This is the accessible text file for CG Presentation number GAO-08-
489CG entitled 'Saving Our Future Requires Tough Choices Today' which
was released on February 7, 2008.
United States Government Accountability Office:
GAO:
Saving Our Future Requires Tough Choices Today:
Chandler-Gilbert Community College:
Chandler, AZ:
February 4, 2008:
The Honorable David M. Walker:
Comptroller General of the United States:
GAO-08-489CG:
Composition of Federal Spending:
[See PDF for image]
There are three pie charts, containing the following compositions of
spending by category:
Year: 1966;
Defense: 43%;
Social Security: 15%;
Medicare and Medicaid: 1%;
Net Interest: 7%;
All Other: 34%.
Year: 1986;
Defense: 28%;
Social Security: 20%;
Medicare and Medicaid: 10%;
Net Interest: 14%;
All Other: 29%.
Year: 2006;
Defense: 20%;
Social Security: 21%;
Medicare and Medicaid: 19%;
Net Interest: 9%;
All Other: 32%.
Source: Office of Management and Budget and the Department of the
Treasury.
[End of figure]
Federal Spending for Mandatory and Discretionary Programs:
[See PDF for image]
There are three pie charts, containing the following compositions of
spending by category:
Year: 1966;
Discretionary: 67%;
Mandatory: 26%;
Net Interest: 7%.
Year: 1986;
Discretionary: 44%;
Mandatory: 42%;
Net Interest: 14%.
Year: 2006;
Discretionary: 38%;
Mandatory: 53%;
Net Interest: 9%.
Source: Office of Management and Budget.
[End of figure]
Table: Fiscal Year 2006 and 2007 Deficits and Net Operating Costs:
On-Budget Deficit, Fiscal Year 2006 ($ Billion): (434);
On-Budget Deficit, Fiscal Year 2007 ($ Billion): (344);
Unified Deficit[a], Fiscal Year 2006 ($ Billion): (248);
Unified Deficit[a], Fiscal Year 2007 ($ Billion): (163);
Net Operating Cost[b], Fiscal Year 2006 ($ Billion): (450);
Net Operating Cost[b], Fiscal Year 2007 ($ Billion): (2760);
Sources: Office of Management and Budget and Department of the
Treasury.
[a] Includes $185 billion in Social Security surpluses for fiscal year
2006 and $186 billion for fiscal year 2007; $1 billion in Postal
Service surpluses for fiscal year 2006 and $5 billion for fiscal year
2006.
Sources: Office of Management and Budget and Department of the
Treasury.
[End of table]
Short-term Fiscal Position versus Long-term Fiscal Exposures:
[See PDF for image]
This figure is a multiple line graph illustrating short-term fiscal position versus long-term fiscal exposures. The following data is depicted:
Fiscal year: 2004;
Long-term Fiscal Exposures: $43.4 trillion;
Net Operating Cost: $615.6 billion;
Operating Deficit: $568 billion;
Unified Deficit: $412.7 billion.
Fiscal year: 2005;
Long-term Fiscal Exposures: $46.4 trillion;
Net Operating Cost: $760.2 billion;
Operating Deficit: $493.6 billion;
Unified Deficit: $318.3 billion.
Fiscal year: 2006;
Long-term Fiscal Exposures: $50.5 trillion;
Net Operating Cost: $449.5 billion;
Operating Deficit: $434 billion;
Unified Deficit: $247.6 billion.
Fiscal year: 2007;
Long-term Fiscal Exposures: $52.7 trillion;
Net Operating Cost: $275.5 billion;
Operating Deficit: $344.284 billion;
Unified Deficit: $162.8 billion.
Source: GAO analysis.
Note: Data are from the Congressional Budget Office and the Department of Treasury. Estimates of the federal government’s long-term fiscal exposures are based on the Financial Report of the U.S. Government. These estimates include the present value of future social insurance obligations over a 75-year time horizon as of January 1st of the preceding year. These estimates have not been adjusted for inflation.
[End of figure]
Table: Major Fiscal Exposures ($ trillions):
Explicit liabilities (Publicly held debt, Military & civilian pensions
& retiree health, Other):
2000: $6.9;
2007: $10.8;
Percent increase: 57.
Commitments & contingencies (e.g., PBGC, undelivered orders):
2000: 0.5;
2007: 1.1;
Percent increase: 97.
Implicit exposures:
2000: 13.0; (Future Social Security benefits: 3.8;
Future Medicare Part A benefits: 2.7;
Future Medicare Part B benefits: 6.5;
Future Medicare Part D benefits: 0).
2007: 40.8; (Future Social Security benefits: 6.8;
Future Medicare Part A benefits: 12.3;
Future Medicare Part B benefits: 13.4;
Future Medicare Part D benefits: 8.4).
Percent increase: 197.
Total, 2000: $20.4;
Total, 2006: $52.7;
Percent increase: 158.
Source: 2000 and 2007 Financial Report of the United States Government.
Note: Totals and percent increases may not add due to rounding. Estimates for Social Security and Medicare are at present
value as of January 1 of each year and all other data are as of
September 30.
[End of table]
Table: How Big is Our Growing Fiscal Burden?
This fiscal burden can be translated and compared as follows:
Total major fiscal exposures: $52.7 trillion;
Total household net worth[1]: $58.6 trillion;
Burden/Net worth ratio: 90 percent.
Burden[2]:
Per person: $175,000;
Per full-time worker: $410,000;
Per household: $455,000.
Income:
Median household income[3]: $48,201;
Disposable personal income per capita[4]: $33,253.
Source: GAO analysis.
Notes: (1) Federal Reserve Board, Flow of Funds Accounts, Table B.100,
2007:Q3 (December 6, 2007); (2) Burdens are calculated using estimated
total U.S. population as of 10/01/07, from the U.S. Census Bureau; full-
time workers reported by the Bureau of Economic Analysis, in NIPA table
6.5D (Aug. 1, 2007); and households reported by the U.S. Census Bureau,
in Income, Poverty, and Health Insurance Coverage in the United States:
2006 (Aug. 2007); (3) U.S. Census Bureau, Income, Poverty, and Health
Insurance Coverage in the United States: 2005 (Aug. 2007); and (4)
Bureau of Economic Analysis, Personal Income and Outlays table 2, (Nov. 29, 2007).
[End of table]
Potential Fiscal Outcomes Under Baseline Extended (January 2001);
Revenues and Composition of Spending as a Share of GDP.
[See PDF for image]
This is a line/stacked bar graph with one line (revenue) and four
stacked bars containing four spending items (Net interest, Social
Security, Medicare and Medicaid, and All other spending). The vertical
axis represents Percent of GDP and the horizontal axis represents
fiscal years 2005, 2015[a], 2030[a], and 2040[a]. The following data is depicted:
Fiscal year 2005:
Net interest: 0.8%;
Social Security: 4.3%;
Medicare & Medicaid: 3.7%;
All other spending: 7.994%;
Revenue: 20.3%.
