I will look into the CBO methodology. More than likely they are pricing into the equation the numerous inefficiencies of service provision that beset our present cluster of an insane for profit system. Kind of like how the system is gamed up and down to cost shift losses to the government at the tax payers expense while maintaining unaccountable schemes to enrich private shareholders at the expense of the average individuals health and access.

The system is by design far too complex for any rational analysis. The way to approach it is by scrapping the whole mess and starting from a basic set of logical assumptions that we all pay in to a system that we all hope we never have to use but all probably will and that is a shared societal expenditure like national defense or police and fire protection and as such should be regulated and controlled by our democratic institutions not corporate boardrooms with primary concern for profit.