President Bush is truly tough on drugs.

He’s tough on Prilosec. And Lipitor. And Celebrex. And Vioxx — or at least he’s tough on helping you pay for them.

If you’re a Medicare client and your drugs are costing you an arthritic arm and a leg — too bad. The only way Bush is willing to help you get your medicine is if you leave the program.

Welcome to the wonderful world of choice.

“Seniors happy with the current Medicare system should be able to keep their coverage just the way it is,” Bush announced in his State of the Union speech last week. But, “all seniors should have the choice of a health care plan that provides prescription drugs.”

Note, please, that seniors have just been given a choice between yikes and oy. They can stay with the current system, which — yikes — doesn’t give any drug coverage. Or they can leave it and look for a convenient, caring, liberally drug-dispensing health care plan that is eager to enroll the old and sick.

Oy.

“While I think everyone agrees (Medicare) needs fixing,” says Sen. Chuck Schumer, D-N.Y., “to tell seniors that the only way they can get drug coverage is to put themselves in the loving hands of an HMO is not going to fly.”

Bush is being coy about the fine print of his plan, even as he’s pushing it. Last week, he urged Congress to “modernize” the program — whatever that means — while posing in front of an orange backdrop proclaiming, “Strengthening Medicare.” At least it wasn’t covered with “Cured in the U.S.A.” labels.

Still, some of us have few illusions about what this “strengthening” entails. It entails weakening the 38-year-old entitlement program by draining it of cash. Just as Bush wanted us to place our Social Security stash in the stock market and our education funds in private schools through vouchers, now apparently he wants to take money out of Medicare and turn it over to the HMOs.

HMOs that even he doesn’t trust! As he stated point-blank in his State of the Union address, “Instead of bureaucrats, trial lawyers and HMOs” — the health care axis of evil — “we must put doctors and nurses and patients back in charge of American medicine.”

Yes! We must! That’s what Medicare did. Participants chose their doctors, the old-fashioned way.

Meantime, it’s not like most health care insurers are even keen on catering to Medicare’s clientele. They never were.

Medicare was enacted by President Lyndon Johnson in part because so many seniors were being denied health coverage. Why was that? Duh — because they got sick a lot.

Even a few years ago, when the government decided to experiment by allowing Medicare clients to sign up for HMOs through something called Medicare+Choice, many of the participating HMOs quickly closed up shop. Caring for the elderly just wasn’t profitable enough.

Are these really the kind of bottom-line-obsessed health care providers we want? The kind that even Bush derides? Doesn’t it make more sense to keep Medicare the way it is — but beef it up with some drug benefits?

That’s what Rep. Charles Rangel, D-N.Y., is proposing. He has drafted a bill that would let seniors seeking drug coverage pay a $25 monthly fee to cover 80 percent of their drug costs. Hit $2,000 in one year, and the government picks up the rest.

Sure, it’s an expensive proposal. It could cost $900 billion over 10 years. But guess what? Bush’s latest tax cut boondoggle would cost $900 billion over 10 years too.

So let’s see: Do we want more health for everyone or more wealth for the wealthiest?

That, o compassionate president, is the real choice.