Fiscal year 2015[A]:
Net interest: 0%;
Social Security: 5.1%;
Medicare & Medicaid: 4.9%;
All other spending: 5.574%;
Revenue: 20.4%.
Fiscal year 2030[A]:
Net interest: 0%;
Social Security: 6.6%;
Medicare & Medicaid: 9.4%;
All other spending: 3.991%;
Revenue: 20.4%.
Fiscal year 2040[A]:
Net interest: 0%;
Social Security: 6.7%;
Medicare & Medicaid: 9%;
All other spending: 4.361%;
Revenue: 20.4%.
Source: GAO’s January 2001 analysis.
[a] All other spending is net of offsetting interest receipts.
[End of graph]
Potential Fiscal Outcomes Under Alternative Simulation; Revenues and
Composition of Spending as a Share of GDP.
[See PDF for image]
This is a line/stacked bar graph with one line (revenue) and four
stacked bars containing four spending items (Net interest, Social
Security, Medicare and Medicaid, and All other spending). The vertical
axis represents Percent of GDP and the horizontal axis represents
fiscal years 2006, 2015, 2030, and 2040. The following data is depicted:
Fiscal year 2006:
Net interest: 1.7%;
Social Security: 4.2%;
Medicare & Medicaid: 3.9%;
All other spending: 10.6%;
Revenue: 18.4%.
Fiscal year 2015:
Net interest: 2.3%;
Social Security: 4.8%;
Medicare & Medicaid: 5.7%;
All other spending: 9.6%;
Revenue: 18%.
Fiscal year 2030:
Net interest: 5.8%;
Social Security: 6.6%;
Medicare & Medicaid: 8.8%;
All other spending: 9.6%;
Revenue: 18.6%.
Fiscal year 2040:
Net interest: 11.6%;
Social Security: 7.2%;
Medicare & Medicaid: 10.8%;
All other spending: 9.6%;
Revenue: 18.6%.
Source: GAO’s August 2007 analysis.
Notes: AMT exemption amount is retained at the 2006 level through 2017
and expiring tax provisions are extended. After 2017, revenue as a
share of GDP returns to its historical level of 18.3 percent of GDP
plus expected revenues from deferred taxes, i.e. taxes on withdrawals
from retirement accounts. Medicare spending is based on the Trustees
April 2007 projections adjusted for the Centers for Medicare and
Medicaid Services alternative assumption that physician payments are
not reduced as specified under current law.
[End of graph]
Growth in Spending for Social Security, Medicare, and Medicaid Expected to Outpace Economic Growth:
[See PDF for image]
This image is a bar graph depicting Growth in Spending for Social Security, Medicare, and Medicaid Expected to Outpace Economic Growth. The vertical axis of the graph represents growth in constant dollars, 2007-2032 in percentage from 0 to 150. The horizontal axis represents spending growth in the four areas. The following data is depicted:
Growth in Constant dollars, 2007-2032:
GDP: 71%;
Social Security Spending: 127%;
Medicaid Spending: 224%;
Medicare Spending: 235%.
Source: GAO analysis based on data from the Office of the Chief Actuary, Social Security Administration; Office of the Actuary,Centers for Medicare and Medicaid Services; and the Congressional Budget Office.
Notes: Social Security and Medicare projections based on the intermediate assumptions of the 2007 Trustees’ Reports. Medicaid projections based on CBO’s August 2007 short-term Medicaid estimates and CBO’s December 2005 long-term Medicaid projections under mid-range assumptions.
[End of graph]
Social Security, Medicare, and Medicaid Spending as a Percent of GDP:
[See PDF for image]
This is a line graph with three stacked lines (Social Security,
Medicaid, and Medicare). The vertical axis represents Percent of GDP
and the horizontal axis represents fiscal years 2000 through 2080.
The following data is depicted:
2000:
Social Security: 4.229;
Medicaid: 1.23;
Medicare: 2.277;
Total: 7.736.
2001:
Social Security: 4.334;
Medicaid: 1.322;
Medicare: 2.433;
Total: 8.089.
2002:
Social Security: 4.409;
Medicaid: 1.44;
Medicare: 2.523;
Total: 8.372.
2003:
Social Security: 4.371;
Medicaid: 1.501;
Medicare: 2.56;
Total: 8.432.
2004:
Social Security: 4.283;
Medicaid: 1.516;
Medicare: 2.629;
Total: 8.428.
2005:
Social Security: 4.254;
Medicaid: 1.457;
Medicare: 2.7;
Total: 8.411.
2006:
Social Security: 4.28;
Medicaid: 1.383;
Medicare: 3.072;
Total: 8.735.
2007:
Social Security: 4.29;
Medicaid: 1.401;
Medicare: 3.185;
Total: 8.876.
2008:
Social Security: 4.24;
Medicaid: 1.449;
Medicare: 3.255;
Total: 8.944.
2009:
Social Security: 4.26;
Medicaid: 1.490;
Medicare: 3.333;
Total: 9.083.
2010:
Social Security: 4.32;
Medicaid: 1.531;
Medicare: 3.414;
Total: 9.265.
2011:
Social Security: 4.36;
Medicaid: 1.578;
Medicare: 3.49;
Total: 9.428.
2012:
Social Security: 4.44;
Medicaid: 1.630;
Medicare: 3.588;
Total: 9.658.
2013:
Social Security: 4.54;
Medicaid: 1.683;
Medicare: 3.694;
Total: 9.917.
2014:
Social Security: 4.65;
Medicaid: 1.739;
Medicare: 3.806;
Total: 10.195.
2015:
Social Security: 4.76;
Medicaid: 1.799;
Medicare: 3.918;
Total: 10.477.
2016:
Social Security: 4.86;
Medicaid: 1.864;
Medicare: 4.044;
Total: 10.768.
2017:
Social Security: 4.976;
Medicaid: 1.930
Medicare: 4.183;
Total: 11.089.
2018:
Social Security: 5.08;
Medicaid: 2.2;
Medicare: 4.331;
Total: 11.611.
2019:
Social Security: 5.2;
Medicaid: 2.2;
Medicare: 4.483;
Total: 11.883.
2020:
Social Security: 5.31;
Medicaid: 2.3;
Medicare: 4.642;
Total: 12.252.
2021:
Social Security: 5.41;
Medicaid: 2.3;
Medicare: 4.809;
Total: 12.519.
2022:
Social Security: 5.22;
Medicaid: 2.4;
Medicare: 4.988;
Total: 12.608.
