FRBSF Economic Letter
2003-27; September 19, 2003
The Fiscal Problem of the 21st Century
Last year, the Congressional Budget Office (CBO) released a remarkable
report entitled A 125-Year Picture of the Federal Government's Share
of the Economy, 1950 to 2075. This report projects the future of government
spending as a share of GDP assuming current policies remain in place,
and the projections put forward are stunning: while the share has averaged
about 19% since 1950, it is projected to rise drastically in coming decades,
more than doubling to 39.7% by 2075. With no change in tax policies, this
rise in spending implies exploding budget deficits, reaching 20% of GDP
The inescapable implication of this report is that our current policies
are unsustainable, and something will have to change. This Economic
Letter explains the nature of this fiscal problem and provides some
perspective on how it might be resolved.
The fiscal problem
1 and 2 summarize the forecasts in the CBO's report. For the period 1950
to 2000, the figures plot actual numbers for the U.S. economy. For the
period 2010 to 2075, the figures plot CBO projections under the assumption
that current policies continue. In general, the projections are based
on reasonable assumptions for the future path of wages, the number of
recipients of various entitlement programs, and spending per recipient.
Figure 1 graphs several statistics related to this fiscal problem. The
first is total federal spending, excluding interest on the debt, as a
fraction of GDP. The CBO projection quoted at the start of this Letter
referred to a spending share that rose to nearly 40%. What Figure 1 implies
is that about 10 percentage points of this total consists of interest
on the debt, under the assumption that tax revenues as a share of GDP
do not rise with spending. The rise in non-interest spending is more modest,
but still quite significant: by 2075, revenues would need to rise by about
9 percentage points of GDP to cover non-interest spending.
Figure 1 also shows the main change accounting for the rise in government
spending: federal spending on three entitlement programsSocial Security,
Medicare, and Medicaid. This entitlement spending has risen from 0.3%
of GDP in 1950 to 7.6% in 2000. Total federal spending has averaged about
19% of GDP over this period, so spending on health and retirement has
gone from a negligible fraction to more than a third of the total.
What are the reasons for this increase? One is the increased generosity
of these entitlement programs, and another is the larger fraction of the
U.S. population that will be eligible for these benefits because of the
general aging of the U.S. population. For example, in 1940 there were
8.6 people of working age for every person aged 65 and above; by 2000,
this number had fallen by nearly half to 4.7 (CBO 2002b).
What is even more remarkable about federal spending on health and retirement,
however, is the continuation of the trend in the CBO's projections. As
shown in Figure 1, under the assumption that current policies continue,
the fraction of GDP devoted to entitlement spending on these programs
will rise from 7.6% in 2000 to 13.9% in 2030 and to 21.1% by 2075. This
increase is driven by the continued aging of the U.S. population: the
ratio of working-age population to the population aged 65 and over is
expected to fall from 4.7 in 2000 to 2.8 in 2030 and to 2.4 in 2075.
To put the rise of this entitlement spending in perspective, Figure 1
also plots federal revenues as a percentage of GDP. Like total federal
spending, federal revenues have averaged about 18% or 19% of GDP since
1950. Assuming current policies continue, the CBO projections assume that
revenues stabilize at 19% of GDP in the future. When entitlement spending
was low, this left ample room for additional spending on defense, unemployment
insurance, environmental protection, and federally funded research, among
other things. However, according to the CBO projection, health and retirement
spending by itself will exceed 19% of GDP by 2070 if current policies
2 breaks down the projections for the entitlement programs into health
care costs and Social Security. The CBO projects Social Security expenditures
to rise from 4.2% of GDP in 2000 to 6.2% in 2030, and then to level off.
In contrast, spending on Medicare and Medicaid rises from 3.4% of GDP
in 2000 to 7.7% of GDP in 2030 and then to 14.9% of GDP by 2075. A primary
cause of this increase in the projections is an underlying assumption
that health care costs per recipient will grow at a rate that is 1 percentage
point faster than the rate of per capita GDP growth. While this rate may
appear to be high, it is, in fact, slower than the rate of growth in health
costs in recent decades.
