My buddy Tom Hamburger of the L.A. Times published another peek inside the Washington sausage factory over the weekend revealing that the American Medical Association (the doctors' lobby), which is supporting the Dem health care bills, has, at the same time, secured a permanent cancellation of $228 billion in scheduled cuts in Medicare payments to doctors over the next 10 years.

Pres. Obama loves to tick off the big health-related lobbies that are supporting his health care plan, including many groups that have opposed previous efforts. And the doctors are always high on the list in this category, especially noteworthy because historically they have been more than leery of the increasing government role in their industry. (The AMA popularized the term "socialized medicine" in their efforts to defeat Medicare in the 1960s.)

But Hamburger's reporting (and other similar pieces by other Washington-based reporters) indicate that most of these groups have received very considerable concessions that may have had something to do with their enthusiasm for the package. He previously reported, for example, that the pharmaceutical company has been assured that the government will not, after all, seek to negotiate lower prices for seniors under the Medicare Part D benefit.

The health insurance industry seems likely to get exactly the "tradeoff" they want: millions of new customers who will be mandated to buy their service and will receive federal subsidies enabling them to do so, but no serious public option to compete with them to put downward pressure on the premiums they can charge.

I don't know whether the concession to the AMA is justifiable on its own merits. Hamburger quotes a whistleblower who portrays it as a bribe, but Tom seems not to go there in his own voice. But he does portray the concession as "the most costly concession to any single interest group made so far."

It gets harder and harder to believe that Obama's cost-containment promises can be kept is this pattern continues. It's pretty hard to contain costs without somebody losing some income or some profits, and whoever is on the losing end is liable to oppose the whole bill unless you "take care" of that problem. This may all be necessary to get any bill past the big lobbies. And This may all be worth it. I don't know. But it's not pretty.