Effective steps should be taken to establish facts and correct abuses in the heart pacemaker industry as they affect the government’s Medicare program. The Senate Special Committee on Aging has estimated that as much as half of the $2 billion that Medicare is expected to spend on pacemaker implants this year may represent “inappropriate” outlays. Medicare patients account for around 85 percent of all pacemaker implants, say news accounts. The staff of the special committee has alleged that improper practices range from implantation of units in patients who don’t need them to kickbacks and other inducements to physicians made by pacemaker companies or their salesmen. The cost for pacemakers-small electrical devices that keep the heart beating regularly–may range from $10,000 to $18,000 each for all hospital, surgical, equipment and related expense. Medicare pays 80 to 90 percent of all pacemaker procedures. In recent congressional testimony, a former sales executive for a heart pacemaker firm said he had never seen a business “so dirty” and “so immensely profitable.” Such charges should be fully investigated and either substantiated or disproved. Already the Senate health subcommittee has announced it will consider changes in the Medicare law to counter the abuses. And in a separate action, Secretary Richard Schweiker ordered the Department of Health and Human Services to develop a proposal for Congress on an advance payment for hospital care to control fast-rising Medicare outlays. Sen. David Durenberger, R-Minn., visualized one option under the proposal as switching payment for pacemaker units to Part B of Medicare which basically covers physicians’ charges up to 80 percent. Currently, the cardiac units are counted as hospital costs under Part A of Medicare, which pays l00 percent. Durenberger believes requiring Medicare patients to pay 20 percent of the cost would help check on pacemaker practices. He probably is right. Senate Budget Committee Chairman Pete Domenici, RN.M., put the matter in perspective when he commented that the government’s readiness to pay for overpriced and often unnecessary pacemakers is an example of the problems that threaten to bankrupt the Medicare system, The government needs to face up to such problems promptly-not only to correct abuses but to safeguard the Medicare program and keep its operation in line wit.h intended objectives.