Last week we posted some summary and analysis of the CBO report to Congress about the actual scoring of the legislation on the true costs of the HCR packages being proffered. In this post we follow up with a juicy little find from a place we had not previously scoured. We learned today from Hot Air Blog that President Obama has met with the CBO this week. You, like us, might initially be asking, “Why is this important?
Well, on digging a bit we learn that The CBO exists to keep a check on the executive branch. The “Congressional” part of CBO is intentional. So, this does indeed raise the curious question of why Mr. Obama would be meeting with the CBO. The Hot Air post is a worthy read– and there is certainly some conjecture there. We would simply like to add, what may be obvious, but none-the-less crucial. Obama is having a very difficult time getting traction with his arguments that HCR is urgent and that his solutions being proffered (a 1000 page bill crafted in 4 months is supposed to solve over 50 years of accumulated problems). In Newsweek today we see a wonderful piece on this issue and also from the Investors Business Daily that both lay out quite nicely the political headwinds and reality that Obama and Co. are turning towards. There appears to be consensus at the moment on three major issues: First that the current HCR legislation shows no evidence of reform, but simply expansion. Second, that this expansion will not in fact be budget neutral, and lastly, that without reform, adding 40+ million new people to the system that all widely agree is largely dysfunctional, is a recipe for disaster. This is the consensus as we here at TBM see it. How this plays forward is more difficult to say. We have argued consistently that genuine reform is needed– but that the current proposals are weak, dangerous or both. The real concern comes if in fact the current reform efforts fail, as many are predicting is imminent. There is an old diplomatic axiom that if in the process of winning, one makes their opponent lose face or feel humiliated, that opponent is impotent to you moving forward as a partner. This axiom has guided policy for generations (refuse to talk to a world leader and risk having no one to deal with when that country begins to implode because you made that leader appear superfluous). If Mr. Obama and Ms. Pelosi lose this “battle” (or as some are calling it, the Waterloo moment), then you have a humiliated and perhaps quite neutered Democratic Speaker and President. Ms. Pelosi is clearly upping the ante in this already very high-stakes game. Game afficionados will be the first to provide the rest of us an education here– but it seems to us that the more belligerent one becomes,the more “egregious” ones betting, the likelihood that there is a bluff behind those cards, grows. The bluff here is that Obama and Co. have literally everything to lose if they fail to win this hand. Wonderful, many may say. We are not so certain at TBM. We will post more about this later, but the problem with street fights is that they are dirty and the fear that we at TBM have is that if Ms. Pelosi and Mr. Obama are backed into a political corner having lost the HCR overhaul hand, they will resort to street tactics and begin a series of retribution acts on anyone that opposed them. First among these would be the Hospitals (in the form on Medicare reimbursement rates) and doctors (by allowing the SGR payment cuts to be triggered). In this world that would be unfolding around Christmas 2009, the noise from the street brawl would be deafening and one thing is certain, no person in need of genuine thoughtful discourse about HCR will benefit.

We can only hope we are wrong here, but given the meeting between Mr. Obama and the CBO this week, the evidence of desperation and reckless betting has us quite worried that someone is going to call the bluff. The problem for all of us is that President’s rarely fold their cards.