Preface

The authors of this paper are longtime federal budget and policy experts who have been drawn together by a deep concern about the nation’s long-term fiscal outlook. Our group covers the ideological spectrum. We are affiliated with a diverse set of organizations. We have been meeting informally for over a year, under the auspices of The Brookings Institution and The Heritage Foundation, to define the dimensions and consequences of the looming federal budget problem, examine alternative solutions, and reach agreement on what should be done. Despite our diverse philosophies and political leanings, we have found solid common ground. We agree that:

• Unsustainable deficits in the federal budget threaten the health and vigor of the American economy.
• The first step toward establishing budget responsibility is to reform the budget decision process so that the major drivers of escalating deficits--Social Security, Medicare, and Medicaid--are no longer on autopilot.

More specifically, we recommend that:

• Congress and the president enact explicit long-term budgets for Medicare, Medicaid, and Social Security that are sustainable, set limits on automatic spending growth, and reduce the relatively favorable budgetary treatment of these programs compared with other types of expenditures.
• The programs be reviewed on a regular schedule by the Social Security and Medicare Trustees or the Congressional Budget Office to determine whether they will remain within budgeted amounts.
• Significant long-term deviations from budgeted amounts trigger automatic adjustments in benefits, premiums, provider payments, or other revenues. These adjustments could only be over-ridden by an explicit vote of Congress and acceptance by the president.

We provide examples of specific policies that might be adopted to bring the programs in line with their long-term budgets but believe that the first action needed to restore long-term fiscal balance is a change in the way budget decisions are made.

The remainder of this paper describes why we think this change is so important and what the next steps should be. . . .

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Joseph Antos is the Wilson H. Taylor Scholar in Health Care Policy at AEI. Robert Bixby is the executive director of the Concord Coalition. Stuart M. Butler is the vice president of domestic and economic policy at the Heritage Foundation. Paul Cullinan is the research director of the Budgeting for National Priorities project at the Brookings Institution. Alison Fraser is the director of the Thomas A. Roe Institute for Economic Policy Studies at the Heritage Foundation. William Galston is a senior fellow at the Brookings Institution. Ron Haskins is a senior fellow at the Brookings Institution. Julia Isaccs is a child and family policy fellow at the Brookings Institution. Maya MacGuineas is the president of the Committee for a Responsible Federal Budget and the director of the fiscal policy program at the New America Foundation. Will Marshall is president and founder of the Progressive Policy Institute. Pietro Nivola is the vice president and director of the Governance Studies Program at the Brookings Institution. Rudolph G. Penner is a senior fellow at the Urban Institute. Robert Reischauer is the President of the Urban Institute. Alice M. Rivlin is a senior fellow at the Brookings Institution. Isabel V. Sawhill is a senior fellow at the Brookings Institution. Eugene Steuerle is a senior fellow at the Urban Institute.