Josh Gordon, policy director at the Concord Coalition, a nonpartisan group advocating fiscal responsibility.

Unfortunately, most of the legislation's fiscal risks are on the downside. Large spending programs tend to endure and when tied to health care inflation, they are certain to grow. Thus, there is little risk that coverage costs will be lower than projected.

The offsets and savings are less certain. This is primarily a political concern, not a policy one. Most ideas about how to reduce health care inflation are in the bill -- notably those that might transform the delivery system and those that limit tax-free health insurance.

Adhering to the legislation's cost controls requires politicians to commit to hard choices, but those have been weakened and delayed. This is especially true of the provision to limit tax free insurance -- which will now have a higher cap (allowing more tax-free benefits) and will not take effect until 2018.

While the Medicare Commission might politically insulate some needed changes, fiscal success will largely depend on future politicians swallowing harder than current ones.

While that is better than not having enacted any tough choices now (and credit is due there) it is not yet cause for celebration. Furthermore, even if the bill works according to plan, we are a long way from getting our health care system and our fiscal house in order.