Medicare is stuck. A crucial prescription drug benefit and the reform of the health care system for most of the nation’s seniors is hung up on ideology that threatens the essential improvements drafted in Congress. President Bush, who earlier urged the Senate to complete its version of the reform, should help again by encouraging the House and Senate conference reviewing the proposals to find a bipartisan, bicameral agreement that protects the core of the program.

In the absence of strong leadership on this issue, the two sides are hardening their positions and making negotiations more difficult. The House and Senate bills are divided on several issues, including the scope of a prescription-drug benefit. But the primary disagreement is whether Medicare will in the next several years leave the security of the public sphere to try its luck in the marketplace. The Senate wants to ensure the federal government will always have a role in ensuring Medicare services are offered to all who qualify; many House members, adamantly, do not.

After debating this issue specifically for the better part of a year, Congress is no closer to an agreement and is running out of time. In July, 37 Democratic senators said they would support a final bill only if it looked like the Senate’s version. Seventy-six House Republicans replied with a letter saying they would support only the House privatization version. House “Blue Dog” Democrats, including Rep. Mike Michaud, and some moderate Republicans countered with their own letters saying they favored the Senate version themselves, and last week 13 conservative House Republicans said in a letter it was either their way or no way. So much correspondence, so little communication.

The difficulty of financing Medicare in the future and the need to try dramatic solutions are inescapable, making the conservative pitch for privatizing the system understandable. But rural areas across the country should have serious concerns about this. Just as deregulating the electricity market did not prompt a lot of new electric providers to offer service in sparsely populated areas, deregulating the health care market for seniors is unlikely to entice providers to these regions. What then? The Senate version keeps available the same government program currently offered and provides a drug benefit without penalty for those seniors who choose to stay with what they know and trust.

Sen. Olympia Snowe, who has been at the forefront of this debate for years, has the right goal in mind: “When we send a bill to the President’s desk, seniors must be able to choose the prescription drug plan that best meets their needs and comfort level – whether through traditional fee-for service or a private delivery plan.” Sen. Susan Collins similarly supports this sensible approach.

One other point about the House plan. As with most insurance, there are three parties involved whenever Medicare is used: The patient, the health care provider and the entity that pays the bill. The recent House letter makes two demands on this relationship in regard to a drug benefit. First, it requires a “policy of no price controls on the U.S. drug industry” and, second, the final bill “must include a cost control feature in the bill that guarantees” the federal government will not pay more than it budgets. If the provider – the drug industry – is protected and the payer – the federal government – is protected, whom do you think is going to get stuck with all additional costs?

If you answered the patient, you understand Congress and the problem with the House bill. The Senate’s version is not perfect, but it provides essential protection to patients and keeps them from being priced out of receiving care. President Bush could move this issue along by informing the House that rural seniors depend on Medicare just as much as urban seniors do and by supporting the Senate version now in conference.