Medicare has chugged along since 1965 largely unchanged and might have gone on for a couple of more decades without revision if it had not been for the mounting cost of prescription drugs and a coming presidential election.

Prescription drugs have become a problem to those of Medicare age because Americans are living longer and because prescription drug medical care cost increases with age.

Most senior prescription drug use is maintenance care and deals with preventing or controlling high blood pressure, heart disease and chronic conditions like arthritis. But even these drugs have become expensive, so expensive for some seniors that they have had to choose between proper dosage and proper nutrition.

The result is that more and more senior Americans are using more and more drugs, and the cost of these medications has been rising precipitously, even when they are generic and not patented.

This has brought on more and more pressure from seniors for help in paying for medications. The new Medicare revision's primary aim is to do just that. The new act also includes an effort to establish the favorite cliché of many legislators, "privatized" Medicare.

Medication clauses in the act, designed to help seniors pay for their drugs—or at least for some portion of them—are, as someone has said, the imposition of a whole new set of confusing regulations for drug reimbursement based on income, deductibles and caps, which will take not only seniors but also the government a long time to figure out. Some people below the poverty level will get their prescriptions almost free, but the majority of Medicare recipients will have to deal with deductibles, caps, gaps and other restrictions. And some seniors will still have to pay for most of their drug care. How much they will pay remains uncertain.

Whether the new "privatized" system will work or not also remains to be seen. Whether it does or not, it is going to cost taxpayers—many of whom are not seniors—a lot. Congress has estimated, without much real knowledge, that it needs to appropriate at least $400 billion spread over the next half-dozen years for the cost of drugs. The rest of the program also may be expensive, depending on how well "privatized" health care works.

The law also envisions forcing Medicare recipients into using the law's prescription-drug provisions. Not to do so will increase the amount of insurance premiums the Medicare recipient pays. In other words, you're damned if you do and damned if you don't.

The law also seeks to get Medicare recipients to opt for "privatized" plans similar to the health maintenance organizations that failed to work or work very well as part of the current Medicare law. Despite the fact that the constantly rising cost of medical care in the United States makes it obvious that profit-making HMOs are likely to have continually declining incomes and that HMOs tend to try to ration care to help their bottom line, the Bush administration is reluctant to abandon this sop to "private enterprise."

The new law also goes into effect after the coming presidential election in 2006, making it certain that no one is going to know how well or poorly it really works until the election is over, some insurance for the Bush administration, as it were. (All's fair in love, war and, apparently, medical insurance politics.)

Both provisions of the law ignore the fact of continually rising medical costs and of the continual increase in the cost of medical insurance.

Privatized health or not, Medicare recipients are going to cost someone more and more as time passes, notably their children.

Clearly, senior Americans, who soon will include the first units of the army of aging baby boomers, want, even expect, their health care to be paid for when they retire.

Under either the old or the new versions of Medicare, the health insurance industry, including that redoubtable outfit, the AARP—which now sells its own health insurance and drug program—stands to benefit from any rise in medical-care costs. The more expensive drugs become, the more expensive are health insurance premiums.

And, of course, no one really wants to pay for any of this. Everyone thinks someone else is going to pick up the tab, although who remains a mystery.

So far as I can see, Congress or not, compromise or privatization to the contrary, we're all going to pay for it. We're going to pay for it with more taxes.

And because that's true, we ought to stop compromising. We ought to enact what we have needed for a long time: a single-payer, universal, government-operated health-care system.