Underlying fierce Republican efforts to stop President Obama's health care law and the White House drive to save it is a simple historical reality: Once major entitlement programs get underway, they quickly become embedded in American life. And then they grow.
That makes the battle over the Affordable Care Act more consequential than most Washington political fights. "If it's in place for six months, it will be impossible to repeal it or change it in ways that significantly reduce the benefits," said Robert D. Reischauer, a Democrat who used to lead the Congressional Budget Office.
Douglas Holtz-Eakin, another former CBO director, reflects the concern of fellow Republicans in framing the stakes more dramatically. Either the law's health insurance exchanges "can't cut it," he explained, or "it's Katie, bar the door we have an explosively growing new program."