2023:
Social Security: 5.61;
Medicaid: 2.4;
Medicare: 5.173;
Total: 13.183.
2024:
Social Security: 5.71;
Medicaid: 2.5;
Medicare: 5.359;
Total: 13.569.
2025:
Social Security: 5.8;
Medicaid: 2.6;
Medicare: 5.547;
Total: 13.947.
2026:
Social Security: 5.89;
Medicaid: 2.6;
Medicare: 5.739;
Total: 14.229.
2027:
Social Security: 5.97;
Medicaid: 2.7;
Medicare: 5.935;
Total: 14.605.
2028:
Social Security: 6.05;
Medicaid: 2.7;
Medicare: 6.131;
Total: 14.881.
2029:
Social Security: 6.12;
Medicaid: 2.8;
Medicare: 6.322;
Total: 15.242.
2030:
Social Security: 6.17;
Medicaid: 2.8;
Medicare: 6.505;
Total: 15.475.
2031:
Social Security: 6.22;
Medicaid: 2.9;
Medicare: 6.682;
Total: 15.802.
2032:
Social Security: 6.27;
Medicaid: 2.9;
Medicare: 6.851;
Total: 16.021.
2033:
Social Security: 6.3;
Medicaid: 3;
Medicare: 7.017;
Total: 16.317.
2034:
Social Security: 6.32;
Medicaid: 3.1;
Medicare: 7.279;
Total: 16.669.
2035:
Social Security: 6.33;
Medicaid: 3.1;
Medicare: 7.34;
Total: 16.77.
2036:
Social Security: 6.34;
Medicaid: 3.2;
Medicare: 7.498;
Total: 17.038.
2037:
Social Security: 6.34;
Medicaid: 3.3;
Medicare: 7.643;
Total: 17.283.
2038:
Social Security: 6.34;
Medicaid: 3.3;
Medicare: 7.774;
Total: 17.414.
2039:
Social Security: 6.33;
Medicaid: 3.4;
Medicare: 7.894;
Total: 17.624.
2040:
Social Security: 6.31;
Medicaid: 3.4;
Medicare: 8.01;
Total: 17.72.
2041:
Social Security: 6.3;
Medicaid: 3.5;
Medicare: 8.121;
Total: 17.921.
2042:
Social Security: 6.28;
Medicaid: 3.6;
Medicare: 8.229;
Total: 18.109.
2043:
Social Security: 6.27;
Medicaid: 3.6;
Medicare: 8.334;
Total: 18.204.
2044:
Social Security: 6.25;
Medicaid: 3.7;
Medicare: 8.437;
Total: 18.387.
2045:
Social Security: 6.24;
Medicaid: 3.7;
Medicare: 8.54;
Total: 18.48.
2046:
Social Security: 6.23;
Medicaid: 3.8;
Medicare: 8.64;
Total: 18.67.
2047:
Social Security: 6.22;
Medicaid: 3.8;
Medicare: 8.737;
Total: 18.757.
2048:
Social Security: 6.21;
Medicaid: 3.9;
Medicare: 8.829;
Total: 18.939.
2049:
Social Security: 6.2;
Medicaid: 3.9;
Medicare: 8.916;
Total: 19.016.
2050:
Social Security: 6.2;
Medicaid: 4;
Medicare: 9.002;
Total: 19.202.
2051:
Social Security: 6.19;
Medicaid: 4.063;
Medicare: 9.008;
Total: 19.261.
2052:
Social Security: 6.19;
Medicaid: 4.127;
Medicare: 9.172;
Total: 19.489.
2053:
Social Security: 6.19;
Medicaid: 4.192;
Medicare: 9.256;
Total: 19.638.
2054:
Social Security: 6.2;
Medicaid: 4.258;
Medicare: 9.344;
Total: 19.802.
2055:
Social Security: 6.2;
Medicaid: 4.325;
Medicare: 9.439;
Total: 19.964.
2056:
Social Security: 6.21;
Medicaid: 4.393;
Medicare: 9.538;
Total: 20.141.
2057:
Social Security: 6.21;
Medicaid: 4.462;
Medicare: 9.634;
Total: 20.306.
2058:
Social Security: 6.22;
Medicaid: 4.533;
Medicare: 9.728;
Total: 20.481.
2059:
Social Security: 6.23;
Medicaid: 4.604;
Medicare: 9.82;
Total: 20.654.
2060:
Social Security: 6.23;
Medicaid: 4.676;
Medicare: 9.91;
Total: 20.816.
2061:
Social Security: 6.24;
Medicaid: 4.75;
Medicare: 10;
Total: 20.99.
2062:
Social Security: 6.24;
Medicaid: 4.825;
Medicare: 10.087;
Total: 21.152.
2063:
Social Security: 6.24;
Medicaid: 4.901;
Medicare: 10.175;
Total: 21.316.
2064:
Social Security: 6.25;
Medicaid: 4.978;
Medicare: 10.262;
Total: 21.49.
2065:
Social Security: 6.25;
Medicaid: 5.056;
Medicare: 10.349;
Total: 21.655.
2066:
Social Security: 6.25;
Medicaid: 5.136;
Medicare: 10.429;
Total: 21.815.
2067:
Social Security: 6.25;
Medicaid: 5.217;
Medicare: 10.502;
Total: 21.969.
2068:
Social Security: 6.26;
Medicaid: 5.299;
Medicare: 10.574;
Total: 22.133.
2069:
Social Security: 6.26;
Medicaid: 5.383;
Medicare: 10.648;
Total: 22.291.
2070:
Social Security: 6.26;
Medicaid: 5.467;
Medicare: 10.718;
Total: 22.445.
2071:
Social Security: 6.27;
Medicaid: 5.553;
Medicare: 10.784;
Total: 22.607.
2072:
Social Security: 6.27;
Medicaid: 5.641;
Medicare: 10.845;
Total: 22.756.
2073:
Social Security: 6.27;
Medicaid: 5.73;
Medicare: 10.906;
Total: 22.906.
2074:
Social Security: 6.27;
Medicaid: 5.82;
Medicare: 10.964;
Total: 23.054.
2075:
Social Security: 6.27;
Medicaid: 5.912;
Medicare: 11.022;
Total: 23.204.
2076:
Social Security: 6.27;
Medicaid: 6.005;
Medicare: 11.079;
Total: 23.354.
2077:
Social Security: 6.27;
Medicaid: 6.099;
Medicare: 11.134;
Total: 23.503.
2078:
Social Security: 6.28;
Medicaid: 6.195;
Medicare: 11.187;
Total: 23.662.
2079:
Social Security: 6.28;
Medicaid: 6.293;
Medicare: 11.239;
Total: 23.812.
