It's hard to say which presidential candidate will win the election, but easy to identify one group that will lose: Americans under age 50. The way things are going, none of us will be able to enjoy the benefits of Medicare.

By 2010, spending on Medicare will be nearly double what it is today, as each enrollee becomes more and more costly. Then, all hell will break loose. The Baby Boomers will start retiring and the rate of enrollment will double. Right now, there are almost four workers supporting each Medicare beneficiary. By 2030, there'll be only two. Meanwhile, the cost per enrollee will continue to rise. To continue the program as we know it, each worker will have to contribute a fifth of every paycheck to Medicare taxes.

Both Mr. Bush and Mr. Gore pay lip service to this fact. But instead of advancing responsible ideas for saving the program, they pander.

Mr. Bush outlines vague plans to add a prescription drug plan to Medicare and to essentially change it from a defined benefit to a defined subsidy plan, allowing seniors to shop for plans themselves. (It won't work, as evidenced by the experience with risk HMOs.) What's more, Mr. Bush wants to cut taxes, and in his position statement, he says "Medicare payroll taxes must not be increased." Read my lips.

Mr. Gore envisions expanding Medicare. He plans to add a $338 billion prescription drug plan and also wants to make it available to people 55 and older. He essentially wants to make many preventive services free. Paying for this will be painless, Mr. Gore says soothingly. We'll just use the overage from the Medicare payroll tax to pay down the national debt, thus saving on interest payments and "extending the life of Medicare to at least 2030." Why didn't I think of that?

We need to keep the Medicare program. It's been one of the best things government has ever given us. People forget that before 1965, most seniors could not get insurance. Many of those struck by health problems ended up in the poorhouse. Covering all elderly under one plan is the only way all can be covered.

We won't keep it, though, unless we gut it up, and vote for a politician who will tell us the truth about what needs to be done to save it. Cut benefits, raise the age limit, increase the deductibles and co-payments, and (horrors) raise taxes slightly now, before it's too late.