The ongoing debate over health reform at times seems like a sporting event, with Democrats and Republicans trying to name winners and losers in passing or repealing legislation. But in my Fiscal Times op-ed this week, I explain why, when it comes to health reform, this winner-take-all mentality misses a major point: government programs, whether well designed or poorly designed, need to work within budget constraints. While such constraints inevitably identify losers relative to an open-ended budget (which, like deficits, can hide the losers), they do lead to far better budget and health policy.