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Old 02-15-2020, 07:00 PM
UltraVires is online now
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Why can't we balance the budget by simply limiting its growth?


I know that 1995 called and wants its GOP argument back. But it seems very sensible and I hope we can have this debate without too much partisan sniping. So I am looking at these numbers:

https://www.whitehouse.gov/omb/historical-tables/ (Sorry, it is Table 1.1 and requires an Excel download).

If we look at 2007 outlays you get approximately $2.7 trillion dollars. If you adjust that for inflation using this calculator: (https://westegg.com/inflation/) it is approximately $3.6 trillion in 2019 dollars. That is what the government received in 2019.

So, guess what ladies and gents? If the government since 2007 had simply increased its spending relative to inflation and no more, the budget is balanced in 2019 even including Trump tax cuts, Obamacare subsidies, and increased defense spending.

Again, I don't want a partisan argument. Maybe we raise taxes and enact UHC. Maybe we lower taxes and cut defense spending. Maybe we raise taxes and pay down debt. Maybe we lower taxes and cut social spending. All of these are arguments for other threads.

My proposition, up for debate, is that the government should balance its budget by only increasing spending relative to inflation and the deficit is solved. What unforeseen problems am I missing with this admittedly simplistic argument?
  #2  
Old 02-15-2020, 07:02 PM
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Oops. The budget is not balanced if we include increased defense spending and Obamacare. *smack. That represents increased spending, sorry. But my point stands. Spending is only increased by the rate of inflation. Budget solved.

Last edited by UltraVires; 02-15-2020 at 07:04 PM.
  #3  
Old 02-15-2020, 08:32 PM
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My opinion based on 20 years of observation:

The more that government spends, the more that becomes "necessary." As a small example, witness the detailed statistics that the government collects on the economy. That collection is only a few decades old. For well over a century, the government and the country got along just fine without knowing all those figures. But if anybody proposed cutting out the spending to collect those statistics, there would be howls of outrage from industry, from economists, from business groups, and probably other quarters as well.

Between various lobbies that will fight to the death to keep government money flowing their way; and the segment of the populace, who, when anything bad happens at all, their first reaction is, "There outta be a law!"; and politicians who hardly ever met a government spending program that they didn't like--the higher that government spending rises, the higher the "acceptable baseline" ratchets up.

Thus, only a sustained, determined effort will make any reduction, no matter how slight--not necessarily in actual spending, but rather in the increase in spending.
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Old 02-15-2020, 08:59 PM
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What unforeseen problems am I missing with this admittedly simplistic argument?
The world changes. Those changes affect what is needed to meet the goals underlying the spending.

We are part way through the baby boomers hitting Medicare and Social Security eligibility. It overlaps the period you used and spending under those programs will continue to increase for about a decade. Do we cut their benefits to avoid paying out more or cut other programs to avoid increasing overall outlays?

During recessions government spending goes up as more people draw on social safety net programs. Cutting other spending to pay for that, or raising taxes in the trough of the business cycle, may worsen the recession or slow recovery. Your proposal would also tie the governments hands to do things like temporarily increase eligibility for unemployment payments. I worry your proposal may make the negative effects of the normal business cycle more extreme.

How to measure and implement it is also an issue. We make budgets based on estimates of cost and tax revenue. Are we good for the year even if the economic environment changes and the estimates change? If we aren't we could be implementing a system that creates great uncertainty about government spending late in the fiscal year. That could create greater inefficiency in government spending as we go through quarterly feast and famine periods. It is also incredibly damaging to long term projects and contracting when we tie things that tightly to current economic performance. "Ooops the Wuhan coronavirus caused a global economic slowdown we didn't guess. That half research project or building project just got canceled." There is a reason that the Congressional Budget Office uses decade long estimates for costs to help average out the short term blips.

Then there are the issues caused by balancing the budget. Issuing debt is part of our overall monetary system. Treasury bills are the legislatively mandated investment for surpluses in Social Security. There actually were some problems related to the couple of years in the Clinton admin where we had a surplus. We need to take a good hard look at all the implications before Treasury is not issuing bonds.

