What's the difference between Fred Hiatt and a GOP spin doctor?

I give up; I don't know either.  Hiatt:

The [health care] bill also could take America a step closer to bankruptcy.

Not passing anything is damned sure to take us there.

And for progressives in particular -- for those who believe that government has a mission to help the poor and protect the vulnerable -- that prospect should be alarming. If federal debt continues rising on its present path, hastened by a $1 trillion health-care bill, it is the poor and vulnerable who will be most harmed.

And you were so concerned about such things during the Bush years.  Whopping tax cuts for the rich, two wars, another big round of tax cuts for the rich, an attempt to gut Social Security that would have required trillions in borrowed money - but all you ever wanted to do was cut entitlements.

I guess that's one of the differences: a GOP spin doctor has a harder time passing himself off as a credible concern troll.

President Obama has acknowledged this dilemma and offered three broad answers: Health-care reform should not add to the deficit. It should control health-care costs. And, once reform is passed, the government will get serious about deficit reduction.

Unfortunately, the House bill fails his first test. True, the Congressional Budget Office has said that the bill is paid for. But the CBO is not allowed to count $250 billion in projected Medicare payments to doctors over the next 10 years, because the House -- after first acknowledging that cost in its reform bill -- decreed it had nothing to do with reform because lawmakers didn't want to pay for it.

That's because it had nothing to do with health care reform.  It's about an adjustment to Medicare reimbursement rates that - reform or not - Congress will apparently make every year between now and the heat death of the Universe, but the (never-realized) revenues still appear in budget projections. 

So there's no reason why the health care reform bill should pay for it.  Sure, Congress should pay for it - but one thing has nothing to do with the other.

Nor is the CBO permitted to ask whether Congress will truly cut hundreds of billions of dollars from Medicare programs in coming years, as the House bill assumes. History suggests that legislators will not be deaf to the complaints of seniors and those who treat them when it comes time for the axe to fall.

Except that, from the POV of seniors and taxpayers, this is basically money lying on the street: the prime target of the proposed cut is the Medicare Advantage subsidy, where we pay insurance companies to compete with Medicare.  Medicare proper would not be cut, but insurance companies would be out some serious money.

But I suppose it wouldn't be politically correct for Hiatt to say, "History suggests that legislators will not be deaf to the complaints of insurance companies when it comes time for the axe to fall."  It would certainly be more honest, though.

As Post health reporter Ceci Connolly explained in a front-page story last week, the House bill also does not do much to lower costs. It includes some valuable pilot programs. But it doesn't end the tax break for employer-provided insurance, a break that is both highly regressive and encourages spending. It doesn't allow for much evidence-based medicine that could wring excess treatment out of the system. It doesn't empower an independent commission that could make cost-control decisions that are too hard for Congress. It doesn't target the cost of malpractice litigation and defensive medicine.

And who screamed "RATIONING!!!" at every hint of a cost-control measure?  Or made up bullshit stories about Obama putting Granny out on an ice floe?  Fred, can you summon up the intellectual honesty to say, "Republicans blocked Obama from doing these things"?  (No.)  And if we're gonna talk about the cost of malpractice litigation, let's mention that that's a mere sliver of healthcare-related costs in this country, while 'reforms' of malpractice litigation have left many victims of malpractice deprived of reimbursement for their costs.  Or would we rather just repeat GOP talking points?  (Yes.)

The root difficulty is Obama's insistence that the nation can afford a large new social program without raising taxes on anyone who earns less than $250,000 per year.

Funny how we could afford two even more expensive wars without any new revenue at all - in fact, we could afford them while cutting taxes.  As Atrios said this morning, "Shorter Fred Hiatt: if Americans get health care, how will we pay for all of my lovely little wars?"  (I'm far less concise than Atrios.  Sorry about that.)

Expanded access to health care has rightly been a goal for decades. No civilized nation should allow sick people to go untreated. Yet neither should a civilized nation saddle its coming generations with a lower standard of living, a likely effect of U.S. profligacy if unchecked. No civilized nation should leave its government too bankrupt to help the poor.

Is there a way out of this dilemma?

Sure: bring our troops home, or raise taxes on the rich and super-rich, or include sensible cost-containment strategies, or pass a fully auctionable cap-and-trade bill with a portion of the revenues dedicated to financing health care, or...you get the idea: there's lots of solutions, but Republicans and 'centrist' Democrats will oppose them all.

Cling to a hope that, as the bill winds through the Senate and conference, Obama puts his clout behind the progressive ideals of thrift and cost containment as well as universal access.

But for some reason, in Fred Hiatt's world, it's all Obama's fault that these solutions can't be realized.