For the most part, Medicare still operates as if it were still 1965-when Martin Luther King marched in Alabama, the Sound of Music debuted in theaters and a first-class stamp was five cents.

Times change, but Medicare has not. And this is something that lawmakers need to address as they wrestle with making prescription drugs a Medicare entitlement, Heritage Foundation health-care expert Robert Moffit says

Take benefits. Changing or adding them into Medicare can take months, if not years, to accomplish. This means Medicare patients are often denied treatments offered to millions in private health plans.

A good example of this is bone density scanning, Moffit says. Imaging techniques to measure bone density were developed in the 1980s. But the process of getting it approved through Medicare's regulatory system took seven years without any results. It got to the point where Congress had to step in and pass the Bone Mass Measurement Act of 1997, requiring Medicare to cover it. Medicare patients finally had access to this service in 1998.

Moffit says if lawmakers just add prescription drugs as a Medicare entitlement without real reform, they might as well send a letter with a five-cent stamp on it: It won't go anywhere.