The latest, hottest attack on health care reform is that it's based on an accounting scam. National Review calls it "taking Obamacare off the books." The Heritage Foundation warns of the "Obamacare Shell game." What's going on here? What's going on is a perfect metaphor for how Obama and the republicans are treating fiscal policy.

More than a decade ago, Congress tried to control Medicare costs by restricting payments to doctors. But the reimbursement cut has proven unpopular. So every year, Congress appropriates more money to fill the hole and keep the doctors happy. Yet the pay cut remains on the books. So, admitting the obvious fact that the reimbursement cuts will never happen would, officially speaking, cost $247 billion over ten years.

Everybody agrees that it's a sham. Since the Democrats are trying to reform, and trim, how much Medicare spends, they planned to wipe the slate clean and just admit the obvious reality that the $247 billion is going to get spent.

Conservatives are attacking this as proof that health care reform is based on fraudulent accounting. See -- they're spending money they don't pay for! National Review calls this "offloading $247 billion in Obamacare costs onto a separate, standalone, unfinanced piece of legislation." But it's not "Obamacare costs." It's money that would get spent whether or not health reform happens. It would be fair to make this charge if Obama were using these illusury savings to cover the cost of the new spending in his health care reform, but he isn't.

So why is Obama getting attacked so bitterly over this? Because he's acknowledging it. It's the same thing that's happened to fiscal policy since he took office. The Bush administration hid the true iscal picture with a plethora of accounting gimmicks -- keeping all war costs out of the budget, pretending the middle-class tax cuts would expire, and on and on. Obama has tried to make the budget reflect reality. Alas, reality is a bummer. (And yes, the long-term deficit is entirely the fault of policies Obama inherited.) So Obama gets attacked for a "shell game" when all he's really doing is admitting the shell game that's been going on for years.

People have made this point before, but the conservative attacks on health care reform's fiscal responsibility are beyond hypocritical. George W. Bush and the Republicans created a new health care entitlement in 2003 that was completely unfinanced. Not a dime was paid for. The Democrats have decided to completely finance every cent of health care reform, and they're taking a hundred times more flack for fiscal irresponsibility than the Republicans ever did. There's a lesson here, and "fiscal responsibility pays" isn't it.