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"But the official liabilities pale in comparison with the off-book entitlements --

...obligations to pay current and future Social Security, Medicare and Medicaid benefits."

Again, not to belabor a point, but Social Security is in pretty good shape, and I hate to see it forever lumped together with the rest. The cost of medical care in general in this country is what's unsustainable, which makes not only Medicare and Medicaid (which is largely a joke among providers who get stuck with its reimbursement) unsustainable, but private insurance-based health care as well.

When you artificially combine Medicare and Social Security, and project the shortfalls to infinity, which is what this administration did when they were trying to dismantle the latter, you can come up with some outrageous numbers. But I think it's worth remembering in 2000 we also projected a 5.6 trillion dollar surplus over just 10 years. It could be that if we, say, returned to the tax structure of 2000, came up with an effective and transparent regime of reasonable, but real financial regulation, and stopped pissing away hundreds and hundreds of billions on non-solutions to our nation's security and financial problems, we might someday be in that happy situation again.

But that seems unlikely to happen, when an awful lot of unfortunately influential people in this country view any of those actions as some sort of apocalypse. So, yes, we need to do something about medical care in this country- there are plenty of tested models out there that seem to work- but even if we don't, we should still be able to keep Social Security, if we can only stop stealing from it.