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“Just the Facts, Ma’am”


In the 1950s, a popular, long-running TV series titled “DRAGNET” featured two, serious-as-a-heart-attack Los Angeles Police Department detectives: Sergeant Joe Friday and his partner, Officer Bill Gannon. Every week they set out to investigate and solve serious crimes in the big city. After viewing one episode, you could tell that neither of these two, steely, uber-committed police officers had a single political bone in their respective bodies. They were all about getting to and understanding the facts—the truth. And, with the facts and the full truth, they could then do the hard work to solve every otherwise difficult and confounding case.

In our modern times of partisan politics, social media and the daily news cycle, there is often very little focus on objectively examining the facts, on finding common ground and on solving many of the great problems of our day. However, the greatness of our country is demonstrated whenever we and our leaders find ways to unite and to gain principled consensus; to find the best, most practical, if imperfect, solutions to the challenging issues of our day.

So, here are some hard-to-ignore facts on an important and daunting challenge: Federal spending on entitlement programs (Social Security, Medicare, Medicaid, the Affordable Care Act) continues to grow at ever higher rates—as a percent of our gross domestic product (GDP), and as a portion of federal revenues. Also, the cost of interest payments on the national debt will rise precipitously over the coming years as large deficits continue to accrue and as artificially-low interest rates rise to market levels. Eventually, this predictable deficit spending will overwhelm the federal budget and lead to a fiscal crisis—if our national leaders fail to control the growth of spending and the cost-drivers within the system.

They say that one picture (or graph) is worth a thousand words. Well, here are 3,000 words from the CBO—the federal, nonpartisan, Congressional Budget Office.

It is instructive—and a bit alarming—to read the CBO report: The 2017 Long-Term Budget Outlook.

Here are some selected excerpts from that CBO report:

“Federal debt held by the public has ballooned over the past decade…it is projected to reach 77% of GDP by the end of this year…For comparison, such debt has averaged 40% of GDP over the past 50 years. If current laws generally remain unchanged, federal debt as a percentage of GDP would reach unprecedented levels—89% by 2027 and 150% by 2047 and will be on track to grow even larger…The burgeoning federal debt over the coming decades will have serious consequences:”

  • Reduce national savings and income in the long term;
  • Increase the government’s interest costs, putting more pressure on the rest of the budget;
  • Limit lawmakers’ ability to respond to unforeseen events: and
  • Raise the likelihood of a financial crisis”


So, what should we do about these “inconvenient facts”? Ignore them—and keep “kicking the can down the road” as long as possible, letting our children, the rising generation, deal with it? Or—should we rather expect our national leaders to be accountable, to better represent our national interests, and to actually face up to this big problem and find solutions. Finding solutions to big problems is always hard work. It involves painful trade-offs and compromise. It takes vision and political courage. It may require new approaches—greater creativity and innovation. But finding ways to agree on the right set of trade-offs, changes and system improvements will prove far less painful than facing much bigger crises down the road.

A large part of what we do in our work at HealthInsight is aimed at fundamentally transforming the national health care system in ways that provide sustainable results. HealthInsight is committed to achieving better health, better health care, and better, more efficient use of federal resources through health system transformation. And one thing seems clear: we won’t have a federal health system (i.e., Medicare, Medicaid, ACA, etc.) in the future if we don’t figure out how to successfully transform it today.

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