While Medicare prescription coverage is a politically popular idea, dramatic reform proposals could be a political minefield, reports CBS News Correspondent Peter Maer.
The President has long-favored a plan to encourage competition between Medicare and private health insurance, but attorney Vicki Gottlich with the Center For Medicare Advocacy questions the idea.
"Medicare was created in 1965 because private insurance companies did not want to insure older people," she told Maer.
Medicare advocacy groups say the program could be more "user friendly" but they warn against "fixing it out of existence."
Mr. Bush will send guidelines to Capitol Hill in the coming weeks that will include the drug benefit. White House officials were said to be still working out details.
He'll have the backing in the Senate not only of Majority Leader Bill Frist of Tennessee, a surgeon, but also influential Democrat John Breaux of Louisiana.
Breaux has worked with Frist in the past on Medicare, and is in agreement with the idea that Medicare should be exposed to marketplace forces and made to compete for its customers.
That means prescription drug coverage would come at a price - major changes in Medicare, despite its popularity among many voters.
"Just adding prescription drugs to an outdated Medicare program is like throwing lead weights onto a sinking ship," argued Breaux, in an interview with The New York Times.
An unidentified White House official hit the same note in his comments to the newspaper, saying President Bush "insists that any proposal for prescription drug benefits must have major Medicare reforms in it. We shouldn't just add liabilities onto a program that's antiquated and likely to go bankrupt."
One idea reportedly being considered by the president's advisers is economic incentives for people eligible for Medicare to enroll instead in private health plans.
Another idea, which would make Medicare operate a lot more like many private health plans, might provide an option for individuals enrolled in Medicare to pay a higher premium in return for better benefits, such as a limit on out-of-pocket costs.
The new option would offer more extensive coverage of preventive services, like mammograms and colon cancer tests, and would provide greater protection against the high costs of serious illnesses. But for such protection, Medicare beneficiaries might be required to pay higher premiums and co-payments, along with any new charge for drug coverage, the Times said, citing unnamed sources.
The White House push to advance a plan to overhaul Medicare comes as the Bush team ramps up for his expected campaign for re-election in 2004.
Practically every member of Congress has promised drug benefits to elderly constituents, but differ on how to do so.
David M. Walker, the comptroller general, has said that Medicare is "unsustainable in its present form," with the costs growing much faster than either the economy or the revenues available to pay for it.
Health care providers are already gearing up to lobby Congress to increase Medicare payments. Administration officials say President Bush would support a small increase in fees paid to doctors, after cuts of 5.4 percent last year and 4.4 percent this year.