It is now projected to cost over $700 billion in its first ten years of operation, nearly triple what Bush had originally said it would cost.

The reason? Twice as many people signed up for it as originally expected. Bush has estimated 11 million people would sign up for D; instead it turned out to be 24 million.

That’s the problem. Once an entitlement is enacted, lots of people who never thought about asking their elected representatives for such an entitlement see that it’s there now, “free” money, and they jump into it.

On the other hand, when Nixon renounced Bretton Woods and let gold float …

And what if it’s 20% wrong in the other direction? Remember, Part D has been much cheaper than originally projected. The savings of this legislation could just as easily end up being 20% greater. And also remember, the CBO was not around in 1965. Why the heck would we judge the likelihood of the estimates being right based on processes and methodologies from almost 50 years ago, instead of the process and methodology that is in place now and has been right (or actually over-estimating costs as of recently)?

Or what if not acting results in costs being 20% higher than projected? We already know that health care costs — not just government health care costs, but all health care costs — pose grave problems for this country in the future. But what if the problems are even 20% worst than projected if we do nothing?

The point is, all you’ve done is assume the worst case scenario and then say we can’t act because that can take place. But if all we do is play a game of speculation, then the arguments are just as strong for acting as not acting.

Moreover, we all know that if the CBO said this thing would increase the deficit by $138 billion, you would be waiving that around and not discussing weaknesses of CBO scoring. You know it, so don’t deny it. There is a reason why we have an official scorekeeper that we rely on. Because whoever doesn’t like the score they get can just make up speculative guesses of the worst possible way in which the CBO could be wrong — which is all that you have done — and then say so we shouldn’t act. But if we do that, we NEVER act, on nothing. Not on supply side tax cuts, fiscal stimulus, health care reform, welfare reform, etc. The only thing we can do is make our best guess of what will happen (which basically is what the CBO does) and then act accordingly.

One last thing. This legislation is a reformer’s dream, including pilot programs for just about every reform idea out there (bungling, hospital incentives, Medicare commission, excise tax (which has not been pushed to god knows when, but to 2018), selling insurance across state lines (yes, contrary to the extraordinary ignorance of many conservatives, it’s in there), etc). As I’ve said, health care costs pose a grave danger to this country’s future. But this bill is our best shot at getting reforms out there that can bend the cost curve. Yes, I would have preferred doing the cost cutting and reforms before adding a new entitlement program, and in fact that was the compromise I hoped would happen after the Brown victory, but the political reality is that either this bill passes with its cuts and reforms, or we don’t do this again for at least 10-15 years and we lose more than a decade of reforms taking root.