As Congress prepares once again to debate whether and how to add a prescription drug benefit to Medicare, the nature of the debate has changed. Many Republicans, including President Bush, also want to revamp the entire Medicare program, beloved by the 41 million people for whom it provides health insurance. They justify totally restructuring a program that works for so many individuals and their families because they claim Medicare hasn't kept up with the times in terms of the health coverage it provides. One of the statements frequently heard, and accepted as gospel by those who don't know, is that Medicare doesn't cover preventive benefits. The statement, like so many others made during this debate, is not true.

In fact, Medicare now includes many preventive benefits including:

• Flu, pneumonia, and Hepatitis B vaccines

• Annual mammograms for women age 40 and over, with no Part B deductible;

• A pap test every two years, and more frequently for those at high risk for cervical cancer; again with no Part B deductible;

• Colon cancer screening tests, including colonoscopy;

• Bone mass measurement procedures for individuals at risk;

• Prostate cancer screening;

• Diabetes screening tests;

• Diabetes management training;

• Medical nutrition therapy for those with diabetes or kidney disease;

• Glaucoma screening for people at risk, including those with diabetes.

Yes, the list of preventive benefits can be improved. Medicare does not pay for an annual physical exam or routine vision or dental care. But the program doesn't need to be thrown out just because those services were excluded from coverage in 1965. As with the preventive benefits listed above, Congress can amend the Medicare statute to make annual physicals and other routine exams available to all beneficiaries as part of the existing program. In fact, many of these preventive benefits have been added by Congress in just the last few years.

Congress could also, if it so chooses, decide to reduce or eliminate co-payments or deductibles for preventive care, again without totally revising the Medicare program. In fact, Senator Jay Rockefeller from West Virginia and Congressman Pete Stark from California have proposed legislation that would do just that - reform the existing Medicare program by adding preventive services and eliminating beneficiary cost sharing for all beneficiaries. Their reform proposal truly addresses the needs of those older people and people with disabilities who rely on Medicare.

To say that Medicare does not cover preventive services is to mislead the American public - and to ignore the work done by Congress over the past decade to improve the Medicare program. To justify destroying Medicare, an American success story, on the grounds that it is irreparable and does not cover services it does cover or could cover, is dishonest. Congress should continue efforts to build Medicare, rather than unnecessarily tearing it apart.