Conservative political leaders sometimes enact tax cuts, hoping eventually that they will force expenditure cuts and reduce the size and scope of government. Liberals, on the other hand, sometimes do the opposite: They pass new programs figuring they can work out the finances later.
Right now, a special danger is the enactment of health reform without working out the finances ahead of time. And, for that matter, also working out the difficult questions: Who will run the new system? Will they have sufficient clout to do so?