2080:
Social Security: 6.28;
Medicaid: 6.392;
Medicare: 11.29;
Total: 23.962.
Source: GAO analysis based on data from the Office of the Chief
Actuary, Social Security Administration, Office of the Actuary, Centers
for Medicare and Medicaid Services, and the Congressional Budget
Office.
Note: Social Security and Medicare projections based on the intermediate assumptions of the 2007 Trustees’ Reports. Medicaid projections based on CBO’s August 2007 short-term Medicaid estimates and CBO’s December 2005 long-term Medicaid projections under mid-range assumptions.
[End of graph]
State and Local Governments Face Increasing Fiscal Challenges:
[See PDF for image]
This is a line graph with two lines (Operating Surplus/Deficit Measure
and Net-lending/Net-borrowing). The vertical axis represents Percent of
GDP from -6 to +2 and the horizontal axis represents fiscal years 1980
through 2050. The following data is depicted:
1980:
Operating Surplus/Deficit Measure: 0.35873454;
Net-lending/Net-borrowing: -0.236601541.
1981:
Operating Surplus/Deficit Measure: 0.34624089;
Net-lending/Net-borrowing: -0.169415676.
1982:
Operating Surplus/Deficit Measure: 0.363124424;
Net-lending/Net-borrowing: -0.387096774.
1983:
Operating Surplus/Deficit Measure: 0.774990811;
Net-lending/Net-borrowing: -0.138547233.
1984:
Operating Surplus/Deficit Measure: 0.8152395;
Net-lending/Net-borrowing: 0.223736398.
1985:
Operating Surplus/Deficit Measure: 0.810172263;
Net-lending/Net-borrowing: 0.035542497.
1986:
Operating Surplus/Deficit Measure: 0.820186878;
Net-lending/Net-borrowing: -0.103074303.
1987:
Operating Surplus/Deficit Measure: 0.348462918;
Net-lending/Net-borrowing: -0.346028062.
1988:
Operating Surplus/Deficit Measure: 0.415329754;
Net-lending/Net-borrowing: -0.289980015.
1989:
Operating Surplus/Deficit Measure: 0.461047699;
Net-lending/Net-borrowing: -0.302676683.
1990:
Operating Surplus/Deficit Measure: 0.12076304;
Net-lending/Net-borrowing: -0.649652772.
1991:
Operating Surplus/Deficit Measure: -0.002324922;
Net-lending/Net-borrowing: -0.823896329.
1992:
Operating Surplus/Deficit Measure: 0.105991132;
Net-lending/Net-borrowing: -0.675323856.
1993:
Operating Surplus/Deficit Measure: 0.17518701;
Net-lending/Net-borrowing: -0.573797579.
1994:
Operating Surplus/Deficit Measure: 0.15154266;
Net-lending/Net-borrowing: -0.429852097.
1995:
Operating Surplus/Deficit Measure: 0.226784;
Net-lending/Net-borrowing: -0.446084594.
1996:
Operating Surplus/Deficit Measure: 0.382430375;
Net-lending/Net-borrowing: -0.292955008.
1997:
Operating Surplus/Deficit Measure: 0.540310442;
Net-lending/Net-borrowing: -0.225184543.
1998:
Operating Surplus/Deficit Measure: 0.711478221;
Net-lending/Net-borrowing: -0.113181662.
1999:
Operating Surplus/Deficit Measure: 0.528375987;
Net-lending/Net-borrowing: -0.240602477.
2000:
Operating Surplus/Deficit Measure: 0.51757156;
Net-lending/Net-borrowing: -0.309666904.
2001:
Operating Surplus/Deficit Measure: 0.213052923;
Net-lending/Net-borrowing: -0.800750395.
2002:
Operating Surplus/Deficit Measure: -0.212758845;
Net-lending/Net-borrowing: -1.20443952.
2003:
Operating Surplus/Deficit Measure: -0.034231078;
Net-lending/Net-borrowing: -1.04098241.
2004:
Operating Surplus/Deficit Measure: 0.03822412;
Net-lending/Net-borrowing: -0.899039488.
2005:
Operating Surplus/Deficit Measure: 0.262769152;
Net-lending/Net-borrowing: -0.762696896.
2006:
Operating Surplus/Deficit Measure: 0.21944499;
Net-lending/Net-borrowing: -0.788126765.
2007:
Operating Surplus/Deficit Measure: 0.412715768;
Net-lending/Net-borrowing: -0.638191188.
2008:
Operating Surplus/Deficit Measure: 0.345168264;
Net-lending/Net-borrowing: -0.630180116.
2009:
Operating Surplus/Deficit Measure: 0.333020741;
Net-lending/Net-borrowing: -0.603351831.
2010:
Operating Surplus/Deficit Measure: 0.302656141;
Net-lending/Net-borrowing: -0.605141837.
2011:
Operating Surplus/Deficit Measure: 0.257109542;
Net-lending/Net-borrowing: -0.630946404.
2012:
Operating Surplus/Deficit Measure: 0.206218592;
Net-lending/Net-borrowing: -0.658720463.
2013:
Operating Surplus/Deficit Measure: 0.16406332;
Net-lending/Net-borrowing: -0.681176041.
2014:
Operating Surplus/Deficit Measure: 0.119677687;
Net-lending/Net-borrowing: -0.707576964.
2015:
Operating Surplus/Deficit Measure: 0.076206951;
Net-lending/Net-borrowing: -0.734940534.
2016:
Operating Surplus/Deficit Measure: 0.026942361;
Net-lending/Net-borrowing: -0.769406462.
2017:
Operating Surplus/Deficit Measure: -0.032335263;
Net-lending/Net-borrowing: -0.814653671.
2018:
Operating Surplus/Deficit Measure: -0.109446599;
Net-lending/Net-borrowing: -0.878965311.
2019:
Operating Surplus/Deficit Measure: -0.19227354;
Net-lending/Net-borrowing: -0.950160744.
2020:
Operating Surplus/Deficit Measure: -0.28349272;
Net-lending/Net-borrowing: -1.030954125.
2021:
Operating Surplus/Deficit Measure: -0.386388384;
Net-lending/Net-borrowing: -1.123450085.
2022:
Operating Surplus/Deficit Measure: -0.483216203;
Net-lending/Net-borrowing: -1.211277239.
2023:
Operating Surplus/Deficit Measure: -0.557423995;
Net-lending/Net-borrowing: -1.275859781.
2024:
Operating Surplus/Deficit Measure: -0.667104614;
Net-lending/Net-borrowing: -1.376919803.
2025:
Operating Surplus/Deficit Measure: -0.781500085;
Net-lending/Net-borrowing: -1.482014441.
