The most important political fact affecting health care reform is the sizable Democratic majority. There are too many Democrats in the House and Senate for a bipartisan bill to make sense.
Given that we are going to have a partisan bill, we are not going to see a bill that tries to address the issue of cost. Any measure that restrains health care spending is going to go against the interests of constituents. This sort of painful step will only be taken when both political parties are involved, with each one providing cover for the other.
At some point, the Democrats will invite Republicans to join in a genuine, bipartisan effort to control the excessive use of high-cost, low-benefit medical procedures. For now, however, the goal of a partisan bill will be to offend as few people as possible.
As I have written before, with a partisan bill, we will get dessert, not spinach. That is, more government subsidies, not efforts to restrain spending.
Down the road a few years, the Republicans will be invited to join in a statesmanlike effort to control costs. For the spinach, they will be allowed to share credit. Not for the dessert.