Problem: The original health bill was too large and increases the deficit.
Solution: Split it into two bills. Put the costly doc-fix into it's own separate unfunded bill, thus making the main health bill cheaper.

Problem: Giving the poor universal health care access is very expensive. It would create a deficit.
Solution: Offload a bunch of it to state budgets. Do it by increasing Medicaid to include more people. Thus, the federal price tag is smaller.

Problem: The bill still costs several hundreds of billions.
Solution: Take $500 billion of that from Medicare and hope it doesn't affect it in any way. Tax the rich for the other $500 billion.

Problem: It still isn't enough.
Solution: The CBO is limited to how it can score things. So abuse that issue. For example, they must double count $52 billion raised by and set aside for Social Security and apply it also towards the health bill.

Problem: It still isn't enough.
Solution: Cap flex spending, and don't index it for inflation, thus killing it off over time. Increase taxes on medical devices, and increase taxes on other elective procedures such as cosmetic surgeries.

Problem: Cadillac health plans should be taxed, but unions don't like that.
Solution: Exempt unions.

Problem: Health care costs will continue to grow faster than GDP, inflation, or cost of living. Taxing the rich and providing subsidies to everyone else can only last so long
Solution: Don't think beyond the first 10 years of the bill.