There are lots of embarrassing little things to mock in the Senate bill (e.g., the special provision for Nebraska), and lots of bad provisions to attack (the tax hikes and federal funding for abortion, to mention two). But Republicans shouldn't lose sight of a core point, embodied in this passage from page 19 of the CBO letter:
"Based on the extrapolation described above, CBO expects that Medicare spending under the legislation would increase at an average annual rate of roughly 6 percent during the next two decades--well below the roughly 8 percent annual growth rate of the past two decades (excluding the effect of establishing the Medicare prescription drug benefit). Adjusting for inflation, Medicare spending per beneficiary under the legislation would increase at an average annual rate of less than 2 percent during the next two decades--about half of the roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care."
Here are the key ten words: "reduce access to care or diminish the quality of care."
CBO is explaining that the legislation's claim to fiscal responsibility requires cutting in half the rate of growth of per capita Medicare spending. And, according to CBO, absent magical greater efficiencies in the delivery of health care, accomplishing those fiscal goals might well require reducing access to health care and/or diminishing the quality of health care. So less access and lower quality is a very real possible consequence of this legislation. This is a point critics of the bill cannot allow to be lost in all the hubbub.