools for the medically uninsurable, usually with health insurers -- and those they insure -- sharing the cost, sometimes with a tax break for the insurers. A bill before Congress would require more employers to provide coverage.

None of the above is happening fast enough to solve the nationwide, or the Virginia, problem.

Can Virginia hospitals afford to pay the $5 a day bed tax without charging patients more? Gov. Baliles thinks so. Virginia hospital officials deny it.

Federal figures show that most hospitals have been staying in the black, some handsomely so, but that their profit margins are decreasing. The government is ratcheting down Medicare payments, which account for 40 percent of the average hospital's income. I believe it is unrealistic to think that most hospitals can stay in the black without passing on any new taxes to as many of their patients as they can.

The Baliles proposal was quickly shot down by the Virginia Hospital Association and its member hospitals, and the influence, very likely, of their potent Political Action Committee, which had contributed to the campaigns of key legislators.

Baliles and the plan's actual architect, Human Resources Secretary Eva Teig, said they were willing to be flexible. Teig said the bed tax was only "one possible idea." But she also said that "the concept of fees is going to be alive, though perhaps not in the {same} format."

Washington Post reporters in Richmond called the episode "a political defeat at the hands of Virginia's powerful medical establishment" and "a case study of a well-financed trade association using its members, money, mail and political muscle to affect legislation" that threatened hospital profits.

That is true.

But the episode can also be described as a victory -- so far -- for already suffering hospital patients.

Next Week: When a doctor kills a terminal patient.