Soul searching about Medicare.

So even a supreme cynic of government must admit that Congress did a good thing by offering prescription drug coverage in its Medicare bill.

Well, some would call it the very height of pandering--carried out by a Republican majority desperate to give President Bush something to brag about in next year's re-election campaign, not to mention many of their own. Or don't you think there's any connection between passage of these so-called reforms and next year's elections?

But that's just politics, right? Besides, as flawed as the drug plan may be, isn't it better than nothing?

It is, but not by that much. The new plan will require lots of comparison shopping, not to mention considerable math skills, to determine which insurer provides the best deal. You can also anticipate that after the hoopla dies down, special interests will put their imprints on the details, so to be charitable, this is a work in progress. They're already comparing it to 1988's legislation providing for catastrophic medical expenses that created a revolt among affluent retirees and led to the legislation being repealed.

That's not likely to happen here, is it?

No, they'll slog through the rough spots because there's just too much pressure for some sort of drug plan, especially among the boomers who are scared stiff about having to give up those $10 co-pays at their local drug store when they hit 65. But don't be fooled by those smiling congressmen and senators--Medicare remains a structurally flawed program.

In what way?

You obviously haven't been to any retirement communities lately. Unlike private health care programs offered by employers where there is an incentive to stay healthy and out of the doctor's office, Medicare has little or no ceiling on how often you get treated. In fact, it's really in the doctor's financial interest to treat patients as many times as possible. The doctors, of course, grouse that they're not being paid enough by Medicare and maybe they have a point. But whichever side you're on, it's clear the system needs a top-to-bottom overhaul and Congress isn't about to do that.

Don't pin that on the Republicans, bub. They're not the ones who insist on keeping this dinosaur alive.

It's true that the Democrats haven't wanted to tinker with their LBJ-vintage legislation and who can blame them--it's all they have to crow about. Besides, it's still a great deal, prescription drugs notwithstanding. Most Republicans don't want to mess around with Medicare either. For both, it would upset just too many special interests--the elderly, to be sure, along with doctors, hospitals and insurers (remember the Clinton plan?). The folks in Congress probably figure it's better to just focus on prescription drugs and let someone else worry about the tough stuff.

But it sounds like the drug program itself will be messy.

Definitely. Except it doesn't kick in until 2006 and by that time Bush will be wrapping up his second term in office, so it won't matter that much.

Are you saying that everything is geared to being re-elected?

Well, yes. But that's the way the system works--success is not always determined by how good a piece of legislation might be, but on whether you can get people to believe it's good or at least an improvement. And once in a while, it actually is. That's what keeps these politicos going--the notion that despite the odds, they occasionally pass something that eventually helps out poor people or businesses or the country in general. Otherwise, how could they sleep at night?

Mark Lacter is editor of the Business Journal.