As a Capitol Hill committee works out an agreement on Medicare reform, you can hear many discussions in Washington about out-of-pocket expenses, something called "FEHBP" and even "doughnut holes."

But something's missing.

It's called the Big Picture-the philosophical framework for every political issue.

Medicare's Big Picture is this: Should a government-run health insurance program continue just as it has since 1965-despite changes in America's population, economy and technology-plus add a prescription drug benefit that could cost at least $400 billion and expand government even further? Or should there be some reforms such as competition and choice?

Politicians shouldn't ignore the Big Picture as they work on reconciling a Senate and House version of Medicare reform, said Stuart Butler, vice president of domestic and economic policy studies at The Heritage Foundation. "We have to have an argument," Butler told The New York Times on July 20. "This is not something where you can just say 'Let's strike a deal.'"

Butler's right. With million of baby boomers planning to retire at decade's end, this is probably the only time when Congress can truly debate how Medicare should operate in the 21st century. This is not the time to make deals about "doughnut holes."

Learn more about Medicare's Big Picture (and "doughnut holes") at heritage.org.

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.