President Bush is right to want to increase the number of options for Medicare coverage, improve the quality of care under the health coverage program for millions of seniors, streamline administration and provide an increasingly important drug benefit. But his reform plan, including a discount card for prescription drugs, made news for little more than a day last week before disappearing, a telling indication of its weightlessness.

Instead of a set of specific reforms, with funding attached, his collection of Medicare principles looked like a way to keep Congress from getting ahead of the administration’s agenda and spending money already committed to tax cuts. No one doubts that reform of this crucial health care program for seniors will take time and should be approached carefully, but there is caution and then there is lack of commitment.

Consider the big news in the plan, a Medicare card that entitles recipients to discounts on prescription drugs. The president would have for-profit discount sponsors offer the card to seniors, who would pay no more than $25 annually for lower-priced drugs. It’s not a bad idea, but such sponsors and cards already exist and are clearly inadequate to achieve enough savings for cardholders. The president’s plan adds to the cost by requiring sponsors to contribute to government-directed marketing assistance. Of greater failing, however, is that the plan does not specify where the savings is to come from, so drugstores and pharmacists, fearful that the pharmaceutical industry will make up the difference on their profit margin, filed suit Tuesday to block the plan.

For measurable savings, the president would need to negotiate a Medicare drug benefit as Medicaid or the VA or private insurers negotiate – not through a voluntary club approach, but through a nonprofit single organization that uses the volume buying power of seniors to reap the best deals with wholesalers. Though this has been proposed and ignored by congressional leadership repeatedly in recent years, the only unusual aspect of such a negotiation is the drug lobbyists’ vehement opposition to it in deference to their record-breaking profits.

The remainder of the president’s plan envisions more preventative and more catastrophic care and a guarantee to current and soon-t-be beneficiaries that what is offered now will not be cut for them. He also wants to put Medicare on “sustainable financial footing,” acknowledging that Medicare is kept solvent now through increasing claims on general revenues, the demand for which is expected to double over the next decade, and that even with this money the program is expected to go bankrupt in 2029. There is no mystery on how to balance the books on this issue – cut services or increase revenues or do both.

The questions are which services and whose revenues and how to balance the demands of health care against the many other demands of government. Medicare reform becomes a real debate when politicians look for answers to these problems. But, so far, neither party has shown real interest in seeing that these questions are asked.