Last edited by DinoR; 02-15-2020 at 09:02 PM.
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Old 02-15-2020, 09:15 PM
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Let's see. Government axes financial regulations and allows un-indicted co-conspirators to nuke the global money system. Follow-up government must spend terabucks to keep the national and global economies from collapsing and provoking widespread calamity. Budget increases tied only to inflation can handle that situation, how?
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Old 02-15-2020, 09:21 PM
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Again, I don't want a partisan argument. Maybe we raise taxes and enact UHC. Maybe we lower taxes and cut defense spending. Maybe we raise taxes and pay down debt. Maybe we lower taxes and cut social spending. All of these are arguments for other threads.

My proposition, up for debate, is that the government should balance its budget by only increasing spending relative to inflation and the deficit is solved. What unforeseen problems am I missing with this admittedly simplistic argument?
Why do you want a balanced budget? Why do you want a budget at all? There's no "unforeseen problems" with your argument, since you've declared that you don't want to discuss any of the issues that real budget politics are about.
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Old 02-15-2020, 09:38 PM
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We are part way through the baby boomers hitting Medicare and Social Security eligibility. It overlaps the period you used and spending under those programs will continue to increase for about a decade. Do we cut their benefits to avoid paying out more or cut other programs to avoid increasing overall outlays?
To put a finer point on this. Letís say in 2007, there were 10 million Social Security recipients drawing $10,000 a year.

Then, in 2020, letís say there are 20 million people eligible for Social Security. Under the UltraVires plan, shall they only receive $5,000 a year (in constant dollars)?
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Old Yesterday, 01:53 AM
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My proposition, up for debate, is that the government should balance its budget by only increasing spending relative to inflation and the deficit is solved. What unforeseen problems am I missing with this admittedly simplistic argument?
Even if this makes sense, which it doesn't, wouldn't you have to raise the budget both with inflation and with population growth? Not just for Medicare, but for everything.
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Old Yesterday, 05:25 AM
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... Spending is only increased by the rate of inflation. Budget solved.
How about increases in population? Do you think a country of 3 million needs to spend more than a country of 2 million? Regardless of the inflation rate?

How about increases in productivity? If this point isn't clear: Does a country with 6-lane asphalt roads need to spend more maintaining them than one with dirt trails? America's GDP today is 50% higher than it was at the end of the Bush-43 years. That's Fifty percent. With an F.

Is SocSec spending on retirees included in your "spending"? Should a country with 35 million people 65 years or older spend no more for their retirement entitlements than it spent when there were only 25 million old people?

Answer these questions. Then we'll reconsider OP.
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Old Yesterday, 05:59 AM
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It seems appropriate to exclude spending like SocSec which Congress has covenanted to pay workers who paid into SocSec. Similarly the ever-mounting interest payments on the Bush and Trump debt bubbles is not discretionary.

So how has discretionary spending varied in recent decades? For a source, I turn to Whitehouse.Gov:

Quote:
Originally Posted by https://www.whitehouse.gov/wp-content/uploads/2020/02/hist_fy21.pdf
Discretionary spending, as a percent of GDP, fell substantially ... from 9.3 percent in 1987 to 6.0 percent in 1999 [of which 2.9% was "discretionary defense"] . Over the following decade, discretionary spending increased ... to 9.1 percent of GDP [of which 4.6% was "discretionary defense"] by 2010. Discretionary outlays ... were 6.3 percent of GDP [of which 3.2% was "discretionary defense"] in 2019.
So, using figures from the current White House, from 1999 to 2019 there has been an additional 0.3% (per GDP) of discretionary spending, all of which was for the military. (Please note that VA benefits to our ever-growing numbers of shell-shocked soldiers is included as NON-defense discretionary spending.)

@ OP - Does this help?
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Old Yesterday, 08:01 AM
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As others have noted, you need to look at per-capita effects of spending. Maintaining a constant defence budget while the population of the defended increases probably doesn’t have any per-capita effect. Maintaining retirement or health care spending while the population both increases and becomes older means that you’re reducing per-capita spending while also delivering less benefits to the recipients than their predecessors. (In other words, even if the overall US population was not increasing, but the percentage of elderly was growing, maintaining constant individual retirement and health benefits would mean that total costs would still rise.) Other government spending programs will have mixed per-capita requirements. It takes more resources to manage a population of 330 million than 300 million. You may not need 10% more roads, but if traffic increases by 10%, you probably want to increase your road maintenance budget and the number of buses.

Another factor is that government spending is part of the economy. You can’t assume that economic growth would be the same whether the government spent $3.6 trillion or $4.8 trillion. The cost effect is obvious, but that extra $1.2 trillion in spending provides economic stimulus that does drive the revenue side of the budget. Some of that spending should be considered investment, where the long term benefits exceed the near term costs.