2026:
Operating Surplus/Deficit Measure: -0.866176187;
Net-lending/Net-borrowing: -1.558258502.
2027:
Operating Surplus/Deficit Measure: -0.971014018;
Net-lending/Net-borrowing: -1.654401786.
2028:
Operating Surplus/Deficit Measure: -1.059403133;
Net-lending/Net-borrowing: -1.733838263.
2029:
Operating Surplus/Deficit Measure: -1.167739726;
Net-lending/Net-borrowing: -1.833479877.
2030:
Operating Surplus/Deficit Measure: -1.259948277;
Net-lending/Net-borrowing: -1.916759702.
2031:
Operating Surplus/Deficit Measure: -1.372065386;
Net-lending/Net-borrowing: -2.020169149.
2032:
Operating Surplus/Deficit Measure: -1.467520327;
Net-lending/Net-borrowing: -2.107108096.
2033:
Operating Surplus/Deficit Measure: -1.596865114.
Net-lending/Net-borrowing: -2.227702996.
2034:
Operating Surplus/Deficit Measure: -1.728257684;
Net-lending/Net-borrowing: -2.350527637.
2035:
Operating Surplus/Deficit Measure: -1.829728717;
Net-lending/Net-borrowing: -2.443203659.
2036:
Operating Surplus/Deficit Measure: -1.964429157.
Net-lending/Net-borrowing: -2.569286091.
2037:
Operating Surplus/Deficit Measure: -2.100986709;
Net-lending/Net-borrowing: -2.697381312.
2038:
Operating Surplus/Deficit Measure: -2.205225568;
Net-lending/Net-borrowing: -2.7928813.
2039:
Operating Surplus/Deficit Measure: -2.325201615;
Net-lending/Net-borrowing: -2.904115765.
2040:
Operating Surplus/Deficit Measure: -2.430489372;
Net-lending/Net-borrowing: -3.00097328.
2041:
Operating Surplus/Deficit Measure: -2.569712106;
Net-lending/Net-borrowing: -3.131648373.
2042:
Operating Surplus/Deficit Measure: -2.709424661;
Net-lending/Net-borrowing: -3.262966376.
2043:
Operating Surplus/Deficit Measure: -2.818508477;
Net-lending/Net-borrowing: -3.363795891.
2044:
Operating Surplus/Deficit Measure: -2.947568546;
Net-lending/Net-borrowing: -3.484450067.
2045:
Operating Surplus/Deficit Measure: -3.058317306;
Net-lending/Net-borrowing: -3.58693672.
2046:
Operating Surplus/Deficit Measure: -3.188512473;
Net-lending/Net-borrowing: -3.709010629.
2047:
Operating Surplus/Deficit Measure: -3.300350183;
Net-lending/Net-borrowing: -3.812861884.
2048:
Operating Surplus/Deficit Measure: -3.432143889;
Net-lending/Net-borrowing: -3.936539309.
2049:
Operating Surplus/Deficit Measure: -3.545556545;
Net-lending/Net-borrowing: -4.041974237.
2050:
Operating Surplus/Deficit Measure: -3.686995315;
Net-lending/Net-borrowing: -4.175627129.
Sources: Historical data from National Income and Product Accounts.
Historical data from 1980–2006, GAO projections from 2007–2050 using
many CBO projections and assumptions, particularly for next 10 years.
[End of graph]
State and Local Fiscal Challenges Add to the Federal Government’s
Fiscal Challenge:
[See PDF for image]
This is a line graph with two lines (Federal Surplus/Deficit and
Combined Surplus/Deficit). The vertical axis represents Percent of GDP
from -20 to +5 and the horizontal axis represents fiscal years 2000
through 2050. The following data is depicted:
Fiscal year: 2000:
Federal Surplus/Deficit: 2.4;
Combined Surplus/Deficit: 2.141.
Fiscal year: 2001:
Federal Surplus/Deficit: 1.3;
Combined Surplus/Deficit: 0.596.
Fiscal year: 2002:
Federal Surplus/Deficit: -1.5;
Combined Surplus/Deficit: -2.624.
Fiscal year: 2003:
Federal Surplus/Deficit: -3.5;
Combined Surplus/Deficit: -4.577.
Fiscal year: 2004:
Federal Surplus/Deficit: -3.6;
Combined Surplus/Deficit: -4.516.
Fiscal year: 2005:
Federal Surplus/Deficit: -2.6;
Combined Surplus/Deficit: -3.389.
Fiscal year: 2006:
Federal Surplus/Deficit: -1.9;
Combined Surplus/Deficit: - 2.677.
Fiscal year: 2007:
Federal Surplus/Deficit: -1.2;
Combined Surplus/Deficit: -1.8.
Fiscal year: 2008:
Federal Surplus/Deficit: -1.6;
Combined Surplus/Deficit: -2.2.
Fiscal year: 2009:
Federal Surplus/Deficit: -2;
Combined Surplus/Deficit: -2.6.
Fiscal year: 2010:
Federal Surplus/Deficit: -2.6;
Combined Surplus/Deficit: -3.2.
Fiscal year: 2011:
Federal Surplus/Deficit: -2.9;
Combined Surplus/Deficit: -3.5.
Fiscal year: 2012:
Federal Surplus/Deficit: -2.8
Combined Surplus/Deficit: -3.5.
Fiscal year: 2013:
Federal Surplus/Deficit: -3.3;
Combined Surplus/Deficit: -4.
Fiscal year: 2014:
Federal Surplus/Deficit: -3.6;
Combined Surplus/Deficit: -4.3.
Fiscal year: 2015:
Federal Surplus/Deficit: -3.8;
Combined Surplus/Deficit: -4.5.
Fiscal year: 2016:
Federal Surplus/Deficit: -4.2;
Combined Surplus/Deficit: -4.9.
Fiscal year: 2017:
Federal Surplus/Deficit: -4.4;
Combined Surplus/Deficit: -5.2.
Fiscal year: 2018:
Federal Surplus/Deficit: -4.8;
Combined Surplus/Deficit: -5.7.
Fiscal year: 2019:
Federal Surplus/Deficit: -5.2;
Combined Surplus/Deficit: -6.1.
Fiscal year: 2020:
Federal Surplus/Deficit: -5.6;
Combined Surplus/Deficit: -6.6.
Fiscal year: 2021:
Federal Surplus/Deficit: -6.1;
Combined Surplus/Deficit: -7.2.
Fiscal year: 2022:
Federal Surplus/Deficit: -6.7;
Combined Surplus/Deficit: -7.8.
Fiscal year: 2023:
Federal Surplus/Deficit: -7.2;
Combined Surplus/Deficit: -8.4.
Fiscal year: 2024:
Federal Surplus/Deficit: -7.8;
Combined Surplus/Deficit: -9.2.
