If the health care reform package makes it through Congress, and we should know sometime on Sunday, much of the credit for its salvation will go to Thursday’s report from the Congressional Budget Office that, according to The Times’s David M. Herszenhorn, predicted “a $940 billion price tag for the new insurance coverage provisions in the bill, and the reduction of future federal deficits of $138 billion over 10 years.” It is an article of faith that the budget office resides, pretty much alone among government bodies, in the refined aerie of nonpartisanship, a paragon of technocratic, if not inhuman, objectivity.

In fact, according to Ezra Klein of the Washington Post, the imprimatur of the C.B.O. takes the health care debate entirely out of the messy realm of political give and take we junkies love so much. “The question people generally ask about the final health-care reform vote is, “Won’t it be politically difficult for many House Democrats to vote yes?” But with the release of the C.B.O. report … I’d flip that question a bit: Won’t it be substantively difficult for many House Democrats to vote no?”

Klein explains:

If you’re a liberal House Democrat, here’s what you’d be voting against: Legislation that covers 32 million people. … If you’re a conservative House Democrat … you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years … Democrats got the score they needed, and now they can go to their liberals and say that this is closer to universality than we’ve ever been, and they can go to their conservatives and say this does more for deficit reduction than has ever been done, and both things will be true.

If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why.

Who ever would have thought that after more than a year of vitriol, the whole health care reform question would result in a win-win bill? Actually, a lot of people still don’t see it that way. Why? As the Economist once put it, “As a creature of Congress, the C.B.O. is required to pretend to believe many impossible things before breakfast.” Some would say the same of Ezra Klein.

“The C.B.O. process has now been so thoroughly gamed that it’s useless,” writes Megan McArdle of the Atlantic. She’s concerned about how many of the costs have been pushed to the tail end of the budgeting period, and that the excise tax on so-called gold-plated insurance plans won’t take effect until 2018:

The proposed changes increase spending dramatically, most heavily concentrated in the out-years. The gross cost of the bill has risen from $875 billion to $940 billion over ten years–but almost $40 billion of that comes in 2019. The net cost has increased even more dramatically, from $624 billion to $794 billion. That’s because the excise tax has been so badly weakened. This is of dual concern: it’s a financing risk, but it also means that the one provision which had a genuine shot at “bending the cost curve” in the broader health care market has at this point, basically been gutted. Moreover, it’s hard not to believe that the reason it has been moved to 2018 is that no one really thinks it’s ever going to take effect. It’s one thing to have a period of adjustment. But a tax that takes effect in eight years is a tax so unpopular that it has little realistic chance of being allowed to stand.

And, she asks, when you borrow from yourself, have you really saved money? “A disturbingly high percentage of the revenues still come from insurance premiums for other programs. About $53 billion of the net deficit reduction is from Social Security taxes collected on the wages people will now be getting in lieu of health care benefits. But since those contributions raise the amount Social Security will eventually have to pay out, the Republicans convincingly argue that this is not true ‘deficit reduction’; it’s just deficit shifting. Ditto the premiums for the new long-term care insurance.”

“Obamacare’s worst tax hike is the imposition of a new 3.9 percent Medicare payroll tax on capital gains and other investments,” adds the economist Larry Kudlow at National Review Online. “What will this do? It will depress the economy, depress wages, and depress jobs. Washington doesn’t understand that you can’t create jobs without new healthy businesses.”

Here’s a more surprising critic: Gov. Phil Bredesen of Tennessee, a Democrat, who sent a letter to two of his state’s members of Congress, Senator Bob Corker and Representative Bart Gordon, explaining the burden the reform bill would put on Tennessee’s coffers:

Bob and Bart, the problem we are facing is simple: by 2013,we expect to have returned to our 2008 levels of revenue and will have already cut our programs dramatically – over a billion dollars. At that point, we have to start digging out — we will have not given raises to state employees or teachers for five years, our pension fund will need shoring up, our cash reserves (“rainy day fund”) will have been considerably depleted and in need of restoration, and we will have not made any substantial new investments for years … In this environment, for Congress to also send along a mandatory bill for three-quarters of a billion dollars for the health reform they’ve designed is very difficult. These are hard dollars – we can’t borrow them – and make the management of our finances post-recession even more daunting than it already is. …

I very much want to support the President, and Lord knows we have plenty of people in Tennessee who need help with health insurance. But this is an extraordinary time for us (and we are better off than many states) and I will appreciate any way in which you can help us manage through this.

Gordon has since decided to vote with the president, and Bredesen himself says he supports the reform, he just thinks his state needs Congress to “help us manage through this.” And, indeed, we found out yesterday that “the 153 pages of changes to the package include an additional $99 million in 2012 and 2013 for Tennessee hospitals that treat many poor people.” Does anyone think the other 49 governors are going to sit back and let Mr. Bredesen get that special help?

Ed Morrissey of Hot Air thinks that plenty of other states will feed from that trough:

Bredesen’s right about the expansion of Medicaid under current conditions — it’s part of the entitlement catastrophe already, and this will hasten its arrival. We’re about to take a program whose growth already outstrips inflation and our economic growth and vastly expand it through federal mandates on the states.

Does this actually save us money? Of course not. It’s a shell game. Our state taxes will have to increase while Nancy Pelosi and Barack Obama blather on about cost “savings” in ObamaCare. Meanwhile, states already running in the red will find themselves desperate for cash infusions, just as Bredesen describes. Where will that come? Given its track record on Porkulus, Obama will almost certainly push for more “stimulus” block grants for states in order to cover those shortfalls caused by the new federal mandates, which means the federal government will pay for this in most cases, probably for the next several years. It just won’t get included in the accounting for ObamaCare, allowing Democrats to claim that they have somehow reduced spending on health care through their reform.

