I’ve been arguing that the GOP’s health care proposals would shift the risk and the cost of insurance from the employer and the government to the individual. It’s what Jacob Hacker calls The Great Risk Shift. By relying on high deductible plans in the individual health insurance market and health savings accounts, Republicans are dismantling the kinds of pooling mechanisms that spread risks “across rich, and poor, healthy and sick, able-bodied and disabled, young and old” and shifting more of the economic costs and risks of insurance onto a single individual. That’s the essence of consumer-driven medicine.

Skyrocketing health care costs are already forcing employers to switch into plans with higher deductibles and co-payments and a new survey of employers finds that without significant reform, Americans will move faster towards the conservative health care utopia. A growing number of employers are predicting that unsustainable health care spending will force them to “charge more to cover spouses, tighten eligibility standards for their health plans and dispense financial rewards or penalties based on the results of certain lab tests“:

Meanwhile, employees at many companies can expect significantly higher premiums, deductibles and co-payments…the new survey is a reminder that even people who are satisfied with their insurance plans cannot count on a continuation of the status quo. With or without reform, coverage at big corporations is likely to become less affordable, and it could become more restrictive. [...]

In addition, employers are increasingly moving toward high-deductible plans, which carry lower premiums while leaving workers responsible for higher out-of-pocket expenses. Next year, 12 percent of employers plan to offer only high-deductible coverage, the survey found.

Conservatives have pushed back against health care reform by arguing that most Americans like the insurance they have. And indeed, reform advocates have had a difficult time engaging the insured majority — who feel insulated from the insurance problems of others. But many Americans in employer based coverage are already experiencing the kind of shifts the survey describes and I suspect if reform doesn’t pass this time around, those poll numbers will begin to shift. Nobody actually wants to use the Republican prescription. Especially when they get sick.

During the AHIP’s insurance conference on Tuesday, AHIP President and CEO Karen Ignagni claimed that health insurers were “very concerned about insurance premiums and the trajectory” of health care spending and promised that the industry remained committed to controlling costs. “We understand that begins also with us. So we are fully committed to cost containment,” Ignagni said.

But just several hours later, on Fox Business’ Neil Cavuto, Ignagni blamed hospitals, doctors, and the pharmaceutical industry for rising costs. Ignangni also falsely claimed that insurers cannot negotiate prices with providers:

IGNAGNI AT 10 AM: “So we are fully committed to cost containment, not finger pointing to other sectors.”

IGNAGNI AT 6PM: “Health care costs are surging. We have our health plans Neil, that are getting quotes from hospitals of up to, they want 40% increases, we see pharmaceutical prices surging. We see tests increasing, exploding…we’ve had consolidation of the hospital arena.”

Watch a compilation:

Ignagni’s hypocrisy exemplifies the industry’s two-pronged strategy of publicly supporting reform while secretly funding efforts to undermine it. Similarly, while the industry’s “charm campaign” has argued that insurers would “lead the charge” on supporting insurance reforms and controlling costs, insurers have continued rescinding policies and increase rates. In August, the Energy and Commerce Subcommittee on Oversight and Investigations investigated insurance practices and concluded that far from “leading the charge” on reform, Assurant Health, UnitedHealth Group, and WellPoint have “continued to rescinded policies for almost 20,000 individual insurance policyholders” and avoided paying more than $300 million in medical claims” over the last five years.

Ignagni isn’t entirely wrong in arguing that large provider groups use their market leverage to raise reimbursement rates and increase health care costs. But her claim that insurers can’t lower these rates through negotiation is wrong. In fact, at the insurers’ own conference, Mark Miller — executive director of the Medicare Payment Advisory Commission (MedPAC) — took insurers to task for overpaying hospitals and doctors and criticized the industry for failing to use their market power (in areas of high market concentration) to secure lower reimbursement rates.

Several news outlets are reporting that Democrats have decided to abandon their negotiations with Rep. Bart Stupak (D-MI) and take the risk that some small number of pro-life Democrats will vote against the Senate bill. Democrats reason that fixing the provision through reconciliation would be impossible and passing a separate bill is unlikely, especially after Stupak rejected an offer to take up abortion after reform.

But the biggest cause for this new push is the realization, on the part of the Democratic leadership, that many moderate pro-life Democrats actually read pages 2069-2078 — which Stupak regularly cites to demonstrate that he is an authority on the subject — and learned that it doesn’t do what Stupak says it does.

Brian Beutler quotes Henry Waxman (D-CA) as saying that the decision to cut off negotiations isn’t final, but likely:

But most members feel that the abortion issue was dealt with in the Senate-passed bill….Ironically, what we have is a situation on abortion which neither side is now particularly happy about and so I don’t now how we’ll resolve it but we’ll keep looking….

We just have to all stay open and keep talking until we see where we end up….

There are many people who share his views who are voting for this bill. They feel strongly about the pro-life position but they feel like the Senate bill encompasses a compromise that they can accept in this legislation and they’re willing to go forward with it. There are some who take a different view and we hope to convince them to join us and they hope to us to make them concessions.

So it sounds like Stupak’s gang members have decided that passing health care reform is, in the words of Mitt Romney, “the ultimate pro-life effort” — one that supersedes Stupak’s goal of striping abortion coverage out of private health insurance.

The abortion issue appears to be solving itself, but Democrats still face significant hurdles to passing the Senate bill in the House. Undecided lawmakers have yet to commit to supporting legislation they have not seen and some members are still asking for major legislative changes. On Thursday, Democrats told the New York Times that “they were not given the text of the latest legislation” and some lawmakers from the Hispanic Caucus are frustrated with the Senate bill’s restrictions against undocumented Americans purchasing coverage and are threatening to vote against health care reform unless changes are made to the bill’s harsh immigration provisions.

House Speaker Nancy Pelosi (D-CA) won’t know if she has the votes until the last possible moment and there is certainly no guarantee that they will pass it.