More than one politician paved the way to Washington last year with rhetoric about a prescription drug benefit for Medicare patients, and if rhetoric were money instead of manure a real benefit of real benefit would be on the horizon.

No one should bet their Pepcid on it, however; there are articles of “clothing” in Victoria’s Secret stores thin enough to read a book through (not that I have ever looked) which provide more coverage than the prescription drug benefit that seems likely to emerge from Washington this year.

Oh, how things have changed. A few months ago prescription drug prices were the Viagra of the campaigns, heating up the elections with passionate talk about seniors choosing between their prescriptions and their rent.

The federal government was awash in budget surpluses, and a politician without a Medicare prescription drug benefit proposal was going nowhere faster than a basset hound on ice. Two thousand-one looked like it would be the year for developing a benefit that covered like Kevlar.

A real benefit, however, has fallen victim to soaring prescription drug costs, soaring rhetoric, the politics of prescription drug price control and this fiscal hemorrhoid; we cannot afford a huge federal tax cut and a real prescription drug benefit for Medicare patients.

The budget President Bush sent to Congress in March proposes a $1.6 trillion tax cut and $153 billion for a Medicare prescription drug benefit over the next 10 years. Now, $153 billion is enough for bikini-like coverage for all seniors or full coverage for a small number of them. Even a benefit that would cover only drug costs above the first $1,000 annually for all seniors would cost $1.1 trillion over 10 years, according to estimates from the Congressional Budget Office.

Surely, $153 billion would not even cover all drug costs above $5,000 for all seniors. The small sum reflects the fact that Bush is far more interested in a big tax cut than he is in ensuring all American seniors have necessary medications. That is not evil; it simply reflects his priorities and tepid support for a Medicare drug benefit.

The president is not alone in his lukewarm support of a real Medicare prescription drug benefit, however. Even many of the concept’s most ardent supporters are reluctant to try this on for size, despite their passion on the stump.

The cost of prescription drugs in this country will double in the next 10 years by some estimates, and the profits on many of them are huge. The cost of a real Medicare benefit for all seniors would probably grow by $20 billion annually, and once it is given it will be politically unacceptable to take it back.

Moreover, a Medicare prescription drug benefit without an attached program for prescription drug price control would produce a huge transfer of taxpayer dollars directly to the pharmaceutical industry, already the most profitable industry in the United States. Taxpayers might just as well send large amounts of cash directly to the companies.

There, really, is the rub. There can be no full Medicare prescription drug coverage that is financially sustainable for the American taxpayer without an associated vigorous program of drug price control, and moose will dance the mamba before such a program exists in this county. Fear of an association between a Medicare drug benefit and federal price controls via some mechanism has kept the American pharmaceutical industry actively opposing such a benefit. As long as the industry continues to have Washington kissing its asterisk in search of the industry’s campaign donations (more than $80 million last year), there will be no price controls and no real prescription drug benefit for Medicare patients.

That being the case, the best Medicare prescription drug benefit at this point is no benefit for any seniors except those who are the least well off and the most in need. The $153 billion to $200 billion likely to be budgeted should be spent on prescription drug programs for low income seniors and those with catastrophic prescription drug costs (such as transplant patients), and not spread out as a skimpy benefit for all seniors. The current idea of a thin benefit for all seniors is effective coverage for politicians but for seniors is the benefit equivalent of a teddy, and should be rejected as the come-on that it is.

The rest of our seniors better hang on instead to the money they save when taxes are cut; they are going to need it to pay for their prescriptions. If it gives them heartburn to take what they save in taxes and spend it instead on medications then, in the immortal words of Marie Antoinette, “Let them eat Prilosec” ($3 per pill).

Erik Steele, D.O. is the administrator for emergency services at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the Bangor Daily News coverage area.