The Big O’s Health Reform Express has been stuck in the La Brea of tar pits for weeks as it confronts dissention among Congressional Democrats and cold feet among key stakeholders it thought were in the bag.

And today’s release by House Democrats of a draft proposal that would tax the rich to pay for health reform and launch a government-run insurance plan that would compete with private insurers only makes things stickier, since it has no chance to pass in the Senate.

Henry Waxman, who has lead reform drafting efforts in the House, continues to act like the kid on the playground who didn’t get picked to be in the game.

Referring to deals struck in his absence by the Senate Finance Committee, the Big O, industry executives and various interest groups, the Chairman of the Energy and Commerce Committee chirped “we’re not bound by (those agreements). The White House was involved…we were not.”

Meanwhile, American Hospital Association reps from several states were criticizing their parents’ $155 billion deal with the Big O on grounds that across-the-board Medicare cuts unfairly penalized providers who already provided care for reasonably low cost.

For their part, 5 Big Pharma CEOs were complaining to White House Chief of Staff Rahm Emanuel and health czar Nancy-Ann DeParle about proposals to permit the purchase of imported drugs and to regulate generic biologics.

On the latter issue, the Biotechnology Industry Organization wants 12 years worth of patent protection for its fancy new drugs. That’s “asking for a protection deal twice as sweet” as that given to traditional drug makers 25 years ago, an incredulous AARP spokesman Jim Dau told the Washington Post.

“How much more money do they think they can wring out of patients and taxpayers?”

Amid all this, Emanuel has remained unphased. The public outcry for an affordable, accessible health care system, he insists, will eventually carry the day. “It leaves those who oppose reform as the defenders of the status quo,” he told the Post.

This post first appeared on the Practice Fusion blog.

Prompted by increasingly permissive reimbursement policies, digital office visits–in which patients and physicians use computers to manage clinical issues that traditionally necessitate an office visit–are growing faster than biceps on steroids.

Big Insurers from Aetna to WellPoint are experimenting with such programs, which are a time-savers for everyone and less expensive than a schlep to the doctor’s.

“If…there is payment for it, we will see many more primary-care physicians doing it,” Ted Epperly told the Wall Street Journal. The president of the American Academy of Family Physicians said that at the moment, about 3% of his organization’s members offer digital office visits.

Physicians agree that the new format is best reserved for simple stuff; colds and flu, urinary infections, back pain and sleep disturbances for example. Even in such instances, some offer the option only to patients they know, mostly as a hedge against malpractice.

And no physician in her right mind would go this route for symptoms that could spell trouble, like chest pain–any kind of pain really–or abdominal symptoms, which are notoriously difficult to diagnose without a physical exam. 

The field is still in shake-out mode, with many formats for the interaction being tried in many venues across the country.

The simplest approach is using secure, HIPAA-compliant email. In another format, patients must complete symptom-specific algorithms in advance of the actual interaction.

The snazziest approach involves live, online visits using Web video, chat or a phone conversation routed for privacy purposes through a secure computer system.

In a joint experiment of the latter approach, American Well and the Hawaii Medical Service Association combined to offer such services to enrollees, who pay a $10 co-pay for the privilege. 

For non-insured online visits, the going rate around the country seems to be about $20-35, a steal when compared to the cost of the old-fashioned schlep.