We cannot properly assess the Senate’s health care compromise because of the lack of detail. However, there are enough bits and pieces of information out there for those Senators most needed to support the bill to balk at it – meaning that calling this a compromise is way too premature.

Olympia Snowe has reiterated her objections to the Medicare buy-in, citing low rural reimbursement rates. But Snowe is also talking about additional problems:

Snowe said she could not see a way for Senate Democratic leaders to even tweak the proposal to win her vote.

“I can’t see it,” said Snowe, who met Wednesday with President Barack Obama. “I am talking to a lot of my providers this afternoon and I know they are mighty unhappy.”

Asked if it meant she would oppose the health care bill, Snowe said: “Among other issues. There would be other issues. That is part of it.”

Joe Lieberman, not one to get out-flanked on being in the dead center of attention, is also raising doubts.

“I am increasingly troubled about the proposal,” Lieberman said. “I am worried about what impact it will have on the Medicare program’s fiscal viability and also what effect it will have on the premiums paid by people benefiting from Medicare now and whether the whole thing is viable. If you separate it from Medicare, it will be an extremely expensive program.”

Jeff Merkley, a freshman Democrat from Oregon, is also talking about opposing the bill because of the reimbursement rates:

Sen. Jeff Merkley (D-Ore.), expressed deep concern on Thursday that a new proposal to expand Medicare to those as young as 55 would seriously exacerbate health care-related problems already existing in his state.

“The basic challenge for Oregon is that a program that expands Medicare using existing Medicare rates would be of very little use in our state,” the senator told the Huffington Post. “And the reason why is because the reimbursement rates are so low in the state of Oregon that doctors aren’t taking additional Medicare patients… They can fill their agenda and their schedules with higher-paying patients.”

Merkley thinks that more conservative Senators should have compromised in the progressive direction, on the opt-out provision. But given the demise of that, you’re looking at a Medicare buy-in which opens up additional cans of worms and parochial issues and interests.

Some Democrats are falling in line, like Carl Levin and even Al Franken, who in a message to supporters said that the compromise may “succeed at keeping premiums down for families,” and that the inclusion of his bill increasing the medical loss ratio, or the percentage of premiums insurance companies must spend on medical care, would “achieve the end result that I want – high-quality, affordable health coverage for Minnesota families and small businesses.”

But if 60 votes is the reason for this compromise, without Lieberman and Snowe, and with some progressives wavering, there’s no path to that 60.

UPDATE: And now the Medicare expansion may be dropped. This is the first article that’s floated such a maneuver. Again, nobody should endorse this at all until we know the details.

David Dayen

David Dayen

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