After the Ballots are Counted, Lawmakers Must Confront Surging Debt

Election Day is right around the corner, and as usual, political ads are everywhere warning Americans of the dire consequences of voting the “wrong way.” Meanwhile, politicos are constantly refreshing prediction market pages to get a sense of where both parties stand heading into Tuesday. The truth is that, regardless of which party controls the House or Senate, there will be a steep uphill battle for the federal government to get its fiscal house in order and address a staggering $40 trillion debt. Members of both parties share the blame for the current cascade of red ink, and both sides will need to work together to get America back into the black.

When the 120^th Congress is sworn in, lawmakers will need to act quickly and decisively to address surging entitlement spending. Social Security, the single most expensive program, costs taxpayers an astounding $1.6 trillion per year. It would be virtually impossible to balance the budget without addressing this costly entitlement. Fortunately, the Taxpayers Protection Alliance’s recently released report “Cutting the Tab: 40 Ways to Reduce America’s Debt” offers a few ideas for reforming this nearly-century-old program. The report notes, “Social Security pays out $100,000 or more per year to the highest earning married couples, and maximum benefits are scheduled to keep rising over time. Proposed by the Committee for a Responsible Federal Budget, the Six Figure Limit would cap combined benefits at $100,000 for couples and $50,000 for individuals claiming at the normal retirement age.”

This landmark change would save taxpayers about $190 billion over ten years. Additionally, lawmakers could switch the program’s Cost-of-Living Adjustment (COLA) from the traditional Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) to the Chained Consumer Price Index (Chained CPI-U), ensuring that annual benefit increases account for “substitution bias”—the idea that consumers buy cheaper alternative goods when prices go up (e.g., buying chicken instead of beef if beef gets too expensive). This change would also save roughly $190 billion over ten years. While no single change will be nearly enough to “fix” enormous entitlement programs such as Social Security, enough incremental changes—backed by some much-needed political will—can stem the surge of red ink.

Reforming Medicare, a federal health insurance program primarily for people who are 65 or older, is also key to solving the nation’s fiscal crisis. The program costs taxpayers an astounding $1 trillion per year, and a few commonsense changes could go a long way toward reining in costs.

For example, under current Medicare rules, the program regularly pays twice for single patient encounters due to overlapping reimbursements for combined clinical services. When a patient receives an evaluation and management (E/M) office visit alongside a procedure with a global surgical period during the same appointment—such as examining a health condition and performing a minor outpatient procedure — providers can bill both services at near-full rates. Although combining these services into a single visit yields significant operational efficiencies for practitioners and added convenience for patients, the current payment structure fails to reflect those shared overhead and labor savings. Consequently, Medicare claims data shows that the program routinely provides duplicate compensation for overlapping clinical work and practice expenses.

To correct this systematic overpayment, CMS proposed a targeted payment adjustment in the calendar (CY) 2027 PFS proposed rule. Under the proposed policy, when an office visit and a procedure subject to a global period are billed for the same patient encounter, Medicare would reimburse the highest-valued service at 100 percent of its fee schedule rate while discounting all additional services billed that day to 50 percent. CMS previously floated a similar policy in the CY 2019 PFS proposed rule but unfortunately opted not to finalize it at the time. Revisiting the issue for CY 2027, the agency explicitly noted that existing billing practices likely duplicate payments across simultaneous services. Lawmakers can build on this laudable effort by working with the agency to track down all duplicate payments and forcing an end to these wasteful practices.

America will not wipe out $2 trillion deficits and a $40 trillion debt tomorrow—with either party in charge. But hopefully, when the dust settles after Election Day, newly elected leadership gets to work tackling this pivotal issue. Future generations of Americans deserve better than endless debt and broken promises.