It seems like a classic case of Washington hypocrisy. When it comes to tax cuts, Democrats like Ted Kennedy and Hillary Clinton rail against Republicans for helping the rich instead of targeting tax relief to the poor. Yet, when it comes to a Medicare prescription drug benefit, those same Democratic senators want the government to start paying for Warren Buffett’s pills.

Similarly, Republican think tanks and senators argue that those who pay most of the taxes — the rich — should naturally get much of the benefit of a tax cut. Yet, when it comes to a Medicare prescription drug benefit, those same senators and think tanks insist that the rich and relatively well off should have to pay for pills out of their own pockets while their Medicare taxes pay for new benefits for the poor.

The double standard extends — on both sides — to the supposed impact on the federal budget. The Democrats complained that the $1 trillion Bush tax cut was a budget-buster — yet they were more than willing to vote for an $800 billion Medicare prescription drug plan. The Republicans complain that the Democratic Medicare prescription drug plan is too expensive — but they backed the Bush tax cut.

Of course, the positions of both political parties are often more complex than consistent. Republicans, for example, have backed school voucher plans restricted to the poorest families in the worst public school districts, while Democrats have blocked these plans. On the Medicare drug issue, the Republicans are justifiably concerned that a plan that covers everyone would be a precursor to price controls and a death blow to innovation by America’s world-leading pharmaceutical industry. The Democrats, meanwhile, have learned a lesson from pre-reform welfare (unpopular) and from still unreformed Social Security (popular). They have learned that, when creating new government programs, it’s worth including — bribing? — the middle and upper classes to assure a broad base of support. One could argue that health care spending is different from income taxation, though that argument falters because Medicare is paid for by its own dedicated tax on wages.

The emergence of Senator Frist of Tennessee as the likely new leader of Republicans in the Senate means that health care legislation will be high on the agenda of the new Congress. After the election last month, Dr. Frist issued a statement asserting that his “top priority” will be “to enact a prescription drug benefit for seniors and Americans with disabilities within the context of a modernized Medicare program.” Part of this drive stems from the politician’s own professional background. Before joining the Senate, he was a heart and lung transplant surgeon, and the letters that follow his name on his Senate Web site are not the customary “R” or “D” for party affiliation but rather an “M.D.,” for medical doctor. Part of it may be his family history: his father and brother helped create the company now known as HCA, the Nashvillebased giant which owns and operates about 180 hospitals in 23 states, England, and Switzerland.

Dr. Frist’s legislative record suggests how he might approach prescription drugs and Medicare. With Senator Breaux, a Democrat of Louisiana, he has offered a plan for a means-tested Medicare drug plan that gives those with incomes above a cutoff the option to pay their way in. First introduced in 2000, that plan might be the starting point for reform now that Dr. Frist will be the majority leader. On taxes, Dr. Frist last year proposed a payroll tax holiday for the month of December. A press release about the proposal noted, “For 2001, the payroll tax is applied to incomes up to $80,400. Therefore the bill would provide tax relief for all individuals making less than that amount. Approximately the top six percent of wage earners will have already reached the limit by December 1, and therefore would not be eligible to benefit from the payroll tax holiday.”

As the parties grapple with how to treat the rich in the Medicare prescription drug program and in the next round of tax cutting, they’d both be wise to remember that class warfare rhetoric can cut both ways. The Republicans and Democrats may each be in for a dose of their own medicine.