Interest rates also need to included in your model and not just inflation. Right now, debt is cheap because interest rates are so low. Even so, the US government expects to spend $378 billion on interest payments in 2020. https://www.thebalance.com/u-s-feder...akdown-3305789 If interest rates go up, overall spending will go up even if all other spending levels are maintained or reduced. Some economists would actually like interest rates to go up, as the economy has been doing well for a long time and lowering interest rates are one of the easy way of stimulating the economy when it takes a downturn. Right now, the US only has a limited ability to take that action.

A fourth factor is that governments like to spend money to get the economy out of trouble, but also like to spend money, or reduce taxes, when they have a surplus. Over the long term, a steady tax and spend policy would be level across the booms and busts of the economy. However governments aren’t very good about saving for a rainy day, whether it’s in terms of keeping the proceeds from the good times (or more realistically paying down debt), or pursuing more constrained fiscal policies.

Having said that, your basic idea is correct. Over the long term, per capita tax revenues should rise as technological improvements lead to increased productivity which leads to economic growth, so long as tax policy remains consistent. If per capita spending increases at a slower rate than revenues, eventually the US budget deficit, and then more eventually the US national debt, will be eliminated. But it will take a long time and steady, stable fiscal policy. Given the current picture of US federal politics, I think you may have to wait a few years for that.
  #12  
Old Yesterday, 09:43 AM
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Originally Posted by UltraVires View Post
I know that 1995 called and wants its GOP argument back. But it seems very sensible and I hope we can have this debate without too much partisan sniping. So I am looking at these numbers:

https://www.whitehouse.gov/omb/historical-tables/ (Sorry, it is Table 1.1 and requires an Excel download).

If we look at 2007 outlays you get approximately $2.7 trillion dollars. If you adjust that for inflation using this calculator: (https://westegg.com/inflation/) it is approximately $3.6 trillion in 2019 dollars. That is what the government received in 2019.

So, guess what ladies and gents? If the government since 2007 had simply increased its spending relative to inflation and no more, the budget is balanced in 2019 even including Trump tax cuts, Obamacare subsidies, and increased defense spending.

Again, I don't want a partisan argument. Maybe we raise taxes and enact UHC. Maybe we lower taxes and cut defense spending. Maybe we raise taxes and pay down debt. Maybe we lower taxes and cut social spending. All of these are arguments for other threads.

My proposition, up for debate, is that the government should balance its budget by only increasing spending relative to inflation and the deficit is solved. What unforeseen problems am I missing with this admittedly simplistic argument?
I think the Demographics of retirement and SS/Medicare make this impossible to actually carry out. The cost of healthcare itself, if we limited that to inflation, would still get swamped by more and more people being qualified for Medicare, etc.

Last edited by survinga; Yesterday at 09:43 AM.
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Old Yesterday, 10:21 AM
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[snip] the higher that government spending rises, the higher the "acceptable baseline" ratchets up.
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Originally Posted by septimus View Post
It seems appropriate to exclude spending like SocSec which Congress has covenanted to pay workers who paid into SocSec. Similarly the ever-mounting interest payments on the Bush and Trump debt bubbles is not discretionary.
Thank you for helping to prove my point. You clearly feel that once the government starts spending money on something, that that spending (by and large) is no longer open for debate. It must continue in perpetuity. Thus government spending can only increase, and never decrease.

This is a very common attitude, as shown by the ludicrous practice of calling entitlement spending "non-discretionary."
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Old Yesterday, 10:37 AM
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Do you feel like the government could just cut social security payments by 10% and that would be okay? People were promised those payments. They paid into the system.
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Old Yesterday, 03:20 PM
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Originally Posted by septimus
It seems appropriate to exclude spending like SocSec which Congress has covenanted to pay workers who paid into SocSec. Similarly the ever-mounting interest payments on the Bush and Trump debt bubbles is not discretionary.
Thank you for helping to prove my point. You clearly feel that once the government starts spending money on something, that that spending (by and large) is no longer open for debate. It must continue in perpetuity. Thus government spending can only increase, and never decrease.
The outgo from the SocSec Trust Fund is very close in size to that Fund's income. In you plan, does USG continue to collect payroll taxes? And if not, with the outgo and income balancing, destruction of SocSec becomes a "wash" ó what's the rub?

