Senate Democrats hoping to convince Sen. Susan Collins (R-ME) to vote for health care reform may be disappointed by her rather unflattering portrayal of the Senate Finance health bill in this morning’s New York Times. “We should rewrite the whole bill,” Ms. Collins said. “There is considerable unease on both sides of the aisle about the impact of this bill, and as more analysis is done, I believe those concerns will only grow”:

Summarizing her study of the bill over the past 10 weeks, Ms. Collins said it was “too timid” in revamping the health care system to reward high-quality care. She said the bill included “billions of dollars in new taxes and fees that will drive up the cost of health insurance premiums.”

And she noted that many of the taxes would take effect before the government started providing subsidies to low- and middle-income people to help them buy insurance. Thus, Ms. Collins said, “there will be a gap for even low-income people where the effect of these fees will be passed on to consumers and increase premiums before any subsidies are available to offset those costs.” The bill sets standards for the value of insurance policies, stipulating that they must cover at least 65 percent of medical costs, on average.

Most policies sold in the individual insurance market in Maine do not meet those standards, Ms. Collins said, so many insurers would have to raise premiums to comply with the requirements. As a result, she said, the premium for a 40-year-old buying the most popular individual insurance policy in Maine would more than double, to $455 a month.

Experts agree with Collins that the bill could do more to contain costs. “[T]he measures take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed,” the New York Times writes, and some have suggested that the bill “could do more to reward quality care over quantity” than simply fund demonstration projects.

Indeed, the Senate could do more to reign in health care costs, but it’s up to senators like Collins to propose improvements. Why not insist on a robust health care exchange that can engage in prudent, selective purchasing of insurance, or a more powerful Medicare Commission that doesn’t protect large groups of providers from cuts? Collins can introduce amendments that limit Medicare’s payment updates to reflect productivity, limit payments in high-cost areas to encourage more appropriate utilization of health care products and services, or “allow private health insurance companies access to Medicare rates, requiring health care providers to accept those rates.” Changing reimbursement rates in Medicare and the private market could lower the cost of the bill, bend the cost curve, and reduce premiums for middle class families.

But Collins wants to reign in costs without voting for controversial cost containment policies. She opposes the existing Medicare reforms and rejects any kind of public option. She thinks plans in the exchange are too costly, but doesn’t want to increase subsidies to ensure that coverage is affordable. She agrees that the bill could go further to reign in costs, but not if she has anything to do with it.