Getting back to the C.B.O. report, Ed Carson of Investor’s Business Daily gives us a pair of other changes not to believe in:

– The Sustainable Growth Rate imposes automatic cuts in Medicare payment rates to doctors.

For several years, fearing a revolt by doctors — and seniors — Congress has suspended those cuts. The original draft of the House health care bill included a permanent “doc fix.” But that ballooned deficits, so Democrats dropped it, even though everyone knows Congress isn’t going to slash doctors’ rates. The C.B.O. has estimated a “doc fix” would cost $247 billion over 10 years.

– Student loans are included
Doctors’ payments are excluded from the health bill, but major student loan program changes are included? Yep. The reconciliation bill will end student loan subsidies to lenders. The C.B.O. says this will save $19.4 billion over the first decade, accounting for virtually all of the $19.8 billion in deficit reduction from the health care reconciliation bill.

Peter Suderman of Reason has another: “The score for the Senate bill includes $72 billion in revenues generated by the CLASS act, a federally-backed disability insurance program. But that $72 billion is just premium revenue that will eventually have to be used to pay out benefits. The score counts that revenue anyway, despite the fact that, according to the C.B.O., it would probably add to the deficit in the long term.”

“As expected, Democrats have maintained the strategy of delaying the major spending provisions until 2014 to create the appearance that the bill is cheaper over the C.B.O.’s ten year budget window, from 2010 through 2019,” adds Philip Klein of the American Spectator. “The bill spends $17 billion in the first four years, while the remaining $923 billion, or 98 percent, is spent in the next six years. I’ve illustrated this tactic in the chart below. One thing to note is that the oft-quoted $940 billion number only pertains to the cost of expanding coverage — which is the bulk of spending in the bill — but it does not include all other costs, such as the providing more Medicare prescription drug subsides, which costs about $38 billion.”

Daniel Foster at the Corner thinks the larger issue is the dependence on Social Security funds and other money that is eventually promised elsewhere:

Consider that $53 billion of the $118 billion in supposed savings over the first ten years of the latest bill (which is still a moving target) comes from increases in Social Security payroll tax revenues resulting from expected increases in wages (the idea being that employers will pay better in an Obamacare world). But even if it materializes, pegging that money to deficit reduction instead of to the continued solvency of Social Security is either naive, disingenuous or both. Likewise, the report counts as savings the estimated $70 billion in premiums to be collected as part of a new government-run, long-term care program for the elderly. But just like premiums in the private sector, these funds will be used to pay out future benefits, not reduce the deficit.

So, how is it possible that all these critics and Ezra Klein are talking about the same piece of legislation? That’s a question Foster considers:

Maybe this is just one of those intractable attitudinal differences between rationalists and conservatives, but I wonder how Ezra Klein can possibly believe that what he is saying is settled fact. As if reality had a proven track record of conforming to progressives’ most optimistic predictions about massive exertions of the welfare state.

The simple fact is that nobody knows what this bill will cost. That’s due in part to the guarantee that history will intervene, in messy and unpredictable ways, over the next decade. And it is due in part to the fallibility of the lawyers and staffers who wrote it, and of the accountants who scored it. And it is due, in no small part, to the baroque lengths to which Congressional Democrats have gone in the name of obscurity.

So, it seems we’re dealing with dual, and utterly opposed, realities. Is there anybody with one foot in each? Donald Marron, who briefly ran the C.B.O. in 2006, tries to straddle the chasm with a Daily Beast column.

The C.B.O. is clear that the legislative package, as a whole, would reduce the deficit not only over the next ten years, but even more substantially in the second decade if the legislation executes as written. Of course, that’s an enormous “if.” These provisions may well be worthy, but they aren’t free. Indeed, if you add them all up, their price tag comes to $132 billion in new spending and $2 billion in new tax cuts. The total cost of health reform is thus $1,072 billion, about one-seventh higher than the $940 billion figure grabbing all the headlines …

Over the next decade, health reform will expand the government’s commitment to health care, not reduce it. The only reason the health reform scores as reducing the deficit is that it is packaged with significant tax increases, most notably a $210 billion expansion in Medicare taxes. Those taxes have traditionally been considered payroll taxes, but the legislation would change that: for the first time ever, the Medicare tax would also apply to the investment income of upper-income taxpayers.

So, the conservatives are on solid ground? Not exactly.

Opponents of the legislation have also employed some spin of their own. For example, a common allegation is that the legislation reduces the deficit only because it combines six years of new benefits with ten years of new taxes. That’s not true either. Moreover, C.B.O. is clear that the legislative package, as a whole, would reduce the deficit not only over the next ten years, but even more substantially in the second decade if the legislation executes as written.

Of course, that’s an enormous “if.” In order to make the long-term budget impacts look better while limiting political opposition in the near term, the original Senate bill adopted a strategy in which many of the most promising savings measures—e.g., reductions in Medicare payment rates and an excise tax on “Cadillac” health insurance plans—would ramp up substantially in later years. … That helps the second decade look good, budget-wise. But it raises an obvious question: Will future presidents and Congresses try to back out of these budget savings, just as President Obama and the current Congress want to back out of paying for more than $300 billion in Medicare spending for physicians? Only time will tell.

Those last four words are the saddest in an opinion editor’s vocabulary — always true and never helpful in the slightest. The additional problem here, of course, is that members of Congress have only the rest of the weekend to guess what time will reveal.