Fiscal year: 2025:
Federal Surplus/Deficit: -8.5;
Combined Surplus/Deficit: -9.9.
Fiscal year: 2026:
Federal Surplus/Deficit: -9;
Combined Surplus/Deficit: -10.6.
Fiscal year: 2027:
Federal Surplus/Deficit: -9.7;
Combined Surplus/Deficit: -11.3.
Fiscal year: 2028:
Federal Surplus/Deficit: -10.3;
Combined Surplus/Deficit: -12.
Fiscal year: 2029:
Federal Surplus/Deficit: -10.9;
Combined Surplus/Deficit: -12.7.
Fiscal year: 2030:
Federal Surplus/Deficit: -11.5;
Combined Surplus/Deficit: -13.4.
Fiscal year: 2031:
Federal Surplus/Deficit: -12.2;
Combined Surplus/Deficit: -14.2.
Fiscal year: 2032:
Federal Surplus/Deficit: -12.8;
Combined Surplus/Deficit: -14.9.
Fiscal year: 2033:
Federal Surplus/Deficit: -13.5;
Combined Surplus/Deficit:-15.7.
Fiscal year: 2034:
Federal Surplus/Deficit: -14.2;
Combined Surplus/Deficit: -16.6.
Fiscal year: 2035:
Federal Surplus/Deficit: -14.8;
Combined Surplus/Deficit: -17.3.
Fiscal year: 2036:
Federal Surplus/Deficit: -15.5;
Combined Surplus/Deficit: -18.1.
Fiscal year: 2037:
Federal Surplus/Deficit: -16.3;
Combined Surplus/Deficit: -18.9.
Fiscal year: 2038:
Federal Surplus/Deficit: -16.9;
Combined Surplus/Deficit: -19.7.
Fiscal year: 2039:
Federal Surplus/Deficit: -17.6;
Combined Surplus/Deficit: -20.5.
Fiscal year: 2040:
Federal Surplus/Deficit: -18.3;
Combined Surplus/Deficit: -21.3.
Fiscal year: 2041:
Federal Surplus/Deficit: -19;
Combined Surplus/Deficit: -22.1.
Fiscal year: 2042:
Federal Surplus/Deficit: -19.8;
Combined Surplus/Deficit: -23.
Fiscal year: 2043:
Federal Surplus/Deficit: -20.4;
Combined Surplus/Deficit: -23.8.
Fiscal year: 2044:
Federal Surplus/Deficit: -21.2;
Combined Surplus/Deficit: -24.6.
Fiscal year: 2045:
Federal Surplus/Deficit: -21.9;
Combined Surplus/Deficit: -25.5.
Fiscal year: 2046:
Federal Surplus/Deficit: -22.7;
Combined Surplus/Deficit: -26.4.
Fiscal year: 2047:
Federal Surplus/Deficit: -23.4;
Combined Surplus/Deficit: -27.2.
Fiscal year: 2048:
Federal Surplus/Deficit: -24.2;
Combined Surplus/Deficit: -28.1.
Fiscal year: 2049:
Federal Surplus/Deficit: -24.9;
Combined Surplus/Deficit:- 29.
Fiscal year: 2050:
Federal Surplus/Deficit: -25.8;
Combined Surplus/Deficit: -29.9.
Source: Historical data from National Income and Product Accounts, GAO
Analysis.
Note: Historical data from 2000–2006, projections from 2007–2050; state
and local balance measure is similar to the federal unified budget
measure. Federal Simulation Assumptions: Discretionary spending grows
with GDP after 2007. AMT exemption amount is retained at the 2006 level
through 2017 and expiring tax provisions are extended. After 2017,
revenue as a share of GDP returns to its historical level of 18.3
percent of GDP plus expected revenues from deferred taxes, i.e. taxes
on withdrawals from retirement accounts. Medicare spending is based on
the Trustees’ April 2007 projections adjusted for the Centers for
Medicare and Medicaid Services’ alternative assumption that physician
payments are not reduced as specified under current law.
[End of graph]
Current Fiscal Policy Is Unsustainable:
The “Status Quo”is Not an Option:
* We face large and growing structural deficits largely due to known
demographic trends and rising health care costs.
* GAO’s simulations show that balancing the budget in 2040 could
require actions as large as:
- Cutting total federal spending by 60 percent or;
- Raising federal taxes to 2 times today's level.
Faster Economic Growth Can Help, but It Cannot Solve the Problem:
* Closing the current long-term fiscal gap based on reasonable
assumptions would require real average annual economic growth in the
double digit range every year for the next 75 years.
* During the 1990s, the economy grew at an average 3.2 percent per
year.
* As a result, we cannot simply grow our way out of this problem. Tough
choices will be required.
The Way Forward: A Three-Pronged Approach:
1. Improve Financial Reporting, Public Education, and Performance
Metrics.
2. Strengthen Budget and Legislative Processes and Controls.
3. Fundamentally Reexamine & Transform for the 21st Century (i.e.,
entitlement programs, other spending, and tax policy).
Solutions Require Active Involvement from both the Executive and
Legislative Branches.
The Way Forward: Improve Financial Reporting, Public Education, and Performance Metrics:
* Improve transparency & completeness of President’s budget proposal:
- Return to 10-year estimates in budget both for current policies and programs and for policy proposals;
- Include in the budget estimates of long-term cost of policy proposals & impact on total fiscal exposures;
- Improve transparency of tax expenditures.
* Consider requiring President’s budget to specify & explain a fiscal goal and a path to that goal within 10-year window—or justify an alternative deadline;
* Require annual OMB report on existing fiscal exposures [liabilities, obligations, explicit & implied commitments];
* Require enhanced financial statement presentation to address fiscal sustainability and intergenerational equity issues;
* Prepare and distribute a summary annual report that is both useful and used;
* Increase information on long-range fiscal sustainability issues in Congressional Budget Resolution & Budget Process;
* Develop key national (outcome-based) indicators (e.g. economic, security, social, environmental) to chart the nation’s posture, progress, and position relative to the other major industrial countries.
The Way Forward: Strengthen Budget and Legislative Processes and Controls:
* Restore discretionary spending caps & PAYGO rules on both spending and tax sides of the ledger;
* Develop mandatory spending triggers [with specific defaults], and other action-forcing provisions (e.g., sunsets) for both direct spending programs and tax preferences;
* Develop, impose & enforce modified rules for selected items (e.g., earmarks, emergency designations, and use of supplementals);
* Require long-term cost estimates (e.g. present value) for any legislative debate on all major tax and spending bills, including entitlement programs. Cost estimates should usually assume no sunset;
* Extend accrual budgeting to insurance & federal employee pensions; develop techniques for extending to retiree health & environmental liabilities;
* Consider biennial budgeting;
* Consider expedited line item rescissions from the President that would only require a majority vote to override the proposed rescission(s).
