When Douglas Elmendorf became head of the Congressional Budget Office earlier this year, a colleague gave him a toy skunk as a welcome gift. The last time a Democratic administration tried to push through universal healthcare coverage in 1993, the CBO played the role of “skunk at the party” when it vigorously disputed the White House’s estimates of how much it would all cost. “Hillarycare” disintegrated shortly after that.

Many in the Obama administration, including Peter Orszag, the head of the White House’s budget office, who was Mr Elmendorf’s predecessor as director of the CBO, fear the statutory watchdog could play a similar spoiling role with Mr Obama’s $120bn a year plan to provide universal healthcare coverage.