America's Most Incurable Disease Is Spending

I have had a fulfilling career as a pediatric neurosurgeon, which unfortunately included numerous instances where worst-case scenarios played out in the operating room. Good surgeons plan ahead for these possible events so that bad outcomes are minimized. But of course, few treatment plans will succeed if the doctor continually fails to make a proper diagnosis before surgery begins.

When I look at our nation’s massive federal debt, it is clear that Washington has chronically misdiagnosed the situation, which has resulted in a seemingly never-ending cycle of borrowing and spending. Much like a life-threatening disease, if the underlying cause is left unaddressed, patient recovery seldom occurs.

Bold leaders in both parties have warned for years that entitlement spending is the major driver of unsustainable deficits, and they have further advised that Washington implement policies to address this problem. While it is distressing to see continued inaction, what troubles me more is that virtually no one has addressed the underlying cause. In other words, why were programs created in a manner that they would eventually become so financially upside-down that our entire economy would be in jeopardy? Furthermore, can and should we do something to ensure that future entitlement programs are created carefully and responsibly?

Let’s look at recent history. In the past 10 years, projected deficits for entitlements created long ago, such as Social Security and Medicare, have grown dramatically. In fact, existing entitlement programs consume about 60 percent of all federal spending. During this time, much political effort has been expended — unsuccessfully — trying to reform these programs. I’m not saying this wasn’t an important effort. But, if these programs are not reformed soon, they will consume 100 percent of projected federal revenue within the next three decades. Imagine that: Our children and grandchildren either will be faced with a federal government that has no money for defense, roads and education, or the tax burden will double on citizens.

Sadly, while Congress was busy failing to fix these existing problems, it passed two new entitlement programs, both of which will only worsen our budgetary shortfalls.

These programs create permanent commitments by the federal government to provide expensive services to people indefinitely, regardless of whether the nation can afford to do so. So, not only have we failed to stop the bleeding, but we also have managed to cause significantly more.

Setting aside the political debate about these two programs — one passed by Democrats, the other by Republicans — are any of us comfortable with the notion that permanent spending programs that grow on autopilot forever can be created as easily as Congress names a post office — by a simple one-vote majority? I understand allowing Congress to pass bills with simple majorities that benefit current constituents, but shouldn’t a bill that is going to affect generations to come require a greater threshold than a short-term partisan majority of as small as one single vote? Shouldn’t such grant programs require greater debate, more bipartisanship, some level of consensus and, of course, fiscal responsibility? Absolutely.

Fortunately, there are some in Congress with real solutions. Rep. Rick Crawford, an Arkansas Republican, in conjunction with PreserveOurFuture.org, has properly diagnosed this problem and started crafting a superb treatment plan. They have proposed the Super Program Amendment, which would impose two new requirements: 1) a two-thirds majority vote to pass any new permanent entitlement program, and 2) no additional deficit spending for new entitlements created in the future. Imagine if such an amendment had been passed by Congress (and ratified by the states) as part of the budget reforms of the 1990s. Instead of seeing our unfunded obligations grow by tens of trillions of dollars, we would actually be in better financial health to deal with the unsustainable growth of entitlements today.

As a physician, I believe in prevention — namely, taking those prudent steps now that can dramatically improve health down the road. The Super Program Amendment would ensure that short-term partisan majorities cannot do more harm to the fiscal health of our nation, giving us the time we need to find consensus on fixing the nation’s other serious problems. Those problems affect everyone regardless of political affiliation, and we must all act as patriotic Americans to resolve them.

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Dr. Ben S. Carson is professor emeritus of neurosurgery at Johns Hopkins University and author of the new book, One Nation: What We Can All Do to Save America’s Future.