A program that is nearly as old as the United States has been marked for extinction by the Reagan administration. The endangered program, nearly 200 years old and run by the Public Health Service at a cost of about $170 million a year, provides free medical and dental care to American merchant seamen.
David A. Stockman's Office of Management and Budget picked it for the budget ax year because the eight PHS hospitals and 27 clinics in major coastal port cities serving the 398,000 seamen eligible for care are "under-used and actually aggravate health care costs in the cities where the hospitals are located."
But PHS didn't stop just at providing services at its facilities. Because some eligible sailors lived in cities other than where PHS hospitals and clinics were located, the service arranged a special network of contracrted services. If a seaman needed medical care, for example, and was not within easy reach of a PHS doctor, he could go to a doctor who had a contract, and the doctor would send the bill to PHS.
As one might expect, the bill for all this medical treatment has not been small. In fact, it ran about $30 million in 1980, and was on its way to $38 million the current year when a decision was made to cut it out.
Now, according to the May 8 Federal Register (page 25622), the contract program has been brought to an abrupt end "for internal budget reasons," according to a PHS official. The reasons: the president wants to end the seaman medical program altogether, and money committed to contract services by August was expected to equal all that paid out in 1980, with another $8 million.
in an example of how fast the rulemaking system can be made to work, PHS's parent, the Department of Health and Human Services, decided on May 3 to halt the program. The rule went into effect May 8, the day it was published in the Register. There were no notices of rulemaking, nor were any public comments sought. "The urgent need for the rule . . . as a means of controlling expenditures" was used as a reason.
But seamen are not being put adrift medically. If they have a "life-threatening medical emergency," such as a heart attack, a case of poisoning or convulsions, they can obtain help from any health-care provider close at hand. But they or their relatives must notify the nearest PHS facility within 72 hours to have medical bills paid. Until Congress changes the law, they can still get free medical care at any PHS facility.