Fearful of losing congressional seats, the Republicans are priming the populist pump for this November's election. One place they hope to find water is the Medicare Part D drug benefit. While seniors are no longer terrified about their choices under this plan, it is hardly problem-free for them or Republicans.

About six million of 43 million of the eligible beneficiaries for Part D failed to meet the deadline of May 15, according to the Medicare actuaries' previous estimates. That comes despite relentless efforts, from President Bush on down, to sign up seniors, and media wrangling about how hard it was for granny to find the right drug plan.

Those who failed to meet the deadline cannot enroll until next November, and when they do, they'll be "fined" 1% of their premium for every month they've delayed. Headlines about grannies not only confused about their choices but also being fined will hardly work to the Republicans' advantage.

Sen. Charles Grassley and Rep. Nancy Johnson have introduced bills in both Houses to abolish the deadline retroactively, so that no senior will be fined. This will further enrage the conservative base, already appalled at the cost of this program. Nor is this the end of government meddling in Part D, whose so-called "market incentives" are beginning to unravel.

Fearful that insurers' might have "baited and switched" seniors to enroll, the administration recently forbade them from dropping medicines from their formularies until the next open enrollment period. And what a time that will be. Apparently concerned that some of the Part D plans might not deliver as promised, the administration has also announced that the entry criteria for plans next year will be tighter.

This will launch another cycle of stories about how granny, having fretted countless hours deciding which plan to join in 2006, will be thrown back to the wolves for 2007. This does not bode well for the electoral success of the party that incorporated the "non-interference clause," which prohibits the government from interfering with price negotiations between Part D insurers and drug makers.

The Republicans cannot compete against Democrats when it comes to the "generosity" of the drug benefit, because the Democrats want to get rid of the private insurers and impose direct government price controls. Polling indicates that 79% of Medicare beneficiaries support such a move. At least two thirds think, against all evidence, that price controls would have no negative consequences for research and development, or quality. This situation, however, is salvageable.

It merely requires moving the "competition" downstream, so that the money flows from Medicare to the patient, who decides which plan to use, rather than directly from Medicare to the insurer. This will give patients more autonomy because beneficiaries will control the resources, rather than simply being on the receiving end of a new government entitlement. More seniors will be satisfied and fewer confused when they control the relationship with the Medicare Part D and Medicare Advantage insurers.

By "voucherizing" this entitlement, the Republicans will at least mitigate the anger of their conservative base. Conservatives are disappointed with the failure of President Bush's Social Security reform, but at least Social Security pays out a cash benefit. Nobody advocates that it be converted into housing, food, transportation, and other necessities provided directly by the federal government.

For Part D, the government already knows what the appropriate dollar figure is, from the amounts that insurers bid for this year's part D beneficiaries. There is no reason why the government should not take the payment it gives UnitedHealth for a Part D beneficiary in Omaha, for example, and give it directly to her to choose the plan she prefers. Larger-value vouchers would attract seniors into Medicare Advantage plans too, and out of traditional Parts A and B.

As things stand, Medicare Part D is hardly sure-fire salvation for seniors or Republicans. Also getting nervous are the insurers and pharmaceutical companies who lobbied hard for the drug benefit. If Democrats gain control of the House, government price controls will arrive.

Rather than feeling satisfied with what they have wrought, this risk should prompt insurers and drug companies to push for further change immediately, if only for self-preservation. All parties need to consider deeper Medicare reforms that trim government meddling and expand choices for seniors.