The document discusses perspectives on the US national debt and health care costs. It notes that while the current national debt is 40% of GDP, it has been higher historically. It argues that economic growth through infrastructure investment can help reduce the debt. It also notes that rising health care costs, not entitlement programs, are the main fiscal problem. Health care spending has grown faster in the US than other nations in recent decades and threatens to absorb half the economy. Solutions require addressing the underlying health care cost crisis.

1. Setting the Record Straight on Our Nation’s Finances

2. Putting The National Debt Into Perspective

3. The Public Debt Today = 40% of GDP National High: 1946 = 108% of GDP National Low: 1974 = 24% of GDP

4. Sources: Department of the Treasury and Office of Management and Budget

5. We can’t reduce the debt by starving the nation.

6. Only by investing in our social and physical infrastructure can we achieve sustained economic growth and as a result reduce the debt

7. But it Can’t All Be Paid for with Debt The U.S. has one of the lowest tax rates of any industrialized country, but in recent years it has been spending more than countries with similarly low tax rates. Source: OECD, http://www.oecd.org/document/61/0,3343,en_2649_34573_2483901_1_1_1_1,00.html

8. Due to huge tax cuts and wartime spending, the U.S. transformed from one of the most fiscally healthy countries to one of the least. Source: OECD, http://www.oecd.org/document/61/0,3343,en_2649_34573_2483901_1_1_1_1,00.html

9. What is mistakenly called an “entitlements crisis” is actually a genuine health care crisis. Rapidly rising medical costs, a large uninsured population, and highly uneven care are all urgent, severe problems.

10. Social Security’s projected shortfall over the next 75 years is just 0.38 Percent of GDP. That is not a crisis. The Social Security System

11. The Projected Shortfall is Less than the Cost of Extending the Tax Cuts of 2001 and 2003 Source: CBPP, http://www.cbpp.org/3-31-08socsec.htm 75-Year Social Security Shortfall and Cost of Making the Bush Tax Cuts Permanent (as share of GDP)

12. The aging of the population will cause social insurance programs to grow—but nowhere nearly as much as rising health care costs, if left unchecked.

13. Source: CBO, http://www.cbo.gov/doc.cfm?index=8877

14. The United States spends a lot more on health care than other advanced nations. And we still have 46 million people with no health insurance.

15. 2006 Medical Spending as a Percent of GDP Source: OECD, http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html

16. Health care spending has also grown much faster in the U.S. than it has in other countries over the past few decades.

17. Increase in Health Care Cost as a Percent of GDP, 1970 to 2006 Source: OECD, http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html

18. If trends continue, health care will absorb about half of all spending in the economy within 75 years. This is not a Medicare or Medicaid problem—it is a system-wide problem.

19. Source: CBO, http://www.cbo.gov/doc.cfm?index=8758 Projected Health Care Spending as Percent of GDP

20. Private employers and families are suffering from rapidly rising health care costs. 119% increase Source: Kaiser Family Foundation, http://facts.kff.org/chart.aspx?ch=706 117% increase $5,791 $12,680

21. Those who say Medicare spending increases are not sustainable are right. In recent years, the nation’s Medicare bill has been growing by 6-7% annually—far faster than workers’ wages. The same is true for private health care spending.

22. Source: CMS, http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf Changes in Spending per Enrollee, Medicare and Private Insurance

23. Peter Orszag, director of the Office of Management and Budget, says, “The gains from higher health care spending are not clear…Substantial evidence exists that more expensive care does not always mean higher quality care.”

24. The Relationship Between Quality and Medicare Spending, by State, 2004 Source: Congressional Budget Office, http://www.cbo.gov/ftpdocs/90xx/doc9016/03-03-2008-NABE.pdf