Here's the fundamental divide. All of the posturing, triangulating, and speechifying about the need for "reform" doesn't mean squat if it avoids the 8000 pound mastodon in the room.
Is the fundamental purpose of health care to take care of people, or to make money? That's the question. You can't have it both ways. The AHIP insurance companies and drug makers and proprietary-hospital industries are industries. They might as well be making yachts or cigarettes or derivatives or machine tools.
It's just a business to these companies. It's capitalism. Maybe the patient will get better, and maybe the provider will get paid. But that's simply a cost of doing business, and as anyone in business knows, business is all about cost containment and revenue maximization. They can be sued by "shareholder activists" if they attempt to do anything that isn't focused on the stockholder's well being. By today's perverted view of law, the only good behavior they are allowed to engage in is that which they are required to, by regulation or statute. Just being nice is a violation of their fiduciary responsibility -- it is only okay to pretend to do so, for advertising reasons, or to do so to the extent that it can be written off ad advertising.
I'm not opposed to capitalism -- it is a fine way to produce products and profit-making services. But we have to recognize it when we see it. Even when it wears a white lab coat and stethoscope.
The alternative view is to treat medical care as a human right, a public good. We do that now with education, with police protection, with fire protection, with roads, and with Social Security. (Recall that into the 19th century, fire protection in some places was sometimes provided by insurance companies to their owns subscribers only; with no insurance, you were left to burn down.) This hasn't eliminated private participation in the entire. There are still private schools, security guards, railroads, and retirement plans. But we have a baseline -- these are the public goods.
AHIP and friends have paid dearly for a Congress that is afraid to remove them from the realm of capitalism. They know that if the gravy train is up if health care is recognized as a public good. So it's all posturing, noismaking, and dancing around the fringes. They won't lower costs, but they'll reduce the outrageous rate of increase by 1 1/2 percent, so it'll still go up faster than inflation but by not quite as much. That's about all they'll offer. Maybe some tweaking around the edges. What they would love is a capitalists' dream, the Massachusetts plan, where rates are unregulated and astonishingly high, and it's mandatory to buy into it. The state then tries to subsidize the poor, but the state budget is hurting... This is not an improvement.
And there is one way to make it worse. McCain proposed funding private insurance for the poor by taxing private insurance on the non-poor. As a self-employed person, I pay about $1500/month for mediocre health insurance, but at least it's tax-deductible. Tax it and it is effectively that much more expensive.
We expect that kind of horror from Rethuglicans, who never miss an opportuntity to milk the middle class. But Democrats have to make a decision. Is health care a public good or a capitalist industry? It can't be both.
BTW there are private insurance companies in some European countries, but they do not compete to lower their costs by refusing care. The state usually equalizes their risk-based costs. They basically do servicing, and do it cheaply. This is not really what the American health insurance industry is about.