As President Obama prepares to sign the reconciled health care bill into law and sell it to Americans, how does it measure up to what he promised? Unfortunately, the gap is huge, and he can hardly claim a mandate for what is in the final bill.

Start with the cost of the program:

The $940 billion health care bill just passed by the House is between 45 and 88 percent more expensive than Obama promised during the campaign. And this excludes the additional $208 billion so-called “doc fix,” which restores  some of the cuts in Medicare reimbursements written into the bill to doctors. The latest Congressional Budget Office estimates indicate that the law won't be budget neutral -- increasing total deficits by $260 billion over the next 10 years, and this ignores many of the costs of the program. This promise of a smaller government health care program has disappeared the same way as his frequent campaign vow to cut the size of government. "Now, what I've done throughout this campaign is to propose a net spending cut," Obama pledged during the third presidential debate with John McCain.

Who pays the bill?

So much for the promise not to tax high cost health insurance plans, the so-called Cadillac plans. That new tax alone increases taxes regardless of income. Ironically, Obama has done what he unjustifiably accused John McCain of doing. But the bill also imposes all sorts of taxes on everyone who uses medical care, again regardless of income. The long list includes an excise tax on medical devices, brand-name drugs, health insurance providers, tanning salons, and even paper manufacturers. The tax hikes at the end of this year, as the Bush tax cuts are phased out, aren't even relevant any longer to the health care program, for they have already been spoken for by the stimulus and other massive new spending plans Obama pushed through Congress.

Promises to strip out special deals from the health care bill

Just in the new reconciliation bill, 11 states and Washington D.C. are given $8.5 billion in special federal funds to provide health care coverage. Likewise, rural areas in some states, such as Oregon, got a last-minute deal to increase Medicare reimbursement rates. Various unrelated deals were made to buy the votes of some congressmen. For instance, take the additional water supplies given to central California to buy the votes of California Democratic Reps. Dennis Cardoza and Jim Costa. Or the promised push for legalizing illegal immigrants that was granted by the president to get the vote of Rep. Luis Gutierrez (D.-Ill.). And then there was the money for a single hospital in Connecticut, special funds for Montana, and the Louisiana Purchase (a $350 billion aide package one for Louisiana).


Just looking at the special deals listed above explains why voters worry about transparency and why Obama’s campaign promise to show everything on C-SPAN was so popular. But the one single broadcast -- where Obama and other Democrats were allowed twice as much airtime as Republicans -- does not fulfill his promise of transparency. Nor did the meeting show the type of horse-trading for votes that motivated Obama’s pledge and was rampant in the process. Obama also vowed during the campaign that voters would have five days to look at the final bill before he signed it, his attempt to let “sunshine” into the process. For the health care bill, he waited just for one-and-a-half days.

You don't have to change your doctor or health insurance plan

This promise seemed to be in every health care speech during the campaign and the beginning of Obama's presidency. But then the reality of the 40 percent tax on high-quality health insurance plans plus the massive number of new regulatory bureaus began piling up. Even the Democrat's Congressional Budget Office Director Doug Elmendorf pointed out that Medicare cuts could “reduce access to care or diminish the quality of care.”  Indeed, the whole point of the taxes and regulations is to get people to spend less by no longer buying the best quality care.


There is a long list of other broken promises. For instance, he assured us during the campaign that he would not mandate that adults purchase health insurance. But would Obama and the Democrats have won election if he had promised what he ended up doing: to dramatically increase government spending and deficits, raise taxes on the middle class, hide special deals on health care, and make it impossible for people to keep their current doctors and health insurance plans?

John R. Lott, Jr. is a FOXNews.com contributor. He is an economist and author of "More Guns, Less Crime (University of Chicago Press, 2010), the third edition will be published in May."