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Hospital executives across America are warily eying the new Congress which will take over the first week in January.  

The House of Representatives is now solidly in GOP control and its members are decidedly more conservative and adamant that the size of government be reduced, that annual budget deficits be eliminated, and that future spending policies be geared to reducing the national debt. That could spell big trouble for hospitals, physicians and other providers since deficit reduction/elimination will require spending cuts, probably including further reductions in Medicare reimbursements.

This nation’s drive toward fiscal responsibility will be tumultuous.  As a nation, shared sacrifice and common good are no longer high on the list of admirable American values. We are also a nation of well-financed special interests which means there will be great temptation for Congress, yet again, to kick the can down the road again.  Except, now that we have already entered the dead-end section of road to fiscal responsibility, we do not have much room to wiggle around. Many economists and political leaders from both parties believe that further delays will only result in a financial crisis of epic proportions.

So how do we cut the spending and avert this crisis?  We talk about sacrifice for the common good, but what does that really mean? Significant reductions in spending will be necessary, but what programs will be affected?

Do you think you can make the tough choices that will be necessary to solve the problem?

The New York Times crafted a budget cutting exercise in its Sunday’s Week In Review Section.  It provides readers with budget cutting alternatives to cut $1.345 trillion from the 2030 budget, the year where many believe that the full impact of baby boomers will be felt in terms of spending on Social Security and Medicare.  The Times scenarios include almost triple the revenue cuts and tax increases needed to solve this mounting financial crisis, allowing you the option to ignore choices you do not want to make.  Of course, Congress will have more alternatives at their disposal, including their now famous creative accounting, but the Social Security surplus which enabled President Clinton to achieve budget surpluses, will be  long gone at that point and Medicare and Social Security will be major contributors to deficit spending.  

Here is the link. Click Here or cut or paste this address in your browser. http://www.nytimes.com/interactive/2010/11/13/weekinreview/deficits-graphic.html.

I was able to do it without capping Medicare spending at GDP plus one percent, but it took deep cuts in spending from other programs, including defense, along with some tax increases. It is important to remember that as I made the tough choices we hear so much about, that I didn’t have any lobbyists or political contributors beating me over the head while I did it.  

Finally, you must remember that these tough choices only limit future annual deficits, they do not address the overall national debt which as of 7:30 AM Monday, November 15 is $13,738,736,868,863.89. If you want to see how much it has increased since this writing, click the U.S. National Debt Clock. And if you want to write a check for your share, they will provide that amount to you as well.  But be warned, it is a depressingly large number.