The Congressional Budget Office’s most recent missive on health reform (available here) discusses the budgetary treatment of health care reform proposals. The underlying issue seems to be under what circumstances the expenses and revenues related to various reform options would be included in the federal budget as receipts, expenses or expense offsets. The CBO looks at mandates, a public plan, insurance exchanges, and pay or play options, giving a preliminary opinion on the extent to which each might affect the federal budget. The interesting question is why are they doing this now–what sparked the issuance of this report? The answer is possibly found on page 6, where it is noted that depending on what gets included in the budget, its total size could be significantly larger or smaller, which makes it look like a bigger or smaller part of the overall economy and, as the CBO put it, a larger budget might be taken as “indicating a greater scope of sovereign governmental activity.” It sounds like the philosophical and political arguments about large or small government may have been at work in generating the request that CBO perform the analysis.