The Way Forward: Fundamentally Reexamine & Transform:
* Restructure existing entitlement programs;
* Reexamine and restructure the base of all other spending;
* Review & revise existing tax policy, including tax preferences and enforcement programs;
* Expand scrutiny of all proposed new programs, policies, or activities;
* Reengineer internal agency structures and processes, including more emphasis on long-term planning, integrating federal activities, and partnering with others both domestically and internationally;
* Strengthen and systematize Congressional oversight processes;
* Increase transparency associated with government contracts and other selected items;
* Consider a capable, credible, bi-partisan budget, entitlement, and tax reform commission.
Key National Indicators:
* What: A portfolio of economic, social, and environmental outcome-
based measures that could be used to help assess the nation’s and other
governmental jurisdictions’ position and progress;
* Who: Many countries and several states, regions, and localities have
already undertaken related initiatives (e.g., Australia, New Zealand,
Canada, United Kingdom, Oregon, Silicon Valley (California) and
Boston);
* Why: Development of such a portfolio of indicators could have a
number of possible benefits, including;
- Serving as a framework for related strategic planning efforts;
- Enhancing performance and accountability reporting;
- Informing public policy decisions, including much needed baseline
reviews of existing government policies, programs, functions, and
activities;
- Facilitating public education and debate as well as an informed
electorate;
* Way Forward: Consortium of key players housed by the National
Academies domestically and related efforts by the OECD and others
internationally.
Key National Indicators: Where the United States Ranks:
The United States may be the only superpower, but compared to most
other OECD countries on selected key economic, social, and
environmental indicators, on average, the U.S. ranks 16 out of 28.
OECD Categories for Key Indicators (2006 OECD Factbook):
* Population/Migration;
* Energy;
* Environment;
* Labor Market;
* Education;
* Public Finance;
* Science & Tech.;
* Quality of Life;
* Macroeconomic Trends;
* Economic Globalization
* Prices.
Source: 2006 OECD Factbook.
Social Security and Medicare’s Hospital Insurance Trust Funds Face Cash
Deficits:
[See PDF for image]
This is a bar graph with vertical bars representing the Medicare HI
Cash Flow and Social Security Cash Flow for each fiscal year. The bars
indicate a Medicare HI cash deficit beginning in 2007 and a Social
Security cash deficit in 2017. The vertical axis of the graph depicts
billions of 2007 dollars from -900 to +200. The horizontal axis depicts
fiscal years from 2005 through 2040. The following data is depicted:
2005:
Medicare HI cash flow: $0.42;
Social Security cash flow: $81.68;
Surplus: $82.1.
2006:
Medicare HI cash flow: $3.26;
Social Security cash flow: $88.75;
Surplus: $90.01.
2007:
Medicare HI cash flow: ($1.00);
Social Security cash flow: $79.40;
Surplus: $78.40.
2008:
Medicare HI cash flow: ($4.88);
Social Security cash flow: $90.10;
Surplus: $85.22.
2009:
Medicare HI cash flow: ($7.61);
Social Security cash flow: $94.30;
Surplus: $86.69.
2010:
Medicare HI cash flow: ($11.11);
Social Security cash flow: $89.80;
Surplus: $78.69.
2011:
Medicare HI cash flow: ($14.40);
Social Security cash flow: $86.10;
Surplus: $71.7.
2012:
Medicare HI cash flow: ($19.27);
Social Security cash flow: $76.30;
Surplus: $57.03.
2013:
Medicare HI cash flow: ($23.85);
Social Security cash flow: $62.10;
Surplus: $38.25.
2014:
Medicare HI cash flow: ($29.83);
Social Security cash flow: $45.90;
Surplus: $16.07.
2015:
Medicare HI cash flow: ($36.28);
Social Security cash flow: $29.20;
Deficit: $7.08.
2016:
Medicare HI cash flow: ($43.13);
Social Security cash flow: $11.50;
Deficit: $31.63.
2017:
Medicare HI cash flow: ($51.11);
Social Security cash flow: ($6.70);
Deficit: $57.81.
2018:
Medicare HI cash flow: ($60.85);
Social Security cash flow: ($26.30);
Deficit: $87.15.
2019:
Medicare HI cash flow: ($70.74);
Social Security cash flow: ($46.80);
Deficit: $117.54.
2020:
Medicare HI cash flow: ($81.45);
Social Security cash flow: ($67.80);
Deficit: $149.25.
2021:
Medicare HI cash flow: ($93.57);
Social Security cash flow: ($88.40);
Deficit: $181.97.
2022:
Medicare HI cash flow: ($107.64);
Social Security cash flow: ($109.00);
Deficit: $216.64.
2023:
Medicare HI cash flow: ($122.16);
Social Security cash flow: ($129.70);
Deficit: $251.86.
2024:
Medicare HI cash flow: ($137.69);
Social Security cash flow: ($150.30);
Deficit: $287.99.
2025:
Medicare HI cash flow: ($153.52);
Social Security cash flow: ($170.90);
Deficit: $324.42.
2026:
Medicare HI cash flow: ($171.35);
Social Security cash flow: ($191.30);
Deficit: $362.65.
2027:
Medicare HI cash flow: ($189.83);
Social Security cash flow: ($211.30);
Deficit: $401.13.
2028:
Medicare HI cash flow: ($209.99);
Social Security cash flow: ($231.30);
Deficit: $441.29.
2029:
Medicare HI cash flow: ($230.01);
Social Security cash flow: ($249.50);
Deficit: $479.51.
2030:
Medicare HI cash flow: ($250.39);
Social Security cash flow: ($266.50);
Deficit: $516.89.
2031:
Medicare HI cash flow: ($272.06);
Social Security cash flow: ($282.50);
Deficit: $554.56.
2032:
Medicare HI cash flow: ($293.90);
Social Security cash flow: ($297.30);
Deficit: $591.2.
2033:
Medicare HI cash flow: ($316.28);
Social Security cash flow: ($310.30);
Deficit: $626.58.
2034:
Medicare HI cash flow: ($338.68);
Social Security cash flow: ($321.40);
Deficit: $660.08.
2035:
Medicare HI cash flow: ($361.93);
Social Security cash flow: ($330.90);
Deficit: $692.83.
2036:
Medicare HI cash flow: ($385.03);
Social Security cash flow: ($339.60);
Deficit: $724.63.
2037:
Medicare HI cash flow: ($408.36);
Social Security cash flow: ($347.30);
Deficit: $762.06.
2038:
Medicare HI cash flow: ($430.55);
Social Security cash flow: ($353.70);
Deficit: $784.25.
