Any student of politics or any journalist who covers politics knows that members of Congress look out for their constituents, or else they may not be around after the next election. It’s really that simple. Of course, anyone can qualify as a constituent: the little old lady struggling on her Social Security check; retailers on Main Street coping with a business downturn; or the big boys—the influential bankers, manufacturers, hospital administrators, and, yes, insurance companies, insurance agents, and insurance brokers.

So all the cluck-clucking and consternation surrounding Sen. Joe Lieberman’s health reform positions should come as no surprise. Joe Lieberman comes from Connecticut, and Hartford is America’s insurance capital. It’s home base to Aetna, one of the country’s largest health insurers and a huge lobbying force this year, not to mention some lesser carriers that dabble in the health insurance business.

First, Lieberman drew his line in the sand over the public option. He would not vote for it, saying that a “public option is shorthand for a Medicare-like government plan that would compete with private companies to cover many of the 47 million Americans who don’t get private health insurance through their employers or elsewhere.” Why that’s the same argument that insurers made way back when the debate got started.

Lieberman also said that he worried about the public plan’s impact on doctors, arguing that it could drive down reimbursements to the levels paid by Medicaid—which, he claimed, paid doctors only “seventy percent of their costs.” Lower payments is the argument that the AMA has made in its fight against the public option. Most people may not remember that the AMA did not support the public plan, but that point got lost because of the AMA’s PR blitz that told the world how much it supported reform. Perhaps Lieberman has heard from AMA members in his home territory.

Next, Lieberman objected to Harry Reid’s hastily arranged compromise—a Medicare buy-in for those between ages fifty-five and sixty-four, an option designed to attract the liberals and what’s left of the single-payer crowd. Letting younger people into Medicare could be a baby step toward a Medicare-for-all solution to the country’s health care woes. And that is precisely what the insurance industry and the doctors don’t want. Said the senator from Connnecticut: “It [the buy-in] has some of the same infirmities that the public option did. It will add taxpayer costs. It will add to the deficit. It’s unnecessary. You’ve got to take out the Medicare buy-in.”

Hospitals weren’t too keen on the Medicare buy-in either. Like the docs, they worried that the government would pay unacceptably low rates for taking care of folks in this age group who need hospital care. So, over the weekend, hospitals across the country quickly mobilized to fight the proposal. It’s a fair bet that Lieberman heard from hospitals in his state, too.

In one of his latest pronouncements, Lieberman repeated that the public plan had to go, saying that “you’ve got to forget about the public option. You probably have to take out the CLASS Act, which was a whole new entitlement program that will, in future years, put us further into deficit.” As Campaign Desk pointed out, the CLASS Act offers the beginnings of a public program for financing long-term care, and the insurance industry doesn’t like it. People who want to plan for their long-term care needs could voluntarily join a government plan which would let them pay premiums during their working career. Later on, they would be entitled to a daily cash benefit to use for home care services or home improvements to avoid a nursing home stay. Insurers are worried that they could lose the business for private long-term care policies, which have never caught on with the public. They want to keep what market there is.

Those who have followed health reform these many months knew that the outcome was always going to come down to raw politics. The insurance industry knew that and so did the docs and the hospitals. Joe Lieberman turned out to be their best lobbyist. Who would have thunk it?

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.