For example, it's already apparent that this bill doesn't include the $200 billion needed for the so-called 'doc fix' to avoid a 21 percent cut in Medicare reimbursements next year. Nor does this 'score' include costs shifted onto individuals, businesses, and state governments. Until we see the actual bill language and the full CBO report we have nothing except a bill that is going to cost Americans a whole lot of money.

Will Democrats like Tom Perriello of Virginia be able to support a “robust public option” as part of a health care package if Republicans sweep to victory in Virginia? If Republicans win or even come close in a deeply "blue" state like New Jersey, will representatives like John Adler think twice about a climate bill that would make energy costs go up in an already weak economy?

Democrats were already deeply divided over health care reform and climate legislation. The results from today's election are unlikely to make their path any easier.

That's the health care equivalent of negotiating with Tony Soprano.

But regardless of how much lipstick they put on this pig, it still is a government takeover of the health care system that would all but eliminate private insurance and force millions of Americans into a government-run system. Apparently the House leadership has decided that if at first you can't get the votes by being honest about your true intentions, lie, lie, again.

Principled Democrats like Kent Conrad of North Dakota are refusing to support the leadership's proposal to deficit-finance a nearly $250 billion fix to Medicare reimbursements. Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi want to keep the change to Medicare's "sustainable growth formula" separate from the main health care reform bill in order to pretend that the health care bill is deficit-neutral. But the reaction from more honest, fiscally responsible Democrats only underscores the difficulties that the leadership faces in trying to put together a health care bill that satisfies both liberals' demands for expanded coverage and moderates' demand for fiscal sanity.

In fact, overall, the tax increases in the bill are more than double the amount of deficit reduction. This isn't a health care efficiency bill or a cost containment bill. It is a tax and spend bill, pure and simple.

Start with the price tag. While the top line numbers from the CBO suggest that the bill would cost less than $900 billion over 10 years, and actually reduce future deficits by $81 billion, those numbers fail to tell the whole story. For example, the bill relies on Medicare "savings" that Congress keeps refusing to make. Specifically, Medicare has long been ordered to cut 21 percent from what it pays health care providers—yet, each year since 2003, for reasons both good and bad, Congress has voted to defer the cuts. Does anyone else really think that Congress is simply going to slash payments to doctors and hospitals by 21 percent across the board?

In addition, this bill would still give the government the power to force most Americans to purchase insurance, allow the government to dictate what benefits insurance should offer, and interfere with how doctors practice medicine.

All this, and it would still leave 25 million Americans uninsured.

Here is some of what we know and don't know:

The Good:

• The plan drops the idea of a government-run "public option" in favor of co-ops. Government involvement with these co-ops would essentially be limited to providing start-up grants. The co-ops are unlikely to have much, if any, impact on the cost or availability of health insurance, but are far preferable to a government run plan.
• The plan takes the first tentative steps toward allowing people to purchase health insurance across state lines. It would allow states to establish interstate compacts for insurance purchasing beginning in 2015. It would also allow insurers to develop national products that could be sold in any state. National plans would be exempt from state mandated benefits. This doesn't go far enough, and risks simply transferring regulation and mandates from the state to the regional or national level, but a first read suggests it is a step in the right direction.

The Bad:

• The plan would force states to increase Medicaid eligibility to individuals at 133 percent of the poverty level, and to enroll single, childless adults. The federal government would pick up some of the increased cost; states would be responsible for at least some of the increase, a provision that will undoubtedly strain already tight state budgets.
• While the employer mandate is much watered-down, it is still there. The Baucus plan has no specific requirement for employers to provide insurance. But any employer who fails to do so would have to pay the cost of all subsidies that the government provides his or her workers to help them pay for insurance on their own, up to $400 per worker. Since it will ultimately be the worker who pays the mandate's cost, through reduced compensation or reduced employment, the government will be giving the worker a subsidy with one hand, and taking it back with the other.
• The bill would cut payments to the Medicare Advantage program. In response, many insurers may stop participating in the program, while others could increase the premiums they charge seniors. Millions of seniors will likely be forced off their current plan and back into traditional Medicare.

The Ugly

• The Baucus plan contains a heavily punitive individual mandate, a requirement that every American purchase a government-designed minimum insurance package. Failure to comply would result in a fine that could run as high as $3,800 for a family of four. Moreover, the mandate may not apply just to those without insurance today. While the summary says that those with "grandfathered" plans would not have to change their current plan to satisfy the mandate, it is vague about what qualifies as "grandfathered." The summary also says that employer-provided plans would have to be changed within five years to comply with new insurance regulations, and that "grandfathered" plans would not be eligible for any subsidies. It is unclear, therefore, whether people will be able to keep their current plans.
• The Baucus plan imposes a 35 percent excise tax on health insurance plans that offer benefits in excess of $8,000. Insurers would almost certainly pass this tax on to consumers in the form of higher premiums. Roughly half of Americans, mostly middle-class, would be impacted. There are also "fees" on prescription drug companies, medical device manufacturers, and clinical laboratories. This is simply a way of hiding taxes, and will result in higher health care costs that will be passed on to consumers.

The real issue has never been the "public option" on its own. The issue is whether the government will take over the U.S. health care system, controlling many of our most important, personal, and private decisions. Even without a public option, the bills in Congress would make Americans pay higher taxes and higher premiums, while government bureaucrats determine what insurance benefits they must have and, ultimately, what care they can receive.

Obamacare was a bad idea with an explicit "public option." It is still a bad idea without one.

But the bigger question is not who eventually gets the job, but why do we need a surgeon general in the first place? After all, can anyone name our current (acting) surgeon general?

In reality, the surgeon general is little more than the "national nanny," hectoring us to stop smoking, lose weight, exercise more, and never ever go out without a condom. I've been flipping through my copy of the Constitution, and I can't find the authorization for the federal government to take taxpayers' money to establish an office to tell us how we should live our lives. There are plenty of private groups that are fully capable of instructing us on how to be healthy, wealthy and wise without the government getting involved. The American Lung Association can tell us not to smoke. Alcoholics Anonymous can preach sobriety. The American Medical Association can lecture couch potatoes on the benefits of losing weight and exercising more. Planned Parenthood and the Family Research Council can fight it out over when and how we should have sex.

The surgeon general does oversee the Public Health Service. But we have a Department of Health and Human Services that is supposed to be running the government's health care programs. Why not let HHS take over any useful functions of the Public Health Service and dump the rest, including the surgeon general?

President Obama says he wants to be a different type of president. Fair enough. Why not start by letting people live the way they want, without a surgeon general looking over our shoulder and nagging us.