A story in the news last week dealing with something called the "doc fix" offers a lesson about how Congress works and about forces behind the health care reform debate.

"Doc fix" is the name given to a previously routine vote in Congress to override or ignore health care savings that were mandated by Congress in 1997 and that called for reductions in Medicare payments to doctors in annual cuts.

Whether or not the law mandating reduced Medicare payments was appropriate is debatable. But doctors did not like the cuts and mounted a lobbying effort in the early years of the law's implementation, which resulted in Congress canceling the planned cuts each year since 2003.

The cuts might well have had the unintended consequences of forcing some doctors to stop seeing Medicare patients. But the larger point is that this action illustrates a way in which Congress passes a cost-saving measure, then quietly blocks the promised savings.

This year, some members of Congress planned to cancel future reductions in Medicare payments to doctors, which would add about $250 billion to the deficit over 10 years.

Sen. Harry Reid, D-Nev., wanted to eliminate the future cuts to doctors, but 13 fiscally conservative Demo-crats joined Senate Republicans in rejecting the proposal unless the $250 billion cost was accepted as adding to the federal deficit and balanced with offsets, meaning cost cuts elsewhere.

Reid's effort has been panned as a fiscal gimmick, and taxpayers should be concerned that there will be other, similar attempts to fudge the true costs of health care reform.

The political support of doctors for Obama's health reform efforts, or at least the 30 percent of doctors belonging to the American Medical Association, could be at risk if the "doc fix" is not passed. That condition apparently was a part of the deal brokered by the White House to gain the AMA's support for reform.

Much like the behind-closed-doors deals the White House struck with the health insurance industry and the major drug makers, the idea was to give the special-interest group what it wanted, which generally means protecting its profits, in exchange for political support.

As another part of the deal with the AMA, Reid and others apparently asked the doctors group to back off its demands for medical malpractice reform to be made part of health care reform.

It's increasingly clear that the changes that would be most effective in reducing health care spending in the United States — and bringing it in line with per-capita spending in other countries — are being bargained away by the White House or Congress to gain political support for getting some form of heath care reform passed.

The health insurance industry's support for Obama's health reform efforts was based on keeping out a public option — or other effective measures to impose real price competition. Industry profits are threatened by increased competition.

The pharmaceutical industry agreed to support health care reform, but only if the federal government would not use its buying power to bargain for lower drug prices — as is done in other major industrialized countries. The failure to bargain for lower drug prices is just one of the reasons why health care spending in other countries is only about 60 percent of what is spent on a per-capita basis in the United States.

Similar to these deals, the AMA would support health care reform, but only if the planned Medicare cuts passed in 1997 were eliminated. But fiscal honesty from some in Congress might put this deal at risk.

Reid's attempted financial sleight-of-hand reveals the inclination of some in Congress to hide the true costs of health care reform, or to push costs into future years when they might be nullified by future congressional action.

The "doc fix" story also shows how difficult it will be for Congress to achieve significant cost savings in health care reform. Nearly every dollar of potential savings in health care spending is a dollar of profit for some special-interest group — health insurers, drug makers, doctors, hospitals or medical device makers. Each of these groups will fight to protect their profits.

Know this: The public should keep a watchful eye on financial gimmicks and also on the larger issue of whether health care savings will be real or illusory.