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Medicare's delayed reality

Talk about sticker shock. The Medicare prescription drug benefit was supposed to cost $400-billion when Congress created it just two months ago. Now, the Bush administration says the price tag is $530-billion, a splash of reality that should motivate Congress to fix the expensive mess it has created.

Both conservative Republicans and Democrats wailed when they heard that the drug program will cost a third more than they had expected. We don't fault the administration for trying to put a realistic price on the program. In fact, everyone should expect the actual cost _ when the full benefit is available in 2006 _ to be even greater. But why didn't the president or congressional supporters raise the cost issue sooner?

The answer seems obvious. Everyone wants to take credit for the program in the upcoming election, and put off the difficult details for another day.

The nation cannot afford (literally) that kind of thinking. With a budget imbalance (projected to be a record $521-billion this year), a more expensive prescription drug program will make it that much more difficult to reduce the deficit, which the president has promised to do. If the president and Congress had really wanted to give retirees a needed benefit and not stick future generations with the bill, they would have found a way to pay for the drug benefit now.

Flaws in the program are obvious, based on the president's cost estimate. Price inflation is mainly attributed to increased privatization of Medicare, which the legislation promotes. The administration figures more retirees will enter HMOs and private health plans, and those are more expensive alternatives than traditional Medicare coverage. Such an outcome is contrary to President's Bush's earlier assertion that privatization will save taxpayers money.

Another major weakness is that the program fails to control drug prices. Medicare is actually prohibited from negotiating with pharmaceutical companies over the cost of prescriptions. That position should be reversed in any rewrite of the law.

Even improved drug legislation will be expensive, and to ignore that reality will only hasten a financial crisis in Medicare. The president and Congress could meet their obligation by cutting spending elsewhere, eliminating some of the recent tax cuts or raising new revenue specifically for the prescription drug benefit.

We don't expect that to happen. But there is now enough unhappiness in both parties that the drug program's future is uncertain. It would be a shame to deny Medicare recipients a needed benefit, or to offer one that is fiscally irresponsible.