The candidates' rival plans reflect the philosophical divide which turns up so frequently in what so far has been an issues-oriented election. Though [Gore] treads the Medicare route pioneered by Democrats, even he would have the government pay only a portion of seniors' drug costs. For a premium starting at $25 a month and increasing to $44 by 2008, his plan would cover 50 percent of prescription drug expenses, beginning with a cap of $2,000 in 2002 and increasing incrementally to $5,000 by 2008. (For complete peace of mind during the transition period, Medicare beneficiaries would have to find a private supplemental insurer who would cover the gap between $2,000 and $5,000.) The plan would cover premiums and co- payments for low-income seniors on a sliding scale. Gore's catastrophic coverage would begin after a patient has spent $4,000 per year in out-of-pocket drug costs ([GEORGE BUSH]'s begins at $6,000).

He promises prescription drug coverage for all seniors through private insurance and HMOs, with the federal government paying all or part of the premiums and co-payments for lower-income recipients, and 25 percent of the premiums for the rest of Medicare recipients. He has yet to say, however, what these plans will cost, or to discuss such limitations as deductibles, co-payments and exceptions. He would leave these decisions to individual insurance companies, reasoning that patients would benefit from a system that fosters choice and market competition. But neither the Medicare client nor the government can tell whether the plans will be affordable.

With longer lifespans, a larger percentage of seniors are high cost risks. Insurance companies do not welcome them and HMOs have found that seniors fill waiting rooms and require more than their share of service. After three Washington area HMOs announced that they would shut down their Medicare plans, the only one left, Kaiser Permanente, announced that it would no longer accept new members. How will Bush sweeten the pot? Even if government picks up 25 percent of the premium, can the private sector provide good coverage at an affordable price?