"Right now, we're mostly in the 'happy talk' phase of the health reform debate. All of the major interest groups are in favor of reform of some sort, and the public is supportive of major action. But there are many elements of the plans that have been proposed that could spark opposition -- for example, requirements on employers and individuals, a new institute or federal agency with a mandate to conduct research on the comparative effectiveness of treatments, new regulations affecting the health insurance industry, and of course how to finance coverage expansions over the long term. In fact, the notion of creating a public plan like Medicare to compete with private insurance plans has become an early target of the insurance industry. CBO scoring will add to the challenge because in general the measures that will be credited with producing the largest short term savings which political leaders will need to pay for their plans will be the most politically controversial."