An interesting article in The New York Times, By ROBERT PEAR and DAVID M. HERSZENHORN — A Primer on the Details of Health Care Reform — outlines some of the key issues in the health care reform debate. The NYT describes the article as, “a guide to the main fight points.”

KEEP IT OR LOSE IT? Mr. Obama has said repeatedly, as he told the American Medical Association in June: “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” These assurances reflect an aspiration, but may not be literally true or enforceable. The legislation does not require insurers or employers to continue offering the health benefits they now provide.

SOCIALIZED MEDICINE Republicans say the public plan would drive insurers out of business and lead to “socialized medicine” or a government takeover of health care. Democrats say they want a “uniquely American” system with public and private elements. For now, the Republican criticism seems overblown. Major versions of the legislation all rely heavily on a continuation of private health plans, offered by employers and by insurance companies, subject to sweeping new federal regulations.

BLAMING INSURERS Democrats have unleashed a blistering attack on private health insurers as they try to convince the vast majority of Americans who already have coverage that the current system is tilted in favor of corporate profits, not patients, and that insurers are a main obstacle to passing legislation. Insurers say they support some of the most important Democratic proposals, including a ban on denying coverage or charging higher premiums based on pre-existing medical conditions.

DEFICIT-NEUTRAL The Congressional Budget Office has yet to issue cost estimates for the latest versions of the bill approved by three House committees. But it has warned that the legislation “would probably generate substantial increases in federal budget deficits” beyond 2019, in part because health costs are rising faster than the rate of inflation and proposed new taxes would not keep up. Over the next 10 years, the budget office said, the House bill would “result in a net increase in the federal budget deficit of $239 billion,” partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors scheduled to occur under existing law.

EUTHANASIA Conservative critics say the legislation could limit end-of-life care and even encourage euthanasia. Moreover, some assert, it would require people to draw up plans saying how they want to die. These concerns appear to be unfounded. AARP, the lobby for older Americans, says, “The rumors out there are flat-out lies.”

CUTTING MEDICARE To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills’ cost. The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. The providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries’ access to some types of care. Some proposals could affect beneficiaries. The major bills in Congress would cut more than $150 billion over 10 years from federal payments to private health plans that care for more than 10 million Medicare beneficiaries.

Robert Reich says he is appalled that the White House has made a deal to bar the government from negotiating lower drug prices — shades of George W. Bush and his Medicare drug benefit — and that, in return, Big Pharma is spending $150 million for TV ads promoting universal health insurance.

Reich says, “We’re on a precarious road — and wherever it leads, it’s not toward democracy.” He writes:

“The deal between Big Pharma and the White House frankly worries me. It’s bad enough when industry lobbyists extract concessions from members of Congress, which happens all the time. But when an industry gets secret concessions out of the White House in return for a promise to lend the industry’s support to a key piece of legislation, we’re in big trouble. That’s called extortion: An industry is using its capacity to threaten or prevent legislation as a means of altering that legislation for its own benefit. And it’s doing so at the highest reaches of our government, in the office of the President.

“When the industry support comes with an industry-sponsored ad campaign in favor of that legislation, the threat to democracy is even greater. Citizens end up paying for advertisements designed to persuade them that the legislation is in their interest. In this case, those payments come in the form of drug prices that will be higher than otherwise, stretching years into the future. …

“Perhaps the White House deal with Big Pharma is a necessary step to get anything resembling universal health insurance. But if that’s the case, our democracy is in terrible shape. How soon until big industries and their Washington lobbyists have become so politically powerful that secret White House-industry deals like this are prerequisites to any important legislation? When will it become standard practice that such deals come with hundreds of millions of dollars of industry-sponsored TV advertising designed to persuade the public that the legislation is in the public’s interest? (Any Democrats and progressives who might be reading this should ask themselves how they’ll feel when a Republican White House cuts such deals to advance its own legislative priorities.)”