Health: Take Two Aspirin and Read This Now

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Republicans insist that January's rough transition will be all but forgotten by November. And they will remind voters that Democrats were unable to get any drug benefit, however flawed, passed while they were in power. "Seniors would have nothing if it weren't for Republicans passing this plan," says Amy Call, spokeswoman for Senate majority leader Bill Frist. G.O.P. leaders have so far rejected the major changes proposed by Democrats, including allowing direct negotiation with drugmakers and easing the rules on reimportation of drugs from Canada.

They are taking seriously the bipartisan calls from states to be reimbursed for the tens of millions of dollars in emergency funds states have set aside to cover the gaps in Part D coverage. Health and Human Services Secretary Michael Leavitt spent last week on damage-control patrol, trying to placate anxious seniors and state lawmakers angry about footing the bill for Medicare's mistakes. Maine Republican Senator Olympia Snowe said Leavitt reassured her on Friday that the Federal Government would use its authority to compel insurance plans to reimburse the states directly. Maine has spent $5 million.

Ultimately, the future of Medicare Part D will depend not just on Republicans or Democrats, insurers or drugmakers, pharmacists or health-care experts. It will hinge on the willingness of the millions of people eligible for Medicare to submit to this experiment in free-market health care. Americans could decide that the health of the old, the sick and the needy deserves a system separate from the one that rules whether Internet companies and T shirt makers live or die. But if enough people agree to endure the smaller upheavals that are sure to come, Part D gives them a drug benefit based on the American ideal of unlimited choice. Some plans will change their rules or increase their prices; others won't survive, and their members will again have to navigate a new plan. For those without any drug coverage at all, that may be a risk worth taking.