The progressive case for Social Security and Medicare reform

Social Security and Medicare finances are headed for a reckoning.

社会保障和医疗保险的财务状况即将得到清算。

Social Security has run an annual deficit since 2010, and its trust fund is projected to become insolvent by 2032.

自 2010 年以来，社会保障每年都出现赤字，其信托基金预计到 2032 年将资不抵债。

1 The Medicare Part A trust fund is projected to follow in 2033.

1 Medicare A 部分信托基金预计将于 2033 年推出。

2 Trust fund accounting may sound like a green eyeshade technicality, but it is only one symptom of the broader unsustainability of both programs.

2 信托基金会计听起来像是一个绿色眼罩的技术细节，但这只是这两个计划更广泛的不可持续性的一个症状。

Clearly, something has to give—before these shortfalls drive the federal debt to a projected 240% of GDP within thirty years and push interest costs high enough to consume a majority of annual tax revenue.

显然，在这些短缺导致联邦债务在三十年内达到预计 GDP 的 240% 并将利息成本推高到足以消耗大部分年度税收之前，必须做出一些让步。

6 Both parties created this unsustainable path, repeatedly expanding Social Security and Medicare benefits well beyond available revenues while failing to account for longer lifespans, fewer workers per retiree, and rising health care costs.

6 双方都创造了这条不可持续的道路，一再将社会保障和医疗保险福利扩大到远远超出可用收入的范围，却没有考虑到更长的寿命、每个退休人员更少的工人以及不断上升的医疗保健成本。

Nor has either party offered a solution.

双方也都没有提出解决方案。

Republican lawmakers take new taxes off the table, while President Trump opposes any benefit reductions.

共和党议员取消了新税收的讨论，而特朗普总统则反对任何福利削减。

Democratic leaders take benefit changes off the table while pledging to limit new taxes to the wealthiest families and corporations.

民主党领导人放弃了福利改革，同时承诺限制对最富有的家庭和企业征收新税。

Neither side will admit that reining in these costs will require both reductions in scheduled benefits and new broad-based taxes.

双方都不会承认控制这些成本将需要减少既定福利和新的基础广泛的税收。

This report aims to show that Social Security and Medicare sustainability reforms can be designed within progressive principles of protecting low-income seniors and promoting income redistribution down the income ladder.

本报告旨在表明，社会保障和医疗保险可持续性改革可以在保护低收入老年人和促进收入阶梯下的收入再分配的渐进原则范围内进行设计。

Specifically, it shows that:

具体来说，它表明：

While the “just tax the rich” approach remains popular among progressives, the notion that it alone can close all or even most of a thirty-year, $157 trillion shortfall collapses under scrutiny.

虽然“只对富人征税”的做法在进步人士中仍然很流行，但仅靠它就能弥补 30 年 157 万亿美元缺口的全部甚至大部分的想法在审查下崩溃了。

Mathematically, even seizing every dollar of billionaire wealth or taxing millionaires at 100% tax rates would fall short.

从数学上讲，即使没收亿万富翁财富的每一美元或以 100% 的税率对百万富翁征税，也是不够的。

7 Economically, marginal rates on top earners can rise only so far before the resulting economic and incentive effects begin to erode revenue.

7 从经济上看，高收入者的边际税率只能上升到一定程度，否则由此产生的经济和激励效应就会开始侵蚀收入。

And politically, for nearly a century even unified Democratic governments have proven unable to enact substantial upper-income tax increases outside of major wars—a constraint likely to persist as Democrats increasingly represent the highest-earning regions, such as California and New York.

在政治上，近一个世纪以来，即使是统一的民主党政府也被证明无法在重大战争之外大幅提高高收入者的税收——随着民主党越来越多地代表加州和纽约等收入最高的地区，这一限制可能会持续存在。

Taxing the rich belongs in any sustainability plan, but it cannot spare middle-class taxpayers or other spending programs from bearing much of the cost.

对富人征税属于任何可持续发展计划，但它不能让中产阶级纳税人或其他支出计划承担大部分成本。

Given these constraints, continuing to give retirement benefits for (often wealthy) seniors the first claim on federal revenue will force other priorities—poverty relief, education, health care, climate, childcare, family leave, and infrastructure—to compete for a shrinking pot of remaining tax dollars.

考虑到这些限制，继续向（通常是富有的）老年人提供退休福利是联邦收入的首要要求，这将迫使其他优先事项——扶贫、教育、医疗保健、气候、儿童保育、探亲假和基础设施——争夺日益缩水的剩余税收。

Progressives can instead protect the poorest seniors, rein in benefits for wealthier ones, and reserve most new tax increases for those other priorities.

相反，进步人士可以保护最贫困的老年人，限制较富裕老年人的福利，并将大部分新的增税保留给其他优先事项。

This part dissects Social Security and Medicare’s projected three-decade cash shortfall of $157 trillion and the mathematical inability of taxing the rich or slashing lower-priority spending to close such a large fiscal gap.

本部分剖析了社会保障和医疗保险预计未来三年将出现 157 万亿美元的现金短缺，以及通过向富人征税或削减较低优先级支出来弥补如此巨大的财政缺口的数学计算能力。

Instead, leaving senior benefits unreformed will inevitably drive up middle-class taxes and force significant cuts to popular social programs.

相反，不改革高级福利将不可避免地推高中产阶级的税收，并迫使大众社会项目大幅削减。

While Social Security and Medicare finances often inspire passionate political arguments, they are not well understood by the public.

尽管社会保障和医疗保险财务经常激发激烈的政治争论，但公众并没有很好地理解它们。

Social Security was originally sold as pure social insurance, a zero-net-cost federal program in which workers would pay payroll taxes during their career and then collect those dollars at retirement.

社会保障最初作为纯粹的社会保险出售，这是一项零净成本的联邦计划，工人在职业生涯中缴纳工资税，然后在退休时领取这些美元。

Medicare, enacted three decades later, was often seen as similarly structured.

三十年后颁布的