There are few issues in recent years that have cut as cleanly between the Democratic and Republican philosophies as the question of how to offer prescription coverage to senior citizens. The lack of consensus about whether the program ought to be administered by the government or private insurance companies has plagued all efforts to act, and lead directly to the latest failure to pass a bill in the Senate this August.

In the House of Representatives, where a simple majority has more power to force through legislation, Republican leaders passed their version of reform in a relatively party-line vote of 221 to 208 in late June, with eight members of each party crossing lines during the final vote.

With the House action, pressure built on the Senate to bring the bill up for a vote. In early July, the upper house began debate, which quickly bogged down. As the debate dragged on for three weeks into late July and little consensus emerged, many senators acknowledged there would be a political price to be paid for the gridlock.

"Our seniors back home don't understand all this haggling back and forth that we've been doing now for two weeks," Democratic Sen. Zell Miller of Georgia said at the time. "If that's all we have to show for ourselves come November, I guarantee you both parties will pay a steep price at the polls."

If Miller's prediction is true, the fall may be tough for many incumbents, because within two days, the debate ground to a halt, and Senate Majority Leader Tom Daschle admitted there would be no bill at this time.

At least one campaign consultant sees health care, and in particular prescription drugs, as a swing issue in the mid-term election.

"I can't think of one Senate race that isn't going to include issues of prescription drugs, patients' rights and affordable health care," Sarah Bianchi, a consultant on health-care policy to Democratic candidates, told the Baltimore Sun in August.

The issue revolves around how to help seniors who are facing rising prescription costs, particularly low- and middle-income elderly.

Although Congress and presidential candidates have debated the idea of government subsidization of prescription drug costs, the actual affected community remains small. According to government statistics, two-thirds of seniors pay less than $1,000 for prescription drugs now -- and only nine percent have annual bills of more than $3,000. But the impact on the elderly -- one of the most vocal and politically active groups in the country -- and concerns about the potential future effects as costs rise prompted intense debate in Washington.

The proposals, all of which cost hundreds of billions of dollars over the next ten years, broke into three camps: the House plan and two Senate plans, one backed by the GOP, the other advocated by Senate Democrats.

Senate Democrats
· Run as a Medicare benefit
· Cost: over $594 billion over eight years
· $25/month premium
· No deductible
· Co-payments: $10 for generic/ $40 for brand-name
· Out-of-pocket expenses are capped at $4,000/year
· Will expire on Dec. 31, 2010 unless renewed by Congress

Senate Republicans*
· Run by private insurers who can change deductibles/coverage with Congressional approval
· Cost: $370 billion over eight years
· $24/month premium
· $250 deductible
· Must pay 50 percent of drugs up to $3,450; all costs from $3,451 to $5,300; and 10 percent of costs more than $5,301 in a single year

House Republicans*
· Run by private insurers who can change deductibles/coverage with Congressional approval
· Cost: $370 billion over ten years
· $33/month premium
· $250 deductible
· Must pay 20 percent on costs up to $1,000; 50 percent up from $1,001 to $2,000; all costs between $2,001 and $3,700 and no costs above $3,701.

*Both Republican plans offer higher benefits and lower costs to the 10 percent of elderly considered low-income.

But aside from the at-times confusing details of the differing proposals, two basic issues underpin the entire debate over prescription drugs: How much will it cost and who will run the program?

The two parties have each endorsed massive proposals -- all three plans would constitute the largest expansion of government spending on health care since the inception of Medicare in 1965 -- but the question of whether the prescription drug initiative is a Medicare benefit or a subsidized private insurance plan continues to fester. Neither Democrats nor Republicans could find a compromise that answered that question and could garner the votes needed to pass the Senate.

As candidates hit the campaign trail this fall, the question of which party will get the blame for Congress' failure to act on prescription drugs continues to linger. Control of the Senate, where Democrats failed to pass a bill and maintain a single-vote majority, could hang on that question.

--By Lee Banville, Online NewsHour