John Dickerson makes a good point in this Slate article "The politics don't add up - Why health care reform will cost more than Congress say it will."
For the first time since 1975, the Social Security Administration has decreed that there will be no cost of living adjustment (COLA) for seniors. Nevermind, replies the Obama administration, let's send the oldsters $250 anyway and put the $13 billion cost on the credit card. But if we can't even abide by the rules of established law, what's the likelihood that Congress will trigger automatic cuts in Medicare and health care spending when those programs get too expensive?
Vanishingly small is the correct answer. Not gonna happen.