Congress and the President are intent on expanding coverage apparently at any cost. The recent CBO "scoring" of the bill is blissfully accepting of some spending projections and dismissive of others (see today's NYT op ed by former CBO director Holtz-Eakin). The current approach is to wrap a costly expansion in deficit-reduction rhetoric.
Health reform is a complex problem that requires trade-offs, fundamental changes in state/federal regulatory authority, a realistic financing plan, and health care delivery reforms. None of these are in the current bill because they are politically difficult and will take time to work out. This is unfortunate, not just because the bill will be costly at a time when the country can least afford it, but because the contraption itself won't work and will create new problems (like inter-governmental lawsuits and higher insurance costs for the young).
There is a measured way to implement real health reforms over time, but it will take discipline and patience. States need to plan for and accept gradual Medicaid expansions. Individuals must plan for and accept an enforceable coverage requirement. States must plan for and accept insurance market reforms. Health plans, hospitals, physicians, and ancillary providers must work together to moderate increases in medical costs. This all requires compromise, planning, balance of the parts, and time.