More details on health care reform. Sort of

From an article in the NYTimes:

• Mr. Obama would, for example, require drug companies to give bigger discounts, or rebates, to Medicaid, the health program for low-income people.

  Drug makers now must provide Medicaid with a discount equal to at least 15.1 percent of the average manufacturer price for a brand-name product. Mr. Obama wants to require discounts of at least 22.1 percent. Pharmaceutical companies have resisted such proposals in the past. (No. Surely not.)

• Mr. Obama said he would save $176 billion over 10 years by cutting Medicare payments to health insurance companies that provide comprehensive care to more than 10 million of the 44 million Medicare beneficiaries.

  Medicare pays private insurers an average of 14 percent more than it would cost to care for the same people in the traditional fee-for-service Medicare program. “It’s time to stop this waste,” the White House said.

  Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, denounced the proposal. (Another surprise.)

• The president also proposed cutting Medicare payments to hospitals that re-admit a large proportion of patients within 30 days after they are discharged. Such re-admissions sometimes indicate that hospitals provided poor care or did not properly coordinate care.

  Under the proposal, hospitals would receive “bundled payments” that cover not only their own services, but also any care provided by nursing homes and home health agencies in the month after patients left the hospital. (What? No one's objecting?)

• Mr. Obama also proposed squeezing $37 billion out of the payments to home health agencies over the next decade.

  William A. Dombi, vice president of the National Association for Home Care and Hospice, a trade group, said this proposal would directly affect frail, sick older people.

  “Patients would lose access to care very quickly,” Mr. Dombi said. “Over 70 percent of all home health agencies would be operating in the red.” (Yet another predictable response.)

• Doctors praised one aspect of Mr. Obama’s budget. He assumes that Congress will protect doctors from cuts in Medicare payments scheduled to occur under current law — cuts of 21 percent in 2010 and about 5 percent in each of the next few years.

  “We are very pleased,” said Dr. Nancy H. Nielsen, president of the American Medical Association. “All previous budgets assumed cuts in doctor payments.” (Predictable yet again)

Everyone so far is running true to form, protecting their particular special interest. We can expect to see a great deal more of this, of course. It's this kind of thing that has always defeated health care reform.

But I'm wondering if it's wise to proceed thus, in piecemeal fashion. Don't we need an overall plan which could be convincingly sold to all players, where everyone could see a benefit to the whole, not just a loss to themselves?