Yet another example of your endless stream of bullshit. Most of the measures in the bill don't kick in until 2014. Of course there are upfront costs. That's why the true savings kick in the following decade. $1.2T in deficit reduction according to the CBO report.

So since your next spin will be "how can we spend $100B a year and cut costs?" I'll answer it even though I'm sure you already know. What the Democrats did was take a long hard look at ways to cut health care costs and implemented almost all of the ideas brought up into the bill. In all likelihood the savings could well be greater than the conservative CBO numbers.

Here are a list of the major cost saving ideas discussed in the last year of debate over health care reform:

• Form insurance exchanges. This was a GOP idea. These would help curb underwriting and inefficient marketing practices that raise costs in the small-group and individual insurance markets. This is addressed in all the House and Senate bills, and the president's proposal.

• Reduce excessive prices, including those of supplemental plans enrolling Medicare beneficiaries. The president's proposal reduces these Medicare Advantage overpayments and others to different providers, even in the face of ridiculous Republican claims that reducing such overpayments is tantamount to rationing care for seniors. ... See More

• Moving to value-based payment in Medicare. Both Democrats and Republicans have called for moving from a system where volume drives reimbursement to one where value drives reimbursement. The president's proposal includes virtually every idea offered for doing this.This is one of the most important changes and will transform America's healthcare system into a far more efficient and effective system in the long run.

• Tax generous insurance plans. Health-insurance benefits are excluded from income taxation, providing incentives for excessively generous insurance. Many economists have proposed capping the tax exclusion to reduce these incentives. The president's proposal taxes some of the most generous policies, though it has deferred the date by which these taxes take effect.

• Empower an independent Medicare advisory board. Interest-group politics intrudes too deeply within the mechanics of Medicare policy, raising program costs and hindering efforts to improve care. Despite powerful opposition, the president proposes this independent board and a process for fast-tracking such recommendations through Congress.

• Combat Medicare fraud and abuse. The administration has started an active task force to combat these problems. Other ideas to reduce fraud and abuse were presented at the recent health-care summit, and were incorporated in the president's proposal.

• Malpractice reform. Another GOP idea. Defensive medicine is a small but important driver of medical spending. The reform proposal makes some headway, encouraging states to experiment with alternative mechanisms to reduce malpractice burdens. More could be done—for example, specialized malpractice courts and a safe harbor for physicians practicing evidence-based medicine—but the president's proposal makes a start.

• Invest in information technology. Many studies suggest savings in the tens of billions of dollars from IT investment. The stimulus bill passed a year ago contains funds to wire the medical system over the next few years, and the administration is supplementing this with significant funds to analyze the comparative effectiveness of different treatments—even in the face of "death panel" claims.

• Prevention. The president's proposal includes significant public-health investments, provides new incentives for physicians to focus on preventive and chronic care, and opens Medicare to finding new ways of supporting prevention. The only area of weakness is the lack of a junk food tax or tax on sugar sweetened beverages.

• Create a public option. This is an idea that died unfortunately. A public insurance option would provide competition for insurers in areas that are nearly a monopoly and provide a path for reforms in Medicare to expand readily in the under-65 population. The public option was eliminated because of Republican and blue dog democrat opposition, however.

This is how savings are made in the system. Unlike the completely unfunded Medicare D, the democrats deserve a great deal of credit for looking hard at ways to get savings out of the system and bend the cost curve while providing almost universal coverage. And they have done it with this bill. Those are the facts.