Four business groups told Indiana’s senators this week to vote against the health reform bill being debated in the U.S. Senate.

They join national business groups that have supported Congress’ health reform efforts, but are now turning against the final product. The bill would raise various taxes to fund subsidies to help more than 30 million uninsured Americans buy health coverage.

The presidents of the Indiana Chamber of Commerce, the Indiana Manufacturers Association, the Indiana Health Industry Forum and the Indiana Hospital Association all signed letters sent to Sen. Richard Lugar, R-Indiana, and Sen. Evan Bayh, D-Indiana. The letter was released publicly on Thursday.

“The current Senate legislation, while expanding insurance coverage, continues and expands many of the dysfunctions of our current health care system,” wrote Kevin Brinegar, Pat Kiely, Kristin Jones and Doug Leonard, leaders of the four business groups.

They mainly faulted the failure of the legislation to change the way doctors and hospitals are paid. Government insurance programs such as Medicare and Medicaid now pay health care providers based on the volume of procedures they perform.

The business groups want the government to base those payments more on patient results or measurements of quality. They also want financial incentives to encourage hospitals, doctors, employers and patients to all work toward common goals.

Those kinds of changes are in the Senate bill, but only as pilot programs. Proponents of the bill say those efforts will expand in the future, but critics doubt that.

“If passed in its current form, it will add stress to an already flawed health care delivery system by increasing demand for health services by millions of newly insured without fundamentally improving the quality of care that patients receive or bend the total cost curve through smart reforms,” the business group presidents wrote.

The business groups also expressed concern about the Senate bill’s higher Medicare and medical device taxes. They also don’t like proposed expansion of the federal Medicare and Medicaid programs, saying these massive insurance plans pay doctors and hospitals too little.