I agree with you, and I also suspect that the ban on discriminating for pre-existing conditions isn't real either. The insurance companies will also be able to work around the medical-loss ratio reform.

If those reforms were real, the health insurers' lobby would be fighting hard against this bill.

Quick Summary:

http://www.kff.org/healthreform/upload/housesenatebill_final.pdf

Pg 35:

 

• Improve workforce training and development:
– Establish a multi-stakeholder Workforce
Advisory Committee to develop a national
workforce strategy. (Appointments made by
September 30, 2010)

– Increase the number of Graduate Medical
Education (GME) training positions by
redistributing currently unused slots, with
priorities given to primary care and general
surgery and to states with the lowest resident
physician-to-population ratios (effective
July 1, 2011);

- Increase flexibility in laws
and regulations that govern GME funding
to promote training in outpatient settings
(effective July 1, 2010);

- Ensure the
availability of residency programs in rural
and underserved areas.

- Establish Teaching
Health Centers, defined as communitybased,
ambulatory patient care centers,
including federally qualified health centers
and other federally-funded health centers
that are eligible for Medicare payments for
the expenses associated with operating
primary care residency programs. (Initial
appropriation in fiscal year 2010)

– Increase workforce supply and support
training of health professionals through
scholarships and loans; support primary care
training and capacity building; provide state
grants to providers in medically underserved
areas; train and recruit providers to serve
in rural areas; establish a public health
workforce loan repayment program; provide
medical residents with training in preventive
medicine and public health; promote
training of a diverse workforce; and promote
cultural competence training of health care
professionals. (Effective dates vary)

- Support
the development of interdisciplinary mental
and behavioral health training programs
(effective fiscal year 2010) and establish a training program for oral health
professionals. (Funds appropriated for six
years beginning in fiscal year 2010)

• Address the projected shortage of nurses and
retention of nurses by increasing the capacity
for education, supporting training programs,
providing loan repayment and retention grants,
and creating a career ladder to nursing. (Initial
appropriation in fiscal year 2010) Provide
grants for up to three years to employ and
provide training to family nurse practitioners
who provide primary care in federally qualified
health centers and nurse-managed health
clinics. (Funds appropriated for five years
beginning in fiscal year 2011)

• Support the development of training programs
that focus on primary care models such as
medical homes, team management of chronic
disease, and those that integrate physical and
mental health services. (Funds appropriated
for five years beginning in fiscal year 2010)

• Improve access to care by increasing funding
by $11 billion for community health centers
and the National Health Service Corps over five
years (effective fiscal year 2011); establishing
new programs to support school-based health
centers (effective fiscal year 2010) and nursemanaged
health clinics (effective fiscal year
2010).

Well then you have to read this:

http://www.princeton.edu/~starr/20starr.html

Was written in 1994 after the failure of that effort. It's amazing how similar some of situations are - including the GOP playbook to defeat the reform.

It's called death by CBO.... The CBO likes the excise tax, thinks it's a swell "cost control" idea and keeps scoring it highly. They think it's better than the original millionaire surcharge (which they scored poorly). So it keeps being put in the bill. My own thinking is that the excise tax will become a lot like the AMT.