An elderly doctor of great wit, learning, and drives away. And he has been learning that a considerable majority of the homeless, on whom the city is spending $33 per person per day, tend to dematerialize when offered concrete jobs. Only to return to the homeless scene a few days or weeks later. Ed Koch is learning, in short, what Roger Starr taught us all many years ago in his book about the disorganized poor. And all this means that when Koch runs again, he will be running not so much as a Democratic Reformer, but as a reformed Democrat.

AN ELDERLY doctor of great wit, learning, and experience thinks he has an idea for the eternal, apparently insoluble problem of the rising cost of medicine.

Now this rise in cost appears to be heavily related to the involvement of the Federal Government in medical expenses. Professor Milton Friedman has as usual said it succinctly: Not long ago, tbe United States spent 4 per cent of its GNP on medicine. Today it spends 10 per cent. And guess what? The government pays 6 per cent of its GNP in medical subsidies.

But Dr. Herbert Berger of Staten Island focuses, for the moment, on malpractice suits and the huge sums that juries award, carried away by their sympathy for the plaintiff and (almost inevitably) confident that after all the cost of a judgment will be paid by an insurance company. The results of this are well known. A physician in Florida needs to spend $180,000 on malpractice insurance, and, of course, the fee is passed along to his patients (who, in significant numbers, pass the bill along to the government). The result, says Dr. Berger, is not only that the cost of medicine is excessive. There are other more subtle consequences. One of them is early retirement by qualified physicians who deal with a clientele that cannot afford to pay the higher prices and is not protected by the government or by insurance companies. Still another consequence is the extraordinary precautions that many physicians feel they need to take, so that when the kid comes in with what appears to be poison ivy and it turns out to be advanced gonorrhea, the doctor, when facing a jury, can point to his having ordered 16 tests to explore every possibility.

“It has been my lot to testify as a medical expert in many trials. At the conclusion, one frequently hears exclamations such as, ‘We’d have won if we had a better lawyer.”‘ Dr. Berger goes on to suggest what can only strike one as, well, inconceivable. It is that a movement, presumably led by a non-Nader type, should be launched to sue lawyers whose presentation of their client’s case is defective. The suggestion, surely, is difficult to imagine as a likely cure for the problem at hand. A lawyer who fails to persuade a jury that his client has been harmed by a negligent doctor is not often guilty of gross negligence. And since many of these lawyers are suing on a contingency basis, charging their clients only a percentage of the award, it is unlikely that they would proceed with actionable negligence,

Even so, the idea is interesting, to the extent that it encourages harsher treatment by the courts of ambulance-chasing lawyers. I like enormously the example Dr. Berger gives: “Perhaps an example of the miscarriage of justice is in order. A lady was awarded $800,000 because she lost her navel after an operation for an umbilical hernia. The navel is always sacrificed after such a procedure. Her result was excellent. The only use for a navel that I had ever heard of was that it was a handy place to keep salt when eating celery in bed.”

No doubt there are lawyers who can persuade a jury that the loss of a handy receptacle for one’s salt when lying in bed is a serious deprivation. But Dr. Berger is clearly correct in suggesting that laws need to be passed by the states, perhaps patterned after Florida’s law that seeks to limit awards for mental anguish. It is one thing to award a patient a substantial sum of money for the loss, say, of a finger. But to add a million dollars for mental anguish is an invitation to judicial extortion.

And it is unquestionably true that state legislatures would react more forcefully if the resentment were more palpable. But as the Federal Government absorbs more and more of the cost of the entire medical enterprise the question becomes abstract. If a doctor can pass along his insurance fees to his patient, who in turn passes them along to the Federal Government, the pressures for reform attenuate: and years go by and nothing happens-except a rise in medical expenses.

THE BUSH Administration is going to have to face the problem of out-of-sight medical costs. The official in charge of recommending sensible reform would do well to call in Joseph Califano, who was secretary of HEW under Carter and explored deeply the question of controlling health costs, which findings he incorporated in his book, Americas Heath-Care Revolution, published several years ago. There is nothing more useful in town than a reformed Democratic heavy-spender. A meeting between the new head of HHS, Dr. Louis Sullivan, Joe Califano, and Dr. Berger should be run in prime time.