Rural Democrats refused to have the House version of the public option reimburse providers with rates tied to Medicare, because Medicare underpays rural hospitals and doctors. Guess what they did for urban hospitals, though!
House Dems decided, instead, to cute the price tag of the bill by expanding Medicaid, which pays providers way less than Medicare, but it is for urban poors. That is a much bigger, but obviously much less important constituency than Real Americans in Small Towns and so on.
So it is good to Cut Down on Government Spending except, obviously, when the Government is Spending Money deserving, hard-working folks in Coors ads and so on.