A Democrat-run CBO may be Obamacare's biggest adversary

Doug Elmendorf is the skunk at Barack Obama's garden party. Last week, the director of the Congressional Budget Office blew a national debt-sized hole in the president's plans for the speedy enactment of Obamacare: Elmendorf testified that none of the major Democratic reform bills reduce federal spending on health care.

In fact, Elmendorf told the Senate Budget Committee that the House Democrats' plan would make the problem worse to the tune of $239 billion. "In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount," he told the panel's chairman, Sen. Kent Conrad, D-N.D. "And on the contrary, the legislation significantly expands the federal responsibility for health care costs."

Elmendorf undermined a key argument for the House Democrats' plan right as it appeared to be gaining momentum -- both the American Medical Association and the American College of Surgeons announced their support last week.

The escalating price tag, however, has caused a backlash among moderate-to-conservative "Blue Dog" Democrats and even diminished the physician lobbies' endorsement. Citing Elmendorf, the Cato Institute's Michael Cannon wrote, "The docs are supporting the Democrats' health care plans because the Democrats are buying them off."

But Elmendorf cannot easily be dismissed as a conservative or libertarian ideologue. He is a Democratic appointee at the CBO and a veteran of the Brookings Institution, a center-left think tank.

Although he has worked with economists across the ideological spectrum (as an assistant professor at Harvard, he taught with Martin Feldstein, a former chief economics adviser to President Ronald Reagan), Elmendorf served in economic advisory positions during Bill Clinton's administration.

When Congress and the White House are controlled by different parties, the officially nonpartisan CBO becomes enmeshed in Washington's political battles. During the 1980s, CBO forecasters were at odds with the "rosy scenarios" allegedly painted by the Reagan administration's Office of Management and Budget. Similarly, Republican-appointed CBO directors sparred with the Clinton administration over deficit figures throughout the 1990s.

Yet when the president's party picks Congress' top green-eyeshade man, the CBO is widely seen as an honest broker and can have a huge effect whenever its analysis suggests the emperor has no clothes -- or at least the emperor's numbers don't add up.

And unlike the politicos who frequently run OMB, the CBO's directors tend to be the wonkiest of wonks. Elmendorf has previously worked on the Council of Economic Advisers, the Treasury Department, the Federal Reserve, and even has a prior stint as an analyst at the CBO from 1993-94.

Few people ever know the CBO director's name, but the facts and figures the organization churns out become the currency of the Washington policy debate. They decide whether a tax cut blows a hole in the deficit or pays for itself, and whether a major new spending program is revenue-neutral or a net drain on taxpayers.

Elmendorf's latest number-crunching makes him more influential on health care than any Republican in Washington.