And you quote mention of interest on the debt. In your plan do you stop paying that?
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Old Yesterday, 04:15 PM
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I haven't abandoned the thread. I am considering all of the posts and trying to figure it out...
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Old Yesterday, 04:29 PM
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Here's my initial thought about the population argument. We had approximately 250 million people in 1990. We have approximately 330 million today. https://www.worldometers.info/world-...us-population/ . About a 1/3 increase.

Yet our government outlays went from $1.25 trillion in 1990 ($2.48 trillion in 2019 dollars). If we increase spending by the population growth as well, we should be spending $3.72 trillion. We are spending $4.45 trillion. That would leave us with a deficit of around $300 billion.

And as others have said, an increase in population doesn't raise government costs across the board for things like national defense. This also includes things which should be a temporary blip like the Boomers now being in retirement and collecting Social Security and Medicare.

$4.45 trillion
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Old Yesterday, 06:11 PM
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Do you feel like the government could just cut social security payments by 10% and that would be okay? People were promised those payments. They paid into the system.
Nobody was promised anything, although many people think that they were. The current payments INTO the system by current workers go straight OUT of the system as payments to current retirees. Your payments do NOT sit around in a pile for 30-40 years until you retire. If that's the type of plan that you want, you need to be investing your money.

And legally speaking, Congress can do whatever they want to the system. It is a well-recognized principle that no session of the legislature can bind a future session of the legislature. The power to pass laws is inherently the power to repeal laws.
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Old Yesterday, 06:27 PM
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So, in the interest of reducing the deficit, you advocate we keep payroll taxes but stop payments to current retirees?
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Old Yesterday, 10:33 PM
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. This also includes things which should be a temporary blip like the Boomers now being in retirement and collecting Social Security and Medicare.
So just wait about a decade or two and this blip in spending on seniors will take care of itself. No need to cut spending just because you find yourself in the middle of a temporary blip. Just tough it out, and everything will be fine before you know it.
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Old Yesterday, 11:22 PM
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... The current payments INTO the system by current workers go straight OUT of the system as payments to current retirees. Your payments do NOT sit around in a pile for 30-40 years until you retire. If that's the type of plan that you want, you need to be investing your money.
Oh my. These fallacies have been addressed at least as often as 1≠0.99999... Let's do it One.More.Time.

When you deposit $100 in your bank account and withdraw it a month later, does the bank give you the same $100 bill you gave it? Do life insurance companies or private pensions keep your payments sitting around in a pile for 30-40 years? Or do they work just as SocSec? One Doper, believe it or don't, wanted the SocSec Trust Fund to keep its money in the form of U.S. banknotes, since that's "real money" unlike Treasury bonds.

And, while you're abolishing SocSec, you could at least answer the simple question posed to you:
In your plan, do workers keep paying their payroll taxes as at present, even though retirees are cut off?
If you answer No; that you will cut off both the checks and the paycheck deductions, then explain how that helps balance the "budget." The one more-or-less equals the other.

Please start another thread if "Which political party took Social Security from the independent trust fund and put it into the general fund so that Congress could spend it?" is your confusion, and Googling that right-wing meme doesn't unconfuse you.
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Old Today, 02:22 AM
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Let's keep it simple.

Let's say the United States wants to buy weapons for the Army. How exactly is the United States government supposed to enforce a policy that the price of an M4 Carbine is not subject to inflation? Do they tell Colt Firearms that they must sell the rifles at the same price they cost in 2007? If Colt says they now cost more to manufacture, do you force them to sell the rifles at a loss? If Colt goes bankrupt, do you force other companies to manufacture the rifles at the price you've set?

Or do you just buy less rifles? Do you tell some soldiers they won't be assigned a rifle? Or do you discharge the soldiers you now can't afford rifles for? Do you expect the remaining soldiers to be capable of the same amount of military strength even though there are now fewer of them?

Figure out some good answers to these questions. Now do the same for everything else the government pays for.
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Old Today, 02:39 AM
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Here's my initial thought about the population argument. We had approximately 250 million people in 1990. We have approximately 330 million today. https://www.worldometers.info/world-...us-population/ . About a 1/3 increase.

Yet our government outlays went from $1.25 trillion in 1990 ($2.48 trillion in 2019 dollars). If we increase spending by the population growth as well, we should be spending $3.72 trillion. We are spending $4.45 trillion. That would leave us with a deficit of around $300 billion.

