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Book Reviews |
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A PDF version of the book reviews is available Review by Kevin L. Kliesen, Federal Reserve Bank of St. Louis |
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Restoring Fiscal Sanity, 2005: Meeting the Long Run Challenge
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In the process, we will put enormous pressure on Social Security, Medicare, Medicaid, civil service retirement, veterans’ benefits, and any other federal program that provides benefits for the elderly. Sum it all up, and what we are about to experience is nothing short of a fiscal tsunami. Or, in the words of the contributors to this book, “the nation is headed for a fiscal train wreck.” Almost one-half of non-defense spending (not counting interest) already goes to people sixty-five years of age and over. But, according to the Brookings team, we haven’t seen anything yet. Over the next 25 years, the share of national income going to Social Security, Medicare, and Medicaid alone will more than double, unless we change course. Economists who follow the annual reports of the Social Security and Medicare trustees already know that the forecast for the future is dire. What they may not know is that the trustees’ report is not a simple projection of the past into the future. Instead, the trustees assume that future health costs increases are moderated, eventually converging on the rate of growth of wages. Rivlin and Sawhill, however, are willing to take seriously the possibility that the rate of growth of future health costs will not be moderate and that health costs will continue to grow in the future as they have in the past. They point out that by 2030, total federal spending is likely to be at 25 percent of GDP and rising—mainly because of elderly entitlements, with most of the growth being in health care. Revenues, by contrast, will be below 20 percent of GDP, even assuming the Bush tax cuts are rescinded. So what are the options? With no change in current policies, we will have soaring debt along with the mounting cost of servicing that debt. In fact, the Congressional Budget Office puts federal spending (including debt costs) at 50 percent of GDP by mid-century and headed ever upward toward the stratosphere. If we try to solve the problem by raising taxes, the authors tell us we will need to double the income tax rate and increase payroll taxes twoand- a half times by 2040. If we choose benefit cuts, we will have to ultimately reduce spending by half. In analyzing problems and proposing solutions, this book does two interesting things to achieve an ideological balance rarely seen in thinktank publications. First, each chapter has two authors—typically pairing one who is left-leaning with one who is right-leaning. (All are from the Brookings Institution unless otherwise noted.) For example, a chapter on the budget is written by Rivlin and Rudolph Penner (Urban Institute). The chapter on Social Security combines Peter Orszag and John Shoven (Stanford). The chapter on health pairs Henry Aaron and Jack Meyer. A chapter on tax policy joins William Gale and Eugene Steuerle (Urban Institute). A chapter on the politics of deficit reduction combines Sawhill and Ron Haskins. On each of these pairings, the first author tends to be associated with Democrats, the second with Republicans – though the association is far from perfect. In another attempt at balance, the book presents a number of reform scenarios designed to appeal to the full ideological spectrum. Solutions include “small government” reforms, “large government” reforms, and one or two scenarios in between. All these solutions involve pain (for small government, read benefit cuts; and for large government, read tax increases); but the reader is free to decide whose ox to gore. For example, on Social Security, the menu of options includes such benefit cuts as (1) price indexing rather than wage indexing of past wages, (2) progressive price indexing of benefits, (3) increasing the retirement age, (4) increasing the number of years used to calculate benefits, and (5) other benefit formula adjustments. The revenue-raising alternatives include (1) increasing the cap on wages subject to payroll taxes and (2) increasing the payroll tax rate. Health care is, of course, the biggest part of our problem; and it is here that the authors tell us we “will face a nasty dilemma” that “will likely require health care rationing for all.” They project that total health care spending will grow from 13.6 percent of GDP to 35.2 percent by 2040 at current trends. And almost half these costs will be paid by government. As in the case of Social Security, we get a menu of options. To reduce Medicare spending, they consider (1) raising the eligibility age, (2) increased cost-sharing by patients, (3) enrolling beneficiaries in private health plans, (4) selective purchasing of health care, and (5) other efficiencies. A disappointment is that we don’t get to learn more about how health care might be rationed, after being told that it’s virtually inevitable. Overall, this volume is better on analyzing problems than on finding solutions. Readers will get a good rundown of policy options popular with think-tank types. However, most of the recommendations would cause one-time shifts in the spending and revenue paths, but they would not change the rate of growth over time. Thus, the painful remedies they consider don’t really solve the long-run problem; they just get us another decade or so down the road. There is no recognition by the contributors that the problems they write about arise because we have a chain-letter approach to retirement. Each generation looks to the next generation to pay its benefits instead of saving and paying its own way. Nor is there any recognition that more than 30 countries today have established funded retirement pension systems as an alternative to the pay-asyou- go system we have. The most interesting of these is Singapore, which has structured its entire economy around the belief that each generation should pay its own way, each family should pay its own way, and each individual should pay his or her own way. Repeatedly, the contributors stress the need to raise national saving and, at one point, bemoan the fact that financial incentives to save do not seem to work. Yet nowhere do they seriously consider forced savings, although they briefly discuss personal Social Security accounts and give the idea short shrift. Other countries have eliminated their unfunded liability for elderly entitlements by requiring workers to save for their own retirement benefits. The Brookings Institution needs to give this idea a closer look.
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Review by John C. Goodman, National Center for Policy Analysis
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