The Medicare reform agreement gliding through the Senate Finance Committee this week is the result of too many years of fighting, a scarcity of money post-tax cuts and an acute sense that failure to have a senior drug benefit ready for the 2004 election would look bad on presidential and congressional r?sum?s. And, of course, seniors would benefit.

Some form of Medicare overhaul looked certain last winter after President Bush described a privatized prescription-drug benefit that penalized seniors who remained in traditional fee-for-service plans, where 85 percent of them currently reside in part because in many states, such as Maine, they don’t have another choice. The House liked the idea; the Senate, which has a bipartisan awareness of the lack of choice across the country, immediately began to dismantle it. Sen. Olympia Snowe, on the Finance Committee, was among the first to grab a wrench.

Senators have reassembled an improved bill. The privatization part is considerably less punitive under the current proposal. The incentive for switching from traditional government-run coverage to private preferred-provider plans, which some see as more efficient systems, is in the emphasis the new plans place in preventive care.

Should this proposal pass Congress, it will be interesting to see how insurers offer this added care, negotiate with providers where the government simply sets prices, make money and still cost less than the current Medicare plan. No wonder private insurers are beginning to act nervous about the reform. Should the insurers’ costs outpace the government’s, Medicare would become even more imperiled than it is expected to become, giving added support for those who’d like to eliminate it altogether.

The new money put into the reform is crucial, and there was good news this week in cost estimates of the proposal that would allow up to $50 billion more to expand coverage of the new drug benefit. The Finance Committee appears in agreement on a $400 billion, 10-year plan, but there is a large warning attached that many have missed in this debate. This money does not mean that prescription drugs will be free to seniors and nor will the program begin immediately. Though low-income seniors would get a break, the drug plan would require perhaps a $275 annual deductible, a $35-a-month premium and a 50 percent copay, up to $3,450 a year – then no coverage until a patient’s out-of-pocket spending on medicine reaches $3,700, at which point the government would pick up 90 percent of the cost. And while a drug card that provides a 25 percent discount would be available soon after the legislation is approved, the full program would not be in place until 2006. Not cheap; not soon.

And it could hardly be otherwise given the change in the federal budget outlook – from a 10-year surplus of $5.6 trillion in 2001 to forecasts of a $4 trillion deficit today. The opportunity to afford a more generous package for seniors is gone. A larger reform, including extending services to younger uninsured adults, is unaffordable. Preparation for the retiring baby boom largely is put off for several more years. Democrats will support the proposed legislation because that’s what is affordable and because Republican Finance Committee members have taken some of the worst elements out of the package.

The Senate spent weeks last summer fighting over similar legislation but couldn’t come to agreement, and voters expressed their displeasure last fall. That won’t be allowed to happen again. Both parties in the Senate are more willing to negotiate now, although many seniors, who would receive a modest benefit, will eventually wonder what all the fuss was about.