And as others have said, an increase in population doesn't raise government costs across the board for things like national defense. This also includes things which should be a temporary blip like the Boomers now being in retirement and collecting Social Security and Medicare.

$4.45 trillion
I think you've made a good point about US government spending. It's reasonable for the government to increase spending in line with inflation, to support an increased population, to support an increased number of people receiving social security and Medicare, and to boost the economy during economic downturns. Accounting for all of those, US government spending increases have still blown way past any metric of reasonableness.

I suppose you could consider war spending as a necessary exceptional cost, but even adjusting for that doesn't make the government spending increases look unexcessive. Here's the costs for Afghanistan and Iraq, $975 billion and $1,060 billion (through 2016) respectively:
https://www.forbes.com/sites/niallmc.../#2b6df0321971
https://www.thebalance.com/cost-of-i...impact-3306301

There's no budgetary sign that the US government is worried about the impact of its debt. I'm not sure where/when the debt crisis point will be, but it does seem like the US government is driving towards that point with its foot on the accelerator rather than the brake.
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Old Today, 03:30 AM
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... Accounting for all of those, US government spending increases have still blown way past any metric of reasonableness.
Drat! I knew I should have used a larger font in #9 to counter this disinformation. To keep it simple, heed especially the stats I've painted red.
Quote:
Originally Posted by https://www.whitehouse.gov/wp-conten.../hist_fy21.pdf
Discretionary spending, as a percent of GDP, fell substantially ... from 9.3 percent in 1987 to 6.0 percent in 1999 [of which 2.9% was "discretionary defense"] . Over the following decade, discretionary spending increased ... to 9.1 percent of GDP [of which 4.6% was "discretionary defense"] by 2010. Discretionary outlays ... were 6.3 percent of GDP [of which 3.2% was "discretionary defense"] in 2019.
If the font-size still isn't large enough, please use your browser's Zoom function.
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Old Today, 07:34 AM
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Let's keep it simple.

Let's say the United States wants to buy weapons for the Army. How exactly is the United States government supposed to enforce a policy that the price of an M4 Carbine is not subject to inflation? Do they tell Colt Firearms that they must sell the rifles at the same price they cost in 2007? If Colt says they now cost more to manufacture, do you force them to sell the rifles at a loss? If Colt goes bankrupt, do you force other companies to manufacture the rifles at the price you've set?

Or do you just buy less rifles? Do you tell some soldiers they won't be assigned a rifle? Or do you discharge the soldiers you now can't afford rifles for? Do you expect the remaining soldiers to be capable of the same amount of military strength even though there are now fewer of them?

Figure out some good answers to these questions. Now do the same for everything else the government pays for.
I'm not an economist (obviously) but inflation is a measure of the increase in price of a basket of goods, no? So, if the M4 Carbine, for whatever reason, outpaces the rate of inflation, then other goods should not rise as much as the rate of inflation making it all even out in the end. If it doesn't, then our measure of inflation is wrong.

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Drat! I knew I should have used a larger font in #9 to counter this disinformation. To keep it simple, heed especially the stats I've painted red.

If the font-size still isn't large enough, please use your browser's Zoom function.
I agree with the prior poster. It's cheating to put spending into "discretionary" and "non-discretionary" categories. The government can spend whatever it wants or does not want.
  #26  
Old Today, 07:46 AM
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Oh my. These fallacies have been addressed at least as often as 1≠0.99999... Let's do it One.More.Time.

When you deposit $100 in your bank account and withdraw it a month later, does the bank give you the same $100 bill you gave it? Do life insurance companies or private pensions keep your payments sitting around in a pile for 30-40 years? Or do they work just as SocSec? One Doper, believe it or don't, wanted the SocSec Trust Fund to keep its money in the form of U.S. banknotes, since that's "real money" unlike Treasury bonds.

And, while you're abolishing SocSec, you could at least answer the simple question posed to you:
In your plan, do workers keep paying their payroll taxes as at present, even though retirees are cut off?
If you answer No; that you will cut off both the checks and the paycheck deductions, then explain how that helps balance the "budget." The one more-or-less equals the other.

Please start another thread if "Which political party took Social Security from the independent trust fund and put it into the general fund so that Congress could spend it?" is your confusion, and Googling that right-wing meme doesn't unconfuse you.
But spending is spending and taxes are taxes no matter the legislative label placed on them. This argument only works because a specific tax was assigned to the social spending program called social security.

