Amid a whirlwind of controversy surrounding the recently signed Medicare drug plan there are some fundamental questions regarding the final cost to the elderly that remain troublesome according to a report in the current issue of Time Magazine.

Time singled out six potential items members of congress on both sides of the aisle may have to face up to once the bill takes effect. President George W. Bush is expected to sign the bill into law Dec. 8, but the debate will certainly not end there.

Aside from Time's list of potential problems with this historic, yet contentious legislation, there are allegations made by retiring Michigan Republican Rep. Nick Smith that certain members of congress were trying to bribe him into voting for the bill, which he ultimately sided against. Rep. Smith's vote didn't factor into the final tally after all, but the bill passed by just five votes on Nov. 22.

Rep. Smith has since attempted to play down his initial charges of wrongdoing, but this and other happenings surrounding this long-overdue bill have cast doubt on the entire process and have led the Justice Department to open an informal investigation into the matter.

Assuming that the bill does become law, here are some of the issues that have the potential to cause reason for the elderly to temper their expectations that this legislation would lead to significant reduction in the pricing and availability of medication.

How Generous is the Drug Plan?
Not as much so as what members of both the House and Senate have given themselves under their federal program and what most employers offer their workers. Some of the reason is the modest amount of money they had to work with, which is $400 billion over 10 years. It sounds like plenty, but the fact that the elderly population is expected to explode in the coming years and the ever-rising cost of health care doesn’t seem to be slowing down anytime soon makes the total look downright paltry. The plan states that beginning in 2006, each Medicare recipient will be required to pay a $35 monthly premium, which entitles them to 75% savings on the price of drugs up to a maximum of $2,250. That in itself isn’t too bad, but consider that the next $2,850 in prescription-drug bills will have to come out of the pockets of the individual.

This may not be a problem, but it all depends on the premium staying the same as the projected $35 per month, which lawmakers admit is at best an educated guess. Also, the costs of prescriptions varies from state to state which may bode well for small states where costs are moderate, but people in big urban centers may not be as lucky.

Does the Bill Really Modernize Medicare?
Short answer is no. But, it does bring the whole process into the 21st century by expanding the amount the government covers for early screening for heart disease and diabetes. That alone will catch problems before they become full-blown and quite costly to both the taxpayer and to Uncle Sam. On the bright side, it does contain provisions to speed up implementation of electronic prescription programs designed to cut down on the various shortcomings of the current system that is prone to be derailed by something as simple as poor handwriting by the prescribing doctor or human error on the part of pharmacists.

Will Private Competition for Seniors Be a Good Thing?
In theory, yes. But, that all depends on the number of people seeking out Medicare coverage and the willingness of private insurers to keep costs in line. If costs soar over the next five to ten years, we may be in a situation as dire as the state of prescription drug benefits leading up to this legislation – if not worse.

Will Drug Prices Go Down?
Most likely, no. Again, it is up to the private medical industry’s ability to keep overall expenses down. That is a big if. If the past decade is any indicator, the rate at which medical care costs will grow should be considered fact and that a reduction would require other factors, which legislators will have to deal with at a later date if this plan is to show significant cuts to the bottom line.

Will Seniors Get New Discounts on Drugs?
Perhaps. Starting in 2004, seniors will be able to buy a Medicare-subsidized prescription-drug discount card for $30 a year. The Department of Health and Human Services estimates that there could be as much as 25% savings because of the card, the General Accounting Office is more prudent in its estimate and tabs a 10% cut as being more realistic. Time will tell.

Does the Program Benefit the Rich or the Poor?
It depends on what party you are aligned with. Democrats say that 6 million of the nation’s most needy already get better coverage by Medicaid, the state-run federal program for the poor. In fact, 10 states already exempt their poorest seniors from paying for medications at all. GOP lawmakers say that the plan will help workers who buy plans that better suit their individual needs and accumulate tax-free money to pay for health care in retirement, which is a minor provision buried deep in this complex legislation that may be either the answer to the beleaguered national health care system or just another case of political hand wringing.

Stay tuned to see how things workout, it should be interesting to see if partisan politics gets in the way of genuine relief for those most in need of a prescription medication solution.