to our creditors. Put another way, one out of every
six dollars that Americans now pay in taxes essentially gets thrown into the trash; it goes to pay interest on the debt, not to buy anything. By 2035, the CBO projects that 22%
of Americans’ tax payments won’t go toward buying anything. Most autopilot spending, however,
doesn’t go toward interest payments on the debt. Most goes toward Social Security and, especially, federal healthcare programs like Medicare, Medicaid, and Obamacare. The former should be viewed very differently from the latter. Social Security was designed with
a dedicated revenue stream, Social Security payroll taxes, that has more than covered the program’s total costs over the past roughly 90 years. Yes, Social Security is expensive
($1.6 trillion this year), and it badly needs some relatively slight reforms, namely, slowly and incrementally raising the retirement age to reflect current demographic realities, to keep
us from having to dip into general revenues to pay for it. But it’s not driving the deficit train. Federal healthcare programs are the primary driver of
our debt, as they are eating up huge and ever-increasing portions of our general tax revenues. This is because when President Lyndon Johnson spearheaded the passage of these Great Society programs and a Democrat Congress passed them into law, no one bothered to think much about how to pay for them. This is very different from Social Security. Indeed, only about one-third of Medicare’s costs
are covered by Medicare payroll taxes, and none of Medicaid’s costs are covered through payroll taxes. This is why LBJ deserves the place of honor on the Mount Rushmore of debt. As I have written previously, “The first year that
Medicare spending visibly hit the books was 1967. From that point through 2020, Medicare and Medicaid cost a combined $17.8 trillion, while our combined federal deficits over that same span were $17.9 trillion. In essence, our deficit problem is a Medicare and Medicaid problem.” As bad as that problem has been, however, it’s
getting worse. In 1975, on the eve of the Bicentennial, we spent 7%
of all federal tax revenues on Medicare and Medicaid combined. In 2025, on the eve of the Quarter-Millennial,
we’re spending 31% of all federal tax revenues on just those two programs. By 2035, the CBO says we’ll be spending 35% — more
than all discretionary spending combined, including all spending on defense, parks, highways, and everything else for which Congress appropriates funds through the usual budgetary process. In the face of these federal healthcare programs’ escalating costs, federal debt held by the public — the portion of the national debt that really matters, as it doesn’t involve the federal government merely borrowing money from itself — is now a whopping 14 times higher, even after adjusting for inflation, than it was in 1974. Lest anyone think that debt numbers can only go in
one direction, that’s after we had cut our debt held by the public in half, in inflation-adjusted dollars, from the end of fiscal year 1946 to the end of FY 1974. We were halfway to being debt-free. Then Medicare and Medicaid really kicked in, and our
debt skyrocketed. With autopilot spending now eating up more than
100% of our tax revenues, and with federal healthcare programs consuming the largest share of that autopilot spending, we won’t be able to get a handle on our runaway deficit spending until we get serious about reforming those healthcare programs. As things stand now, our autopilot is set to fly the
country into the ground. In recent years, Republicans have been only marginally
serious about addressing the deficit, and Democrats have been almost wholly unserious about doing so. This wasn’t the case as recently as 25 or 30 years ago. To turn the debt battleship around, we need to revisit
that late 1990s playbook. The need to get our deficits and debt under control is
obvious and pressing. As recently as 2008, when Barack Obama and Joe
Biden were running as a ticket for the White House, the largest inflation-adjusted deficits on record were, as one would expect, those we ran up during the three full fiscal years of World War II (1943, 1944, and 1945). They now rank 14th, 15th, and 16th on the all-time
list, and they’ll fall another spot once FY 2025 is finished. That’s right: We now run higher annual deficits on a routine basis, even after adjusting for inflation, than we did while fighting a two-front world war. So, we need DOGE, but we also need a lot more than
DOGE. We need serious statesmen to emerge to prevent a fiscal calamity.
Jeffrey H. Anderson is president of American Main Street Initiative, and was director of the Bureau of Justice Statistics at the U.S. Department of Justice from 2017-2021. This article first appeared in The American Mind.
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