There is not a lot of talk about this, either on the campaign trail or in Washington. One reason may be that the federal budget process demands so little accountability. It does not require, for example, any budgeting for entitlement programs, which are deemed "mandatory" spending. They are not subject to the annual appropriations process or to any other weighing of priorities. Instead, spending is determined by eligibility criteria and benefits formulas. In other words, they are on autopilot.

The three largest entitlement programs — Social Security, Medicare and Medicaid — already comprise 42 percent of the federal budget. Within 30 years, that will grow to more than 60 percent without anyone having to vote on whether this is a wise or fair allocation of tax dollars. Demographics and health care costs, not explicit policy decisions, will combine to ratchet up spending.

Over the next 30 years, the number of Americans aged 65 and up will grow from 13 percent of the population to 20 percent. Meanwhile, health care spending has grown faster than the economy for the last 40 years. If the same growth rate continues over the next 40 years, Medicare and Medicaid will nearly quadruple as a share of the economy. Inevitably, this would squeeze out spending on non-entitlement programs and require un-precedented levels of taxation or dangerous levels of debt.

Regardless of the mix between spending and taxes, a responsible budget process should lay the foundation for dealing with the fiscal consequences of an aging population and rising health care costs. Unfortunately, nothing in the current budget process requires Congress and the president to review the budget outlook further than five years ahead, much less take corrective action. This is a major flaw, given that so much of the budget consists of entitlement programs that commit resources far into the future.

That is why I recently joined with 15 other veteran federal budget experts from across the political spectrum to recommend a fundamental reform. In our view, Congress and the president should establish explicit, sustainable, budgets for the three leading cost drivers — Social Security, Medicare and Medicaid — stretching out for at least 30 years. Limits would be placed on automatic spending growth to reduce the favorable treatment these programs receive relative to other programs. Once the budgets are set, periodic reviews every five years would determine whether the programs were within budgeted levels.

To protect against significant long-term deviations from the budget and the political incentives to avoid difficult choices, a trigger device also should be enacted that would make automatic adjustments to benefits, premiums, provider payments or other revenues. Such adjustments only could be over-ridden by an explicit act of the president and Congress.

This proposal would inject a dose of transparency and accountability into the budget process. Without some mechanism to establish priorities on the record, everyone can continue to ignore the long-term consequences of current policy. With it, they must begin to talk concretely about the size and shape of the government they want and to budget accordingly. The first step is to shut off the autopilot.

How about that as a campaign promise?


Robert L. Bixby is executive director of the Concord Coalition.

The Concord Coalition is a non-partisan advocacy group focused on American fiscal policy. Based in Arlington, Va., it was founded in 1992 by the late Sen. Paul Tsongas, D-Mass., former Sen. Warren Rudman, R-N.H., and Peter G. Peterson, a businessman and financier and a former Secretary of Commerce in the Nixon administration. Rudman and former Sen. Bob Kerrey, D.-Neb., are its co-chairs.