Restoring Fiscal Sanity 2005: Meeting the Long-Run Challenge

Brookings Institution Press
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The retirement of the baby boom generation will create spiraling costs for health care and pension programs. Combined with lower revenues, these developments will lead to a decline in economic growth if nothing is done. In this second volume of Restoring Fiscal Sanity, a group of policy experts focus on how to bring spending and revenues in line over the next decade, and even more important, how to balance them over the longer term. They suggest reforms in the tax system, Social Security, and Medicare that might close this looming gap and put the nation on a sounder fiscal footing.

Contributors include Henry J. Aaron, William G. Gale, Ron Haskins, Jack Meyer, and Peter R. Orszag (Brookings Institution), Rudolph G. Penner and C. Eugene Steuerle (Urban Institute), and John B. Shoven (Stanford University).

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About the author

Alice M. Rivlin is a senior fellow in Economic Studies at the Brookings Institution and visiting professor at the Georgetown Public Policy Institute. She has been director of both the White House Office of Management and Budget and the Congressional Budget Office, and has served as vice chair of the Federal Reserve Board. Among her previous books is Beyond the Dot.coms: The Economic Promise of the Internet (Brookings, 2001), written with Robert Litan. Isabel Sawhill is vice president and director of the Economic Studies program at the Brookings Institution. She served as associate director of the Office of Management and Budget.

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Additional Information

Publisher
Brookings Institution Press
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Published on
Apr 28, 2005
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Pages
146
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ISBN
9780815797791
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Language
English
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Genres
Medical / Health Policy
Political Science / Public Policy / Economic Policy
Political Science / Public Policy / Social Security
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Content Protection
This content is DRM protected.
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The United States is standing at a critical juncture in its fiscal outlook. After experiencing a brief period of budget surpluses at the turn of the century, the federal government will run deficits that add about $4 trillion to the national debt over the next decade. Substantial deficits will likely continue long into the future because the looming retirement of the baby boom generation will raise spending in Social Security, Medicare, and Medicaid. At the same time, the federal government appears to be neglecting spending in key areas of social and economic policy. The nation thus faces a vital choice: continue down a path toward future fiscal crisis while under investing in critical areas, or increase resources in high-priority areas while also reducing the overall budget deficit. This choice will materially affect Americans' economic status and security in the immediate future as well as over long horizons. In R estoring Fiscal Sanity, a group of Brookings scholars with high-level government experience provide an overview of the country's likely medium- and long-term spending needs and the resources available to pay for them. They propose three alternative fiscal paths that are more responsible than the current path. One plan emphasizes spending cuts, the second emphasizes revenue increases, and a third is a balanced mix between the two.

The contributors address the policy choices in such areas as defense, homeland security, international assistance, and programs targeted to the less advantaged, the elderly, and other domestic priorities. In the process, they provide an understanding of the short- and long-run trade offs and illustrate how the budget can be reshaped to achieve high priority objectives in a fiscally responsible way.

The United States is standing at a critical juncture in its fiscal outlook. After experiencing a brief period of budget surpluses at the turn of the century, the federal government will run deficits that add about $4 trillion to the national debt over the next decade. Substantial deficits will likely continue long into the future because the looming retirement of the baby boom generation will raise spending in Social Security, Medicare, and Medicaid. At the same time, the federal government appears to be neglecting spending in key areas of social and economic policy. The nation thus faces a vital choice: continue down a path toward future fiscal crisis while under investing in critical areas, or increase resources in high-priority areas while also reducing the overall budget deficit. This choice will materially affect Americans' economic status and security in the immediate future as well as over long horizons. In R estoring Fiscal Sanity, a group of Brookings scholars with high-level government experience provide an overview of the country's likely medium- and long-term spending needs and the resources available to pay for them. They propose three alternative fiscal paths that are more responsible than the current path. One plan emphasizes spending cuts, the second emphasizes revenue increases, and a third is a balanced mix between the two.

The contributors address the policy choices in such areas as defense, homeland security, international assistance, and programs targeted to the less advantaged, the elderly, and other domestic priorities. In the process, they provide an understanding of the short- and long-run trade offs and illustrate how the budget can be reshaped to achieve high priority objectives in a fiscally responsible way.

A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 

"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene  

At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.

In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?

Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. 

The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
In Baltimore's inner-city neighborhood of Upton/Druid Heights, a man's life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world.

In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800. Why?

Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes, for example, are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. These health inequalities defy the usual explanations. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives, to have the power to live as they want. Empowerment is the key to reducing health inequality and thereby improving the health of everyone. Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions; the greater the health inequity, the greater the dysfunction.

Marmot underscores that we have the tools and resources materially to improve levels of health for individuals and societies around the world, and that to not do so would be a form of injustice. Citing powerful examples and startling statistics ("young men in the U.S. have less chance of surviving to sixty than young men in forty-nine other countries†?), The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.
Americans believe economic opportunity is as fundamental a right as life, liberty, and the pursuit of happiness. More concerned about a level playing field for all, they worry less about the growing income and wealth disparity in our country. Creating an Opportunity Society examines economic opportunity in the United States and explores how to create more of it, particularly for those on the bottom rungs of the economic ladder.

Ron Haskins and Isabel Sawhill propose a concrete agenda for increasing opportunity that is cost effective, consistent with American values, and focuses on improving the lives of the young and the disadvantaged. They emphasize individual responsibility as an indispensable basis for successful policies and programs.

The authors recommend a three-pronged approach to create more opportunity in America:

• Increase education for children and youth at the preschool, K–12, and postsecondary levels

• Encourage and support work among adults

• Reduce the number of out-of-wedlock births while increasing the share of children reared by their married parents

With concern for the federal deficit in mind, Haskins and Sawhill argue for reallocating existing resources, especially from the affluent elderly to disadvantaged children and their families. The authors are optimistic that a judicious use of the nation's resources can level the playing field and produce more opportunity for all.

Creating an Opportunity Society offers the most complete summary available of the facts and the factors that contribute to economic opportunity. It looks at the poor, the middle class, and the rich, providing deep background data on how each group has fared in recent decades. Unfortunately, only the rich have made substantial progress, making this book a timely guide forward for anyone interested in what we can do as a society to improve the prospects for our less-advantaged families and fellow citizens.

The American dream is fading: for nearly two decades, the economy has been performing below par, the quality of life has deteriorated, and the government has not confronted the public problems that concern citizens most. In this provocative book, Alice Rivlin offers a straightforward, nontechnical look at the issues threatening the American dream and proposes a solution: restructure responsibilities between the federal and state government.

Under her plan, the federal government would eliminate most of its programs in education, housing, highways, social services, economic development, and job training, enabling it to move the federal budget from deficit toward surplus. States would pick up these responsibilities, carrying out a "productivity agenda" to revitalize the American economy. Common shared taxes would give the state adequate revenues to carry out their tasks and would reduce intrastate competition and disparities. The federal government would be freer to deal with increasingly complex international issues and would retain responsibility for programs requiring national uniformity. A primary federal job would be the reform of health care financing to ensure control of costs and to mandate basic insurance coverage for everyone.

Published in the summer of 1992, Reviving the American Dream was read by presidential candidate Bill Clinton; by year's end, President Clinton appointed its author, Alice Rivlin, as deputy budget director. Today, the ideal in Rivlin's book—and Rivlin herself—are having an impact inside the administration.

Selected as one of Choice magazine's Outstanding Books of 1993

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