The crystal ball is still far too cloudy to predict whether or not Obamacare will pass, but it is not too soon to make some predictions about what the future will look like if it does pass.

The bill will cost more than advertised. It won’t be long before Congress is shocked — shocked! — to discover that health-care reform is going to cost a lot more than expected. It’s not just the budgetary gimmicks that Democrats have been employing to hide the bill’s true cost. It’s also that government programs — and government health-care programs in particular — almost always end up exceeding their cost estimates.

For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was seven times higher — $67 billion. Similarly, in 1987, Medicaid’s special hospitals subsidy was projected to cost $100 million annually by 1992, just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare’s home-care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost in 1993 was $10 billion.

Insurance premiums will keep rising. The president has tried to convince people that health-care reform will cut their insurance costs. They are in for a surprise. According to the Congressional Budget Office, insurance premiums will double in the next few years. The bill will do nothing to diminish that increase. In fact, for the millions of Americans who get their insurance through the individual market, rather than from an employer, this bill will raise premiums by 10–13 percent more than if we do nothing. Young and healthy people can expect their premiums to go up even more.

The quality of care will be worse. Doctors’ reimbursements for providing care will be squeezed, making it harder to find a doctor. A new survey in the New England Journal of Medicine reports that 46 percent of doctors may give up their practice in the wake of this bill. While that is probably exaggerated, many doctors will likely decide to reduce their patient loads or retire. At the same time, increased demand will create additional problems.

In Massachusetts, after the passage of Romneycare, the wait to see a primary-care physician increased from 33 to 52 days. Research and development will also be cut back, meaning there will be fewer new drugs and other medical breakthroughs. And the government will increasingly intervene in medical decision making, micromanaging medical decisions and deciding what treatments are most effective or, frighteningly, most cost-effective.

The Left will keep pushing for more. Speaker Nancy Pelosi’s inner censor was clearly on the fritz this week when she said, “Once we kick through this door, there’ll be more legislation to follow.” Faced with rising costs and higher premiums, not to mention millions still uninsured, Democrats will blame the “evil” insurance companies and demand further reform. They will argue that we tried “moderate” reform and failed. Pelosi could no longer keep a lid on what the hard Left has been restraining itself from saying all along: It sees this legislation as the perfect first step in the long march to universal single-payer health care.

Republicans won’t really try to repeal it. Republicans will run this fall on a promise to repeal this deeply unpopular bill, and will likely reap the political advantages of that promise. But in reality there is little chance of their following through. Even if Republicans were to take both houses of Congress, they would still face a presidential veto and a Democratic filibuster.

But more important, once an entitlement is in place, it becomes virtually impossible to take away. The fact that Republicans have been criticizing Obamacare for cutting Medicare shows that they are not really willing to take the heat for cutting people’s benefits once they have them — no matter how unaffordable those benefits are. Paul Ryan put forth a serious plan for entitlement reform — and attracted just six co-sponsors at last count. Enough said.

As Scrooge asked in A Christmas Carol, “Are these the shadows of the things that will be, or are they shadows of things that may be?” By Sunday night, we should know.