It's make-or-break time for the Medicare prescription drug bill.

The New York Times reports Nov. 19 that lawmakers are "in a final blur" of vote counting and deal making on the proposal, which would offer prescription drug coverage to all 40 million of its patients whether they need it or not, creating the biggest expansion of Medicare since it began in 1965.

But as lawmakers wheel and deal and hem and haw, they should remember why they are working on a Medicare prescription drug bill in the first place, says Stuart Butler, chief domestic policy expert for The Heritage Foundation. "The original idea underlying this legislation was never just about adding drug coverage to Medicare," Butler writes in a Nov. 17 online research paper. "It was about doing so in a way that would not lead to huge additional liabilities to future generations, and in a way that would reform the program so that it could respond to the changing needs of the elderly and disabled."

Does this bill do that? No way, Butler writes. Instead, the proposal "guts critical reforms, relegating them to a 'demonstration project' that is doomed to failure. And it opens the floodgates to new entitlement spending that will mean huge taxes on future workers."

So for lawmakers, their decision on whether to vote on this bill comes down to this: Do they want to fix Medicare just for today (or, in reality, the election year)? Or do they want to fix Medicare once and for all time?

For more information or to receive an e-mail version of "Medicare Maladies," contact [email protected] or call Heritage Media Services at (202) 675-1761.