I think you gotta start with the proposition that nobody with any real power/money/influence is eager to embrace a comprehensive realignment of the forces involved in moving--no matter howsoever delicately or timorously--toward any fundamental change in the way health care is payed for in Murka. The folks running things are quite satisfied with the way things are, health-care wise. Their own care is not now, never has been, and never shall be an issue. They get the best. Period. What happens to the rest of 'us' is not, in their humble estimation, really any business of theirs, or concern either, for that matter. It has nothing to do with them. They are completely insulated--as completely as possible--from the vicissitudes that regularly collapse upon and crumble those among the scrambling hordes not so lavishly provided for.
They are, therefore, vitally eager that the element of "profit" NOT be removed from the calculus, however. The status quo enriches them, and is co constructed that, unimpeded, it will to increasingly enrich them. If it doesn't also provide for the health of the people, well, shit happens.
With this in mind, the trajectory of The "Health-Care/Insurance" debate in Congress became clear to me. At least, here's how I'd do it, if I--the legal representative of the Owners who were at best extraordinarily ambivalent about, if not unutterably opposed to-- had promised 'change', and wanted to make it still look like I wanted "change," but didn't really want to "change" anything that would disturb the Owners any at all, or cost 'em any profits, or deprive 'em of any perqs, or challenge the status quo, or threaten the balance of power, or anything.
The plan--Obama's and that of the Congress as well, all of them in cahoots, one way or another--is to propose and back such a cosmetic, weak, listless, meaningless, expensively inequitable program which NOBODY likes, costs a ton of money, and leaves huge holes in the coverage; then negotiate it down to nothing, or the status quo made mandatory.
And then blame the 'libruls' for failing to compromise for the fact that the bill, when actually evaluated, only perpetuates the basic outlines of the status quo.
Cuz it won't matter what's actually in the bill. By then, any bill passing Congress carrying the "Health Insurance Reform" imprimatur will be covered as avidly and as admiringly as the arrival of the Titanic in NYC Harbor tomorrow might occasion. EVERYONE will proclaim the most miraculous, life-changing, extravagant VICTORAYS! "thePrez" MOST especially. Wide and bright will be the smile! Effusive and self-congratulatory will be the rhetoric: VICTORAY! for the people and against those greedy insurance bastids (while nevertheless being compelled, by force of law, to have health insurance available only through 'private," albeit national providers...).
Cuz nobody WITH power EVER wants to see ANY change to ANY condition that was operating when THEY got power. No incumbent ever really wants to expand the franchise, to make it easier for somebody who hasn't voted before to vote now, for instance. The only reason there are impediments to same-day registration/voting is because incumbents, who have to pass the laws enabling it, don't stand to gain anything by it.
Indeed, in their eyes, in the logic of incumbency, the potential to enfranchise an opponent's voters actually far outweighs the potential to enfranchise your own voters. That's cuz incumbency decides your voters have already voted for you under the current rules. People who haven't previously voted, but who are inspired to vote in some current election, cannot, incumbency surmises, be counted upon to vote for the incumbent associated with the issue which inspires this hitherto placid voter to action. New voters cannot be placated by the status quo, and so are not to be trusted.