Gov. George W. Bush says his $158-billion prescription drug plan is part of “keeping the promise of Medicare.” Its reliance upon the elusive health-care commodities of market competition and flexibility makes “promise” the operative word.

On paper, the governor’s proposed Medicare drug benefit offers the desirable combination of helping those most in need and increasing consumer choice. There is no doubt that the poor and near-poor would benefit from his proposed total subsidy of private insurance drug coverage premiums and co-payments. But slightly higher on the income scale, millions of other elderly Americans burdened with high pharmaceutical bills would likely see no gain. The revelation last week in a report by the Kaiser Family Foundation that soaring health insurance premiums are experiencing their greatest increase in seven years makes that likelihood a near certainty.

The Bush plan is based on the core Republican values of preferring private-sector innovation to government programs and of turning over to the states responsibility for the government programs that by necessity must remain. This would be an attractive approach were it not for the insurance industry’s well-established practice of cherry-picking, and the utter failure of deregulation in everything from airlines to electricity to cause anything but harm to Americans not fortunate enough to live in a few select markets. The argument that the federal government is too sluggish and bureaucratic is lost on anyone who’s tried to deal with an HMO.

Vice President Al Gore’s $253 billion proposal essentially adds drug coverage to the existing Medicare program and assigns the task of managing the benefit to the Health Care Financing Administration, which already administers Medicare. It casts a wider safety net, its means testing is more generous, and it does, as critics charge, merely delay the day of reckoning when Medicare must deal with retiring Baby Boomers and the insolvency they threaten to bring. But if, as Gov. Bush alleges, the Gore plan offers “resources without reform,” the Bush plan offers resources without measurable results.

The Bush campaign, in fact, admits that a direct comparison of the two plans for a hypothetical recipient is impossible because much of the governor’s proposal relies upon decisions yet to be made by the insurance industry. Those who wish to ignore the last seven years are free to assume those decisions will be made in the best interests of the American public; for them, the Bush plan promises competition, innovation, lower costs and wider coverage. For everyone else, the promise of affordability and accountability in health care remains to be kept.