The Medicare bill on its way to the president’s desk is making quite a number of people unhappy. Some of those are congressional Democrats running for re-election — or for president — who don’t want to see President Bush standing in a pharmacy later this month with a sign behind him reading “Mission Accomplished.” Others, however, are conservatives in good standing who see the addition of a prescription drug benefit to Medicare as a huge and unnecessary expansion of a middle-class entitlement. The truth is, the bill, though it is quite flawed, seems to be the best that could have been hoped for in the current political climate. The Bush administration is determined to get a universal prescription drug benefit before the election, and it’s better that this happen sooner rather than later. If this bill hadn’t gone through, the next try certainly would not have yielded a better bill. To the contrary, the AARP, Senator Kennedy, and others would have had more time to strip out the good and pile on the bad as the election grew nearer.

So we might as well focus on the good in this bill — which will only count as good if Mr. Bush understands that the mission hasn’t been accomplished, but as in Iraq, has just begun. One of the most encouraging provisions is the expansion of the idea of medical savings accounts. The new Health Savings Accounts included in the bill will be available to all Americans as of January 1, 2004. This means that Americans will be able to contribute — or have their employers contribute — money into tax-free accounts that they can use to pay for medical expenses. If consumers take to these accounts, as it can be hoped they will, it will mark the beginning of a fundamental change in American health care policy. “The Democrats are so crazy because as soon as people get control of their money, the terms of the debate change,” the president of the Galen Institute, Grace-Marie Turner, told The New York Sun yesterday.

Another plus is giving seniors access to privately negotiated drug discount cards that the Department of Health and Human Services estimates will provide savings between 15% and 25% on prescription drugs. Also, lighter regulations will give preferred provider organizations and health maintenance organizations a greater incentive to compete to provide full health services with integrated drug benefits, which should also cut costs. Still, it is possible, likely even, that the Democrats and the AARP will be back in force during and after the election to increase the size of the drug benefit now that it has been secured. If Mr. Bush wins a second term, there would seem to be little reason for him to cave in to these demands. He will have made his bed, though. The ballooning costs of his expansion of Medicare will force him, lest he have to raise taxes, to start in earnest the process of privatizing and modernizing Medicare. Only when this starts will the mission be anywhere near accomplished.