The Senate will now have to pass the reconciliation package from the House word for word before the chain reaction of changes takes effect starting this year, and really ramping up in 2014.

Anyone thinking that this will be repealable in 2010, 2012, or beyond is really fooling themselves. Ditto for those who think that the courts will find penalty/tax provisions unconstitutional. It’s just not going to happen.

So, when this mess starts blowing out the budget in 2015, 2016, 2017, and beyond because all the CBO projections that didn’t include the Medicare/Medicaid changes that were separately considered weren’t worth the paper they were written on, we’ll be stuck with a far more costly system than envisioned and no one will be accountable for the mess we’ll have at that point. Add to that the fact that the bill voted on included billions from the higher education reviso to balance the books shows the lengths to which the Congress and WH went to get this done without showing the public the true costs for this package on a year over year basis - from now until 2014, the government will be collecting new taxes and fees to begin paying out ever larger amounts in the new programs starting in 2014.

Then, there’s the tax on high cost policies - the Cadillac plans. Unions won a reprieve until 2018. What’s to prevent them from again reducing the 40% tax or further delaying its implementation? That would be a budget buster right there. But because those issues are so far out in the distance, everyone seems to gloss over their costs or even practicality.