very day, Jere Hoffman of Longmeadow sits in his kitchen to count out 34 pills. Ten years ago, the Korean War veteran received a heart transplant, and without the pills he would die.
The prescriptions cost about $15,000 annually, of which Hoffman, until recently, paid a third.
It was a significant chunk of the 70-year-old's income, and he was always cutting corners, doing without a trip to visit family here, some clothing there.
''I had to really cut costs,'' he said, before the Veterans Administration agreed to cover more of his prescription bills.
Hoffman and people like him are at the center of one of the top political issues this presidential year and one that has the Democratic and Republican nominees scrambling to draw up distinctively competing plans.
To Hoffman, Vice President Al Gore's prescription-drug plan essentially says: We will expand government to help you.
Taking an opposite tack, Texas Governor George W. Bush's plan, unveiled yesterday, says: We will invite the private market to assist.
With Bush's plan now in the open, it has become clear that the two candidates have significant philosophical differences on how this politically potent issue should be handled. And the differences go to their respective parties' ideological cores.
Democrats have revered the Medicare program since it was created in 1965, and Gore's plan would spend about $100 billion more than Bush's over 10 years to expand the program to include a prescription-drug subsidy. It is similar to a program offered by President Clinton earlier this year.
Bush believes that the entire Medicare program needs a more fundamental overhaul. He would replace its single, government-set health plan with a market-based approach in which private insurers could compete for seniors by offering a variety of plans.
This, he said, would help cut costs and keep Medicare fiscally stable for decades. Bush's plan, an extension of a recent proposal by congressional Republicans, would offer a smaller subsidy than Gore's but would allow seniors to seek drug coverage from private plans.
Both plans have one aspect in common: They offer total coverage of prescription drugs for impoverished seniors. After that, they would offer varying degrees of help with drug bills.
Gore's plan covers half the drug cost to seniors, up to total costs of $5,000. After seniors have spent $4,000 annually, the Gore plan would cover everything else. Seniors would pay the government $25 a month for its help, a premium that would rise to $44 by 2008.
Under the Gore plan, the government would control which drugs were covered but the coverage would be mostly uniform throughout the country. The Bush campaign criticized this as a rigid, ''one-size-fits-all'' approach.
But this uniformity could allow the government to negotiate lower drug prices with pharmaceutical companies by using the massive population of Medicare seniors as leverage.
The Gore plan carries a $253 billion price tag over a decade.
The Bush plan would reimburse most seniors 25 percent of their prescription insurance premiums. But the rest is up to the market. The plan depends on private health insurance companies offering seniors drug coverage. Insurers could offer a range of coverage plans, with a range of monthly premiums.
Generally, the more extensive the coverage, the higher the premium. This, Bush campaign officials said, would give seniors flexibility to pick plans that best fit them.
The Bush plan would cost an estimated $158 billion over 10 years. He also would allocate $40 billion to reimburse doctors and hospitals for reduced payments under a deficit-reduction act.
Critics of Bush's approach said the private market is too tumultuous to trust, and could result in unpredictably high premiums.
''It's conceivable that elderly seniors would pay a huge portion of their income on drugs,'' said Stephen Soumerai, a professor of ambulatory care and prevention at Harvard Medical School.
In Massachusetts, the private market for seniors has been unstable in recent months. In January, Harvard Pilgrim Health Care stopped insuring Medicare recipients in Barnstable, Bristol, Plymouth, and Worcester counties. More recently, Fallon Community Health Plan and United Health Plans pulled out of several counties, and 10,000 seniors were left to look for new coverage.
Robert Blendon, a professor of health policy at Harvard's Kennedy School of Government, said that seniors he has polled generally favor only limited changes to Medicare. ''For seniors who have modest incomes, they feel more secure with Medicare. For upper incomes, [the Bush plan] might be more appealing,'' he said.
