The Democrats are already working their end runs around these pretend fiscal limits.

^...most health staff are already aware that our health proposal does not contain a "doc fix." Some Republicans have repeated CBO’s November 18th letter that says "the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has been frequently modified (either through legislative or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration in Congress."

The inclusion of a full SGR repeal would undermine the reform’s budget neutrality. So, again, do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. Instead, focus only on the deficit reduction and number of Americans covered.^

Italics are in the original memo.

The marching orders are out, and the gullible are marching right in step.