Running for president in this country without sounding as though you love Medicare is like being a moose at a hunters’ convention carrying a sign supporting the right to arm bears. The need to prove that he “loves” Medicare is what drove President George W. Bush, a conservative Republican known to favor limited government and small federal budgets, to reluctantly support the Medicare prescription drug benefit passed into law last December. That benefit is the largest expansion of a federal entitlement program in 40 years, and will cost an estimated $530 billion over the next 10 years.

As President Bush campaigns for another date to the presidential prom with the American public he will dress himself up for the occasion in the fancy suit of the Medicare prescription drug benefit, and use it to cover his political hide against charges that he does not support really Medicare. The charge has stuck well to Republicans over the years, but not this time, and not to this Republican. Bush will campaign in the political tuxedo of the Medicare prescription drug benefit, made for this presidential Cinderella by his political fairy godmothers in time for the 2004 campaign.

Sometime after the election, however, the stroke of midnight is going to change the spiffy suit back into what it really is, a threadbare affair full of holes with sleeves barely attached, something that Bush borrowed for the occasion. Consider:

. Bush was not a supporter of the Medicare prescription drug benefit until it became apparent that almost 80 percent of Americans were supporters, they were not going to give up, and failure of Bush to support it was political suicide for the president and fellow Republicans. His first proposal for a benefit was so chintzy it would not even have provided complete coverage for patients spending more than $5,000 annually on medications;

. his tepid support of the concept led to many of the compromises which make the Medicare prescription drug law so flawed;

. the whole Medicare prescription drug benefit does not really kick in until 2006. It contains so many “ifs” about its implementation and cost that it is unclear whether it will survive in its current form;

. the law does little to rein in other Medicare costs;

. without other Medicare cuts, higher taxes, or lower defense spending, the benefit is probably unaffordable in its current form. The $530 billion cost is a third more than the Bush administration estimated for Congress as our senators and representatives deliberated the measure, and some estimates place its cost over the next 10 years at closer to $1 trillion. It is unlikely that Congress would have approved the benefit had it known its true cost, a cost the Bush administration hid in part by threatening to fire Medicare’s chief financial analyst if he told Congress what he believed the real cost to be. That real cost was revealed two months after Congress voted the benefit into law;

. the benefit package hinges in part on something not currently available; stand-alone prescription drug insurance plans from private insurance companies. If Medicare recipients cannot find a stand-alone plan they must either enroll in a whole Medicare managed care insurance plan (Medicare HMO) to get a prescription drug benefit or wait for the government to come up with a prescription drug insurance plan alternative. The viability of these latter two options is uncertain, because Medicare HMOs have seen only limited success, and the government has never developed a stand-alone prescription drug insurance plan;

. the Medicare drug benefit law specifically prohibits the federal government from using its purchasing clout with pharmaceutical companies to drive down prescription prices for Medicare recipients buying prescriptions under the benefit plan. That provision in the law, a concession to the pharmaceutical industry without which it would have killed the whole benefit, means prescription drug price increases will simply be passed on to the Medicare recipient. That in turn will rapidly erode the real dollar value of the benefit. If drug prices continue to increase at 15 percent a year, almost one third of the purchasing value of Medicare benefit to the patient will be lost in the two years from passage of the benefit into law in late 2003 to full implementation of the benefit in 2006;

. the law does not prevent private employers from cutting prescription drug benefits to their retirees as those retirees become eligible for the Medicare benefit. The Federal Department of Health and Human Services recently estimated that employers will reduce or eliminate prescription drug coverage for 3.8 million retirees when the Medicare prescription drug benefit goes into effect. That is one third of Americans retirees currently on company health plans.

Employers can win either way; they can cut prescription drug benefits for retirees or get taxpayer dollars to maintain the benefits. The law calls for the federal government to subsidize employers who maintain prescription drug benefits for their retirees, at an estimated cost of $71 billion over 10 years, but that subsidy may not be enough to prevent many employers from shifting these drug costs to taxpayers.

Bush is not the only candidate for president to make a political tuxedo out of a legislative leisure suit. When it comes to political claims about our health care, and what a candidate has or has not done to improve the medical treatment of America’s senior citizens, however, the standard for getting credit should be high. For that reason, if no other, Bush claiming that we should take him to the prom in November because he supported a great prescription drug benefit plan for Medicare recipients is a pill none of us should swallow. He may deserve credit for a lot of things, but a good law establishing a Medicare prescription drug benefit is not one of them.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.