Why is that important, though? If social security was financed originally through an increased income tax, would that make it less sacrosanct?

How about this. Say some years ago, the neocons introduced a "National Defense Tax" and rationalized that as everyone benefits from a national defense, we will assign everyone who works a 6.2% payroll contribution that is designated for national defense and also require all employers to match that 6.2%. In exchange, people were promised a certain level of military preparedness.

Would it be a good argument against proposed cuts in defense spending that people had already "paid" for it? Would it be a breach of a promise to cut defense spending?

Should we argue that the National Defense Tax and spending program is actually a net positive for the government and that the program is run very well?

Or, as I am arguing, do labels not really matter and overall spending is what is important?
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Old Today, 08:08 AM
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What about paying interest on debt? In your mind, is defaulting an option we should always keep on the table?

As far as social security and Medicaid go, I don't think it's politically possible to cut those--not just because you'd get voted out of office immediately, but because the whole economy would be impacted. We are talking about money old people are currently using to survive. Cut those payments, and what do they do? They can't go get a job. So they move in with family? Die? Same with medical care. There may be tweaks we can make, some amount of means-testing, remove the cap on payroll tax, but we can't just cut social security checks, or remove access to medical care.
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Old Today, 08:22 AM
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What about paying interest on debt? In your mind, is defaulting an option we should always keep on the table?

As far as social security and Medicaid go, I don't think it's politically possible to cut those--not just because you'd get voted out of office immediately, but because the whole economy would be impacted. We are talking about money old people are currently using to survive. Cut those payments, and what do they do? They can't go get a job. So they move in with family? Die? Same with medical care. There may be tweaks we can make, some amount of means-testing, remove the cap on payroll tax, but we can't just cut social security checks, or remove access to medical care.
I'm not saying that this should be unfailingly strict down the entire line, and some years may rise higher than others and some years lower than others. Further, my overall plan didn't suggest "cuts" at all. Spending increases in line with inflation.

If you got $10,000 this year and got $10,200 next year, if you weren't starving or moving in with family or dying this year, then you won't next, at least not because of the spending increase in line with inflation.

Maybe X costs way more this year but Y costs way less but Z is in line with inflation. X+Y+Z should = inflation, at least in the near term. If not, then we are measuring inflation wrong.
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Old Today, 08:54 AM
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But inflation assumes all things being held equal. So that only works if you hold medical care static. The cost of medical care has gone up way in excess of inflation, because it has profoundly changed. The same with the military--the military we have now is not the military we had in 1980, so you can't use inflation to measure what it "should" cost. .

It's not possible to tell people "once you hit 65, you won't have access to any developments in medicine". Medical costs just aren't connected to inflation because the product itself is changing. So if you want to put discretionary and non-discretionary in the same pool, it means that other spending will have to be cut. Because inflation is never going to measure changes in medical costs.

We can have other discussions about ways to cut medical costs. But inflation just isn't relevant.
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Originally Posted by Manda JO View Post
But inflation assumes all things being held equal. So that only works if you hold medical care static. The cost of medical care has gone up way in excess of inflation, because it has profoundly changed. The same with the military--the military we have now is not the military we had in 1980, so you can't use inflation to measure what it "should" cost. .

It's not possible to tell people "once you hit 65, you won't have access to any developments in medicine". Medical costs just aren't connected to inflation because the product itself is changing. So if you want to put discretionary and non-discretionary in the same pool, it means that other spending will have to be cut. Because inflation is never going to measure changes in medical costs.

We can have other discussions about ways to cut medical costs. But inflation just isn't relevant.
But doesn't that apply to a lot of things, though?

The TV I bought in 1999 is about the same price, adjusted for inflation, that I would buy today. But the TV I get today is far superior, not even close really, than the one I bought in 1999.

The laptop I bought in 2016 is far superior and costs less in real dollars than the desktop computer and monitor I bought in 2002.

Maybe medical care is unique. I'm not sure, and I really do come to this board to learn and also debate. My opinion is not fixed. However, it seems to me that medical care, from the dawn of civilization to the present could be grouped in five categories at any moment in time: 1) Piss Poor, 2) Below Average, 3) Average, 4) Above Average, 5) The Best of the Best.

I fail to see why any of these categories should rise above the cost of inflation. Yes, we can have debates and make policy choices on what level of care that a particular citizen, any citizen, or all citizens should have, but the costs shouldn't be out of whack with inflation even as technology advances.
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