What is at issue is the difference between government accounting and a realistic assessment of our future costs. Although the Congressional Budget Office and Medicare Trustees accounting conventions have obscured the economic impact of Obamacare, in plain terms it will cost us more money than it will save. Blahous concludes:

Taken as a whole, the enactment of the ACA [Affordable Care Act] has substantially worsened a dire federal fiscal outlook. The ACA both increases a federal commitment to health care spending that was already unsustainable under prior law and would exacerbate projected federal deficits relative to prior law. This is an unambiguous conclusion, as it would result regardless of the degree of future success attained in upholding various cost-saving provisions now embedded in the law.

That the ACA has substantially worsened the federal fiscal outlook is not universally understood. The biggest source of confusion may reside in the widespread consultation of the scoring conventions employed by both CBO and the Medicare Trustees, in which it is assumed in the baseline that various entitlement-benefit promises will be honored without regard to statutory restrictions. Though this is an appropriate scoring convention for many purposes, it is nevertheless true that whenever budgetary savings already required under law to maintain the solvency of either Social Security or Medicare HI are enacted only to be spent on a new entitlement program, the federal government’s fiscal position is unequivocally worsened.

Almost comically, the White House responded by saying CBO says we’re okay, so there is no problem. (“Administration officials dismissed the study, arguing that it departs from bipartisan budget rules used to measure every major deficit-reduction effort for the past four decades — including the blueprint offered last month by House Budget Committee Chairman Paul Ryan (R-Wis.).”) But this fails to address the nub of Blahous’s argument: