It was all conditional, the insurers insist. You know, eventually, gradually -- there were no targets.
That's not what their letter said, of course, and the letter was signed by a major union, the SEIU, as well as the hospital lobby.
What's going on is a negotiation.
The industry is still pushing comparative effectiveness. Its customers still insist on cost savings. But since the letter came out, liberals have been pushing harder for a "public option" -- a government-run health care plan that would compete with private insurance.
It was after Howard Dean made approving noises about efforts by Sen. Chuck Schumer to craft a plan that the insurers suddenly felt a need for backsies.
The deal they have offered since December is that the will agree to soft regulation, to targeted savings using comparatative effectiveness, if the Administration takes a public plan off the table. Their latest move is aimed at making Schumer stand down.
In poker you can't take cards off the table. In a game you can't unring the bell. But in negotiations it's done all the time, as any fan of baseball's "hot stove league" knows.
Insurers want their allies in Congress to refuse the Schumer compromise and to tell Democrats they either stick to the commitments industry made in December or fail to get any reform passed and pay the political consequences.
The question is, will Congress understand that the promise is already baked into the pie, because insurance customers have already won the industry's commitments to comparative effectiveness' cost-savings?