"negotiated in advance with insurance and pharma lobbies"
As disgusting as it was, just more ir-refudiatable evidence that nothing moves in DC without the corps being protected and enriched (and taxpayers wealth transferred to them), without the deals, they would have gone "Harry and Louise" on health care reform (the ghost of Harry and Louise was haunting the entire process), and he would have ended up with nothing. Just like grocery store sausage is full of toxic , DC sausage making is famously repulsive.