Senators are involved in the debate about reforming Medicare. So are House members. Ditto Capitol Hill staffers, lobbyists, policy analysts and number crunchers.

But the one person not involved is President Bush-and his absence puts the future of America's health-care system at risk, according to Stuart Butler in The Los Angeles Times.

"Rather than sitting in the White House waiting for a bill, Bush must lead the public debate on the decisions that will affect us for decades," writes Butler, vice president of domestic policy at The Heritage Foundation, in a Sept. 22 essay. "If he flinches from this important duty, he will have failed a critical test of leadership."

Butler says there are fundamental questions in the debate that Bush must face, including:

· Can we add a $400 billion-plus prescription drug entitlement to Medicare, which even now can't survive without huge transfers of money from our children?

· Is it responsible to promise equal Medicare benefits for both rich and poor? Should a retired Bill Gates get the same Medicare coverage as an ex-bricklayer?

· Why can members of Congress choose a wide variety of health plans, but most Medicare patients can't?

Butler says these are questions Bush can't ignore and should answer them. Now.

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.