Excerpt: President Obama's budget demonstrates how difficult it will be to build a sustainable, effective, and safe health care program for all Americans. His ten-year $634-billion plan for funding health care reform depends on 'asking the wealthy to pitch in a bit more' (budget director Peter Orszag's happy phrase), wringing some of the waste out of Medicare and Medicaid (cuts that are needed, but that will not be popular ); and strong-arming drug makers to raise discounts on Medicare drugs from 15 percent to 21 percent. About half of the money will come from changes in government programs, half from tax increases. As the Congressional Quarterly reports, 'the new proposals for tax hikes on couples earning over $250,000 'will immediately test the limits of the new political dynamic on Capitol Hill in the midst of a recession.' And even then, the budget provides only a 'down payment' on health care reform-- roughly half to two-thirds of what is likely to be needed to cover everyone.

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