An alternative perspective
Another way to look at the problem is presented in Hall (2003), who analyzes
from the standpoint of the typical household in the United States. He
imagines a statistical household consisting of one man and one woman,
earning the typical amount of income over a typical lifetime and facing
the typical health, retirement, and education expenses. Hall then computes
the fraction of this household's pre-retirement resources that must be
devoted to each of these spending categories. An important component of
Hall's analysis is that he looks through the veil of who actually does
the spending: all expenditures on behalf of a given household, whether
paid for by the government or by an insurance company or by the household
itself, are incorporated into the calculation.
According to Hall's analysis, a household that entered adulthood in 1960that
is, people now in their mid-60swill have devoted about 30% of their
pre-retirement resources to health, retirement, and education, with 16%
going to health, 8% to education, and 6% to retirement. The 30% devoted
to health is a substantial fraction, but it pales in comparison to the
expenditures that are projected for future generations.
For example, consider a household entering adulthood in 2001. This household,
according to Hall's projections, can expect to spend a total of 52% of
its pre-retirement resources35% on health, 14% on education, and
3% on retirement. (The reason the fraction of pre-retirement resources
going to retirement is smaller than for the earlier generation is that
high medical and education expenditures limit consumption, so that the
modest labor income received by a typical retired couple is enough to
finance most of its consumption.)
The projections for the generation born in 2003 and reaching adulthood
in 2025 are even more dire. This household could expect to spend 56% of
pre-retirement resources on health and 18% on education, so that nearly
75% of pre-retirement resources are devoted to these two categories.
Hall interprets these results as suggesting that existing institutions,
designed to finance health, education, and retirement expenditures equal
to about 30% of a household's pre-retirement resources, are likely to
come under severe strain when asked to transfer more than twice this amount
for future generations. One of the key institutions doing these transfers,
of course, is the federal government.
The fiscal problem of the 21st century, then, is this: Under current
policies, the fraction of resources society devotes to health care appears
likely to rise substantially over the next 50 years. Reasonable projections
suggest that spending on Medicare and Medicaid as a percentage of GDP
may well rise from 3.4% in 2000 to nearly 15% by 2075.
It is far from clear how our existing institutions can deal with this
projected increase. Tax revenue as a share of GDP has averaged around
18% since 1950, and a rise to 25% or more by 2050 is one option. Alternatively,
the current policies governing the Medicare, Medicaid, and, to a lesser
extent, Social Security programs may be forced to change.
At the moment, existing economic research does not offer clear guidance
as to which of these alternatives is more desirable, or whether some other
alternative is better. In recent decades, society has reaped enormous
gains from its health spending. In the United States in 1950, life expectancy
at birth was 68.2 years, and by 1990 it was up to 75.4 years. Standard
economic analysis suggests that the economic value of these gains in life
expectancy far exceed the cost in terms of health expenditures (for example,
see Jones 2001). If similar returns to future spending could be expected,
perhaps the projected rise in federal health spending is desirable, and
a substantial change in taxes as a share of GDP will be needed. Alternatively,
of course, perhaps Medicare and Medicaid will need to be reformed to bring
projected spending back in line with a lower tax share. A goal of future
research is to help clarify the difficult decisions that society will
face in coming decades.
Charles I. Jones
Associate Professor, UC Berkeley,
and Visiting Scholar, FRBSF
[URLs accessed September 2003.]
Hall, Robert E. 2003. "The Unbearable
Forward Burden: Health, Education, and Retirement." Mimeo. Stanford
University (February 18).
Jones, Charles I. 2001. "The
Economic Return to Health Expenditures." FRBSF Economic Letter
2001-36 (December 14).
U.S. Congress. Congressional Budget Office.
2002a. A 125-Year
Picture of the Federal Government's Share of the Economy, 1950
to 2075. Long-Range Fiscal Policy Brief No. 1 (June 14, revised July 3).
U.S. Congress. Congressional Budget Office.
2002b. The Looming
Budgetary Impact of Society's Aging. Long-Range Fiscal Policy
Brief No. 2 (July 3).