The 900-Pound Fiscal Gorillas in Our Midst

       During this year I will write more about the crisis of spending, debt and deficits; this primer identifies the 3 root causes of the impending train wreck. The trigger will be a fiscal crisis when the debt bomb explodes, rendering the US insolvent; however, the crisis will rapidly transmogrify into civil chaos and jeopardize the rule of law.

Health Care – Root Cause #1

       It is impossible for any society to pay for all health care demanded if it is free or heavily subsidized. It must be rationed in one form or another. Private insurance rations it by cost, while government rations it by denying care, lengthy waitlists and death panels. The problem is exacerbated by third party payments; when government pays, costs skyrocket. If we eliminated or reduced third party payments, as is the case with dentistry, laser eye surgery and cosmetic surgery, costs would be stable. The only hope for controlling health care costs lies in free markets; all else is doomed.

       Medical progress is astounding. In 1900, infectious diseases caused 37% of deaths; today it is 2%. People over 65 were only 18% of deaths; now it is 75%. We have gone from conquering disease to managing chronic conditions; half of Medicare patients have multiple chronic diseases – any one of which once would have killed them. Of all medical spending, 80% is on four chronic ailments: cancer, heart disease, Alzheimer’s and diabetes. One-third of all Medicare spending is in the final six months of life. Federal health care spending has ballooned from 3% 50 years ago to 30% today.

Social Security and Pensions – Root Cause #2

     Social Security faces myriad problems. (1) It is caught up in a demographic time bomb; as the population ages, there are ever fewer workers to support ever more retirees. (2) Life expectancy keeps rising, from 60 when SS began to nearly 80 today. (3) Chronically low bond yields have savaged SS. (4) Congress is gridlocked and refuses to act. SS is now 25% of the budget and heading for the stratosphere.

    Social Security is but one part of the pension bomb. State and local pensions are vastly underfunded. Mushrooming pension costs (due to public sector unions) threaten future retirees. The goosed up spending on pensions (and health care) has crowded out infrastructure spending; our roads, bridges and airports are a disaster. Health care and pensions suck all the oxygen out of the budget, leaving behind only chump change.

Interest on the National Debt – Root Cause #3

    The ratio of US debt to GDP is 104% for total debt and 75% for public debt. No country, in 600 years of government borrowing, has survived a public debt/GDP ratio above 90%. We will exceed 90% in a few years. Interest currently consumes 9% of the budget but is headed for 15% by 2020. When (not if) we experience another recession or higher interest rates, that number easily could snowball to 20% or even more.

The Fiscal Train Wreck in Our Future

     By 2020, Social Security will suck up 36% of the budget, health care 34% and interest 15%. That adds to a gobsmacking 85% and they will continue to burgeon after 2020. Defense is 12%, leaving only 3% for the rest of the government. During the 2020s, the three root causes will gobble up the entire budget and then some. It won’t stop until the train goes over the cliff. If something cannot go on forever, it won’t!

     America is sleepwalking into an existential crisis and a fiscal death spiral that is totally predictable. The train that is America is barreling toward a fiscal cliff. Almost everyone sees the train about to go over the cliff, but is inured to the terrible tragedy unfolding before their eyes – and there is no deus ex machina anywhere in sight.