2039:
Medicare HI cash flow: ($453.30);
Social Security cash flow: ($358.80);
Deficit: $812.1.
2040:
Medicare HI cash flow: ($475.73);
Social Security cash flow: ($363.40);
Deficit: $839.13.
Source: GAO analysis of data from the Office of the Chief Actuary,
Social Security Administration and Office of the Actuary, Centers for
Medicare and Medicaid Services.
Note: Projections based on the intermediate assumptions of the 2007
Trustees’ Reports. The CPI is used to adjust from current to constant
dollars.
[End of graph]
Key Dates Highlight Long Term Challenges of the Social Security System:
Event: Cash surplus begins to decline;
Date: 2009, OASI, OASDI.
Event: Annual benefit costs exceed cash revenue from taxes;
Date: 2018, OASI;
Date: 2005, DI;
Date: 2017, OASDI.
Event: Trust fund ceases to grow because even taxes plus interest fall
short of benefits;
Date: 2028, OASI;
Date: 2013, DI;
Date: 2027, OASADI.
Event: Trust fund exhausted;
Date: 2042, OASI;
Date: 2026: DI;
Date: 2041, OASDI.
Source: Social Security Administration, The 2007 Annual Report of the
Board of Trustees of the Federal Old-Age and Survivors Insurance and
Disability Insurance Trust Funds(Washington, DC: April 2007).
[End of table]
Possible Way Forward on Social Security Reform:
Make little or no changes to those who are near retirement or already
retired and make a number of adjustments that would affect younger
workers:
* Phase-in an increase in the normal retirement age and index it to
life expectancy;
* Consider phasing-in an increase in the early retirement age and index
it to life expectancy with a modified disability access provision;
* Modify income replacement and/or indexing formulas for middle and
upper income earners;
* Strengthen the minimum benefit;
* Consider a modest adjustment to the COLA formula;
* Increase the taxable wage base, if necessary;
* Consider supplemental individual accounts and mandatory individual
savings on a payroll deduction basis (e.g., a minimum 2 percent payroll
contribution and a program designed much like the Federal Thrift
Savings Plan with a real trust fund and real investments).
Growth in Health Care Spending Health Care Spending as a Percentage of GDP:
[See PDF for image]
This figure is a bar graph depicting Growth in Health Care Spending Health Care Spending as a Percentage of GDP for five specific years. The vertical axis of the graph represents percent from 0 to 25. The horizontal axis of the graph represents years 1975, 1985, 1995, 2005, and 2015. The following data is depicted:
Year: 1975;
National health expenditures as a percent of GDP: 8.1%.
Year: 1985;
National health expenditures as a percent of GDP: 10.4%.
Year: 1995;
National health expenditures as a percent of GDP: 13.7%.
Year: 2005;
National health expenditures as a percent of GDP: 16.0%.
Year: 2015;
National health expenditures as a percent of GDP: 19.2%.
Source: The Centers for Medicare & Medicaid Services, Office of the Actuary.
Notes: The figure for 2015 is projected.
[End of graph]
Key Dates Highlight Long Term Challenges of the Medicare Program:
Date: 2007;
Event: Medicare Part A outlays exceed cash income.
Date: 2007;
Event: Estimated trigger date for “Medicare funding warning.”
Date: 2013;
Event: Projected date that annual “general revenue funding” for Part B
will exceed 45 percent of total Medicare outlays.
Date: 2019;
Part A trust fund exhausted, annual income sufficient to pay about 80%
of promised Part A benefits.
Source: 2007 Annual Report of The Boards of Trustees of The Federal
Hospital Insurance and Federal Supplementary Medical Insurance Trust
Funds(Washington, DC, April 2007).
[End of table]
Issues to Consider in Examining Our Health Care System:
The public needs to be educated about the differences between wants,
needs, affordability, and sustainability at both the individual and
aggregate level.
Ideally, health care reform proposals will:
* Align Incentives for providers and consumers to make prudent
decisions about the use of medical services;
* Foster Transparency with respect to the value and costs of care, and;
* Ensure Accountability from insurers and providers to meet standards
for appropriate use and quality;
Ultimately, we need to address four key dimensions: access, cost,
quality,and personal responsibility.
Selected Potential Health Care Reform Approaches:
Reform Approach: Revise the government’s payment systems and leverage
its purchasing authority to foster value-based purchasing for health
care products and services;
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Consider additional flexibility for states to serve as
models for possible health care reforms;
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Consider limiting direct advertising and allowing
limited importation of prescription drugs;
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Foster more transparency in connection with health
care costs and outcomes;
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Create incentives that encourage physicians to utilize
prescription drugs and other health care products and services
economically and efficiently.
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Foster the use of information technology to increase
consistency, transparency, and accountability in health care;
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Encourage case management approaches for people with
chronic and expensive conditions to improve the quality and efficiency
of care delivered and avoid inappropriate care.
Short-term action: [check];
Long-term action: [Empty].
Reform Approach: Reexamine the design and operational structure of the
nation’s health care entitlement programs—Medicare and Medicaid,
including exploring more income-related approaches;
Short-term action: [check];
Long-term action: [check].
Reform Approach: Revise certain federal tax preferences for health care
to encourage more efficient use of health care products and services;
Short-term action: [check];
Long-term action: [check].
Reform Approach: Foster more preventative care and wellness services
and capabilities, including fighting obesity and encouraging better
nutrition;
Short-term action: [check];
Long-term action: [check].
Reform Approach: Promote more personal responsibility in connection
with health care;
Short-term action: [check];
Long-term action: [check].
Reform Approach: Limit spending growth for government-sponsored health
care programs (e.g., percentage of the budget and/or economy);
Short-term action: [Empty];
Long-term action: [check].
Reform Approach: Develop a core set of basic and essential services.
Create insurance pools for alternative levels of coverage, as
necessary;
Short-term action: [Empty];
Long-term action: [check].
Reform Approach: Develop a set of evidence-based national practice
standards to help avoid unnecessary care, improve outcomes, and reduce
litigation;
Short-term action: [Empty];
Long-term action: [check].
Reform Approach: Pursue multinational approaches to investing in health
care R&D;
Short-term action: [Empty];
Long-term action: [check].
[End of table]
Moving the Debate Forward:
The Sooner We Get Started, the Better:
* The miracle of compounding is currently working against us;
* Less change would be needed, and there would be more time to make
adjustments;
* Our demographic changes will serve to make reform more difficult over
time.
Need Public Education, Discussion, and Debate:
* The role of government in the 21st Century;
* Which programs and policies should be changed and how;
* How government should be financed.
These Challenges Go Beyond Numbers and Dollars—It’s About Values and
People.
{End of presentation]
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