Mr. Day is Vice-president of The Prudential Insurance Company of America.
As the new decade dawned, we saw many predictions of the bold new things needed for the surging population of the sixties. There was mention, of course, of new plants and facilities to provide new jobs, of more homes, and of more new products to go with those homes. But where in another era this awakening to rapid growth ahead might have meant expanded farm output, new rail lines, more steel capacity, and the like—financed in the past by private capital—the top needs now emphasized are highways, schools, airports, rapid transit, water resources, public housing for the elderly, more hospital beds, more capacity in colleges and universities, space research, "closing the missile gap," aid to underdeveloped countries—all of which must be financed in whole or to a predominant degree by public funds.
We are used to hearing it said that even though a certain program might be desirable for adoption by a city, county, or state government, the particular government unit simply can’t afford it. Each of us is familiar with situations where local governments have "made do" with older public buildings, or with something less than perfection in quality of services, pay levels for public employees, and modernization of streets, sewers, and schools.
There have always been those, of course, who insisted the federal government could not afford this or that new or expanded program. But the fact that the federal government can go hugely into debt without voter approval of bond issues (states and cities usually can’t), has made the ceiling on federal spending highly flexible. So on federal spending, those who could make a good case for "desirability" could almost always prevail over those who asked, "Where’s the money coming from?" For the federal money was always forthcoming—even if it meant, as in fiscal 1958-59, a $12 billion deficit in a peacetime year.
Suddenly, at a time when pressure for public spending at all government levels was never greater, the day of reckoning has arrived. Eighty billion dollars of the federal debt must be refinanced in 1960 at a time when 5 per cent federal bonds have appeared on the scene for all to see. All at once we hear about "gold drain" and "deficit in international payment balances" and even "flight from the dollar." Getting federal spending and debt under control is no longer a matter of argument—it is a crystal clear necessity.
Near term federal tax reduction seems less and less a sensible possibility. State and local taxes seem bound to continue their upward climb. The theory that the federal government was going to confine itself to certain kinds of taxation and the state and local governments were going to confine themselves to others, has proved to be just that: a theory. State income taxes (with ever higher rates), school district income taxes, and city payroll taxes are competing for the same net earnings dollar as the federal income tax. And by 1969 the Social Security tax, even to support the program as it now stands, will be 9 per cent of taxable payroll—with half to come from the employee (and not deductible from the employee’s federal income tax).
We have to face up to our total needs for future spending at all levels of government, assign priorities among programs and projects, do some major retrenching in existing public programs to preserve solvency, and then decide whether we can afford to open the door to a vastly expensive, expansive federally financed health care program.
The Forand Bill would amend the Social Security Act to provide broad hospital, nursing home, and surgical benefits for all persons—already 13.7 million—receiving payments from the Social Security program. This group includes not just those men over 65 and women over 62 who are entitled to benefits, but also widows with children under 18, and totally disabled persons entitled to benefits and their beneficiaries.’
1 Editor’s Note: What may have happened with regard to the Forand Bill by the time this article appears in print is anyone’s guess. But there need be no doubt about the economic consequences of any such political measure.
To provide the benefits proposed to the limited group described would cost over $2 billion the first year and between $6 billion and $8 billion by 1980. It would mean that Social Security costs would increase by 26 per cent on a long term basis. Where Social Security will cost nearly 9 per cent of payroll by 1969, just as it now stands, the Forand Bill would bring the over-all cost to 11 per cent of taxable payroll.
What is more, (1) the Forand Bill, if enacted, is bound to be only a "first step" to an enormously expanded and still more expensive federal health care program, (2) invariably these publicly financed health care plans (such as in England and Canada) have cost far more than was estimated when they were proposed, (3) other expensive liberalizations of the Social Security program are in the offing, (4) the Social Security program as it now stands may be so badly underfinanced that major tax increases may be needed just to pay for benefits already promised.
No Further Leeway
Let us face up to another new fact of life that has overtaken us fairly recently. Where in the past our federal government had a large amount of leeway, through deficit spending and increased debt, to conduct a crash spending program in case of war or depression, the leeway is now gone. In view of our situation on federal borrowing difficulties, it is clear we are gambling there will be no international blow-up and no economic blow-up.
If we did have either, the money would have to come from practically confiscatory tax increases superimposed upon the wartime tax levels we have continued into peacetime.
Present-day taxpayers will find it ironic to be told that government financial leeway exists only in still higher federal taxes. But that is the sad fact. And even that weak reed, that inadequate leeway, is being weakened still further by rising Social Security tax rates. Social Security taxes must come out of the same pie (i.e., tax base) as taxes for missiles, federal debt service, highways, schools, city police, county jails, or whatever. For obviously 100 per cent of the public’s earnings is the whole tax source pie: the complete, final, nonexpandable tax base, no matter what the tax or the tax purpose or the taxing entity is called. It doesn’t help to say that Social Security taxes are "special purpose" or "not in the federal budget." Except for a capital levy (an unthinkable device) all taxes, no matter what they are called or where they are budgeted, have to come out of earnings of the public. Many have a mistaken belief that Social Security is a savings plan, with the payroll taxes saved up to provide for the employee’s future benefits. The fact is that Social Security is a pay as you go plan—or, more accurately, an under pay as you go plan.
We have graciously provided that employees of 1969 shall pay a 41/2 per cent rate for the benefits for which employees of 1959 paid 21/2 per cent (3 per cent beginning with 1960).
The Social Security Trust Fund is in fact only a contingency reserve. Some estimates, based on the existing program, say the Trust Fund will be used up entirely by the year 2000. But, big as the Trust Fund seems, it would have to be three times as big as it now is just to pay future benefits to the 13.7 million people already on the benefit rolls. And other tens of millions are qualified to become new recipients in the future.
Already we are postponing the evil day on paying for the present Social Security benefit structure. When it comes to the multibillion dollar addition to the structure proposed by the Forand Bill—we can’t afford it!
A crash attack on the major problems of health suits our impatient culture. But those who might be commissioned to do the research know that it is poor strategy. At present we are more limited by the state of general scientific knowledge than by want of specific instruments or difficulties in engineering… Historically the method of uncommitted wondering has been the source of major ideas. From the confusion of detail general principles emerge—not because they are summoned for some crash program but because they are already latent in the facts that are available… Obviously we, in various specialties, and the public at large have a common interest in seeing that a substantial base of scholarship is supported in its own right and not as an instrument in achieving some popular goal… It may indeed be proven by history that ignorance and folly were greater evils than cholesterol or cancer.
VINCENT P. DOLE, M.D., On Crash Programs