Administration health planners have sent to the White House a memo laying out four possible national health insurance schools, and implicitly supporting organization would cover the entire population under a mix of public and private practice with federal minimum styles.
The memorandum circulated to members of the Cabinet and top White House officials by Health, Education and Welfare Secretary Joseph A. Califano Jr. estimates that the proposals could cost from $25 billion to $72 billion in increased federal expenditures.
President Carter has promised to submit a bill to Congress this year to establish a national health insurance program.
Of the four proposals, the HEW staff memo appears to find the least problems with a "publicly guaranteed plan" that seeks to provide universal coverage, federal control over financing and to allow the private health insurance industry to continue to play a substantial role.
This plan would require everyone to purchase a federal insurance plan unless employment groups chose to be exempted by purchasing private insurance - approved by the federal government. Federal revenues would finance coverage of the poor, the elderly and the disabled
Employers would be required to pay at least 75 percent of the premiums for their employes, although the proposal raises the possibility of federal tax credits "to minimize potentially adverse effects on employment and inflation."
The memo estimates that a "relatively lean, but comprehensive" benefit package including hospital, outpatients, doctor services and a limited mental health benefit with some preventive services for children would cost about $156 billion in 1980 without any national health insurance program.
With the publicly guaranteed plan, the total cost would be about $182 billion for the same benefits, including an increased cost of $34 billion to the federal government. Employers would have to pay $13.5 billion more, before tax credits are figured in, and employes an additional $4 billion.
The staff memo stresses that the figures "are extremely soft and tentative. We are working to improve them, but at the moment our figures can provide only a general idea of potential costs."
The other three proposals:
A "target plan" to provide coverage for the poor and protection against catastrophic medical expenses - those above 25 percent of annual income. This proposal would cost the least in new money, about $15.5 billion, but would give the least coverage.
A consumer choice, plan, using tax credits and vouchers for the poor to stimulate competition among health providers. Additional cost: $21 billion.
A public corporation supplanting private insurance companies which would be used only to administer benefits but not to underwrite risks. Additional cost: $25.5 billion
The memo also contains a discussion of a fifth proposal, presented by Sen. Edward M. Kennedy (D-Mass.) and organized labor representatives to the White House and HEW.
An aide to Kennedy said the memo's discussion of the proposal, a variation on the publicly guaranteed plan, is a "serious distortion" of the proposal and contains several errors, including an estimate of an $80 billion increase in federal expenditures, rather than $30 billion.
Kennedy, along with several top officials from organized labor who support national health insurance legislation, is scheduled to meet with Carter today.