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option that would ease but not solve the problem is to add more people to the workforce to increase monthly Social Security tax payments. The three large pools of potential new workers are seniors themselves, people with disabilities who can work, and new immigrants. In the late 1990s, I signed two bills that I hoped would encourage more workforce participation. One allowed seniors to enter the workforce without having their own Social Security payments reduced, but they would still pay income and payroll taxes on new earnings. The other allowed people with disabilities to enter the workforce without losing their Medicaid benefits. Previously, when disabled people had to give up Medicaid coverage if they took a job, very few of them could afford to work because their annual health-care costs are often greater than any salary they could earn, and they are uninsurable under employer-provided policies. Now disabled Americans can enter the workforce and contribute payroll taxes to the Social Security fund.

Both Presidents Bush and Obama tried to reform our immigration laws to legalize more immigrants whose earnings would contribute to the Social Security fund. As long as we have a shortage of Americans trained in science, math, and high-tech fields, just increasing the number of well-educated immigrants under the H-1B visa program would help cutting-edge companies grow and add new employees who are American citizens to their workforce. The Obama administration announced a change in immigration policy in August 2011 that is a step in the right direction. Previously, immigrants with special skills, mostly in technology, had to have a specific job offer to get a visa. Now they are eligible if they commit to starting a new business. When they do, they and their employees will pay Social Security taxes.

Of course, these proposals are academic as long as the United States is creating so few jobs, but they’re worth keeping in mind when the economy gets going again, because we need to make some changes in Social Security, and more people contributing to the system means lower burdens in future tax and benefit changes for everyone else.

The long-term health of Social Security is very important. Though most seniors have other sources of income, almost half of them would fall below the poverty line without their monthly Social Security checks. Because everyone recognizes that Social Security has a cash-flow problem, that costs are rising as the number of seniors increases, and that the available options to fix the problem are not too draconian, even the AARP has indicated a willingness to negotiate a long-term solution. If we did, it could reduce the debt by $200 billion or more over ten years.7

EVEN WITH SUBSTANTIAL REDUCTIONS below future projections in nondefense discretionary spending, and savings in the military budget and Social Security, we still won’t be able to balance the budget, because of the growth of health-care spending, led by Medicare and Medicaid, but including the Children’s Health Insurance Program, the Federal Employees Health Benefits Program, the VA system, and the TRICARE system for veterans. Since 1981, overall health-care costs have increased at three times the rate of inflation, although during the 1990s, the spread of managed care and the spotlight the health-care reform effort put on excessive costs kept increases closer to the overall rate of inflation. The cost restraints and the Children’s Health Insurance Program, enacted in 1999, led to the first increase in the percentage of Americans with health insurance in twelve years.

When the large cost increases began again in 2001, the percentage of our citizens without insurance started going up again. Every time this happens, it increases the deficit, because government spending on health care goes up. For example, in 2009, in the depths of the recession, insurance companies raised their rates so sharply that their profits increased 56 percent, while most Americans were worried about going broke. As a result, five million people lost their health coverage,