Against Our Will

President scores a personal victory, but costly, unpopular health bill isn't a win for the country

President Barack Obama used his Democratic majority, buttered with promises and payoffs, to pass a health care bill he declares is good for the American people, but one that the people despise.

Passing such sweeping legislation against the public will, with the votes of just one party and by bending the rules of lawmaking, will make it much harder to convince taxpayers to endure the sacrifices that these changes will mandate.

In the end, passage is a solid personal political victory for Obama. His perseverance in driving the bill forward despite it repeatedly coming off the rails stands as a historic presidential achievement, and one that must be admired even by opponents of the measure.

But it is not likely to deliver a win for the country. For starters, there's the cost.

The Congressional Budget Office scored the cost of the bill at $950 billion over 10 years, keeping it under the $1 trillion threshold that many moderate Democrats said they would not cross. The CBO also says it will reduce the federal deficit by $138 billion. But achieving that feat on paper required fiscal sleights of hand and for congressional Democrats to pretend to have forgotten everything they know about how government works.

The CBO had to score the bill based on what Congress says it intends to do. But no one who voted for this bill could possibly believe that Congress will, for example, cut $500 billion out of Medicare costs by attacking fraud. Nor are lawmakers likely to trim payments to doctors and hospitals by the amounts required to make the numbers work.

Former CBO Director Douglas Holtz-Eakin estimates in reality the bill will add $562 billion to the deficit and cost 2 1/2 times what is projected.

In addition, the coverage mandates included in the bill will drive up health insurance premiums for both individuals and businesses. And it is paid for with direct tax hikes on high-income earners and indirect tax hikes on everyone else.

The bill also stands as the most impactful legislation ever passed without a single vote from the minority party. The only bipartisanship reflected in the bill is the few Democrats who joined Republicans in voting against it.

But the bill is done, at least for the moment, and is not likely to be undone. Carping about its costs and dangers is now pointless.

The challenge ahead is to make sure the nation can pay for it without piling on deficits and raising taxes to the point where they diminish quality of life and kill economic growth.

That starts with Congress turning into law the cost-cutting promises issued to make the bill look balanced.

Recognizing that the measure -- like every other entitlement program ever passed -- is likely to cost far more than projected, the president and Congress must commit to holding spending in other areas in check.

Obama claims to be fretful over rising deficits, and yet he keeps adding new spending programs that consume tax dollars in $10 billion clips. That has to stop. Spending should be restrained and the savings used to fund this bill.

The legislation levies 10 years of taxes to pay for six years of benefits. Congress must promise not to spend that money as it comes in on other programs, as it has always done with the Social Security surplus.

What's most important is that the partisan strong-arming used to force this bill into law not be repeated for other items of the president's ideological agenda, most notably a carbon cap-and-trade bill.

If Obama continues along that route, he will have earned the defeat his victories will cost Democrats this fall.