Seniors deserve a Medicare drug benefit, and Congress is in the midst of considering two very different approaches on how to do that. One proposal would rely on private insurers to provide prescription drugs, and the other would make prescription drugs part of the basic Medicare benefit package. It is important to understand the differences in these two proposals -- especially in how well they each would allow seniors to get the drugs they need.

The House of Representatives recently passed a Republican plan that would require seniors to choose a drug plan offered by private insurers. An alternative plan that was supported by House Democrats would have made prescription drug coverage available to all Medicare beneficiaries on a voluntary basis. Those who decide to participate would have paid approximately one-third of the monthly premium, about $25 a month, with Medicare paying the other two-thirds.

The Senate now will have an opportunity to look at these two very different approaches. I have very serious concerns about the plan recently passed by House Republicans, which relies on the private insurance market to provide a Medicare drug benefit. The failure of the private market to offer affordable health care to seniors is what led to the creation of Medicare in 1965.

More recently, we have seen the failure of Medicare+Choice, another market-based approach to insuring Medicare beneficiaries. This program was created in 1997 to provide seniors with greater access to HMOs, PPOs and medical savings accounts. However, in Maryland and across the country, private health plans are withdrawing from the program, leaving seniors with fewer choices today than in 1998.

In fact, the Republican plan has been harshly criticized by the very insurance industry that would be called upon to offer it. The Blue Cross and Blue Shield Association described the plan as "a false hope" that would be unaffordable for most seniors. Representatives of the insurance industry have said the Republican plan is based "on unrealistic assumptions." Currently, most of America's seniors lack a reliable prescription drug benefit. Unfortunately, the private insurance plan would offer only limited assistance in paying premiums. In addition, it would do nothing to keep down the rapidly escalating cost of drugs.

Instead, by guaranteeing a prescription drug benefit as a basic part of Medicare, we would make it possible for seniors to access any drug that their physician certifies as medically necessary. These decisions should be made by doctors and patients, not insurance companies. This plan would also help pay copayments and premiums for low-income seniors and pay half the cost of each prescription, with no deductible.

It's clear that seniors need a guaranteed, affordable prescription drug benefit. The question facing Congress now is how best to do that. We've all seen the failures of the private market to provide for seniors. We know that Medicare works. If we are truly serious about making sure seniors get the health care they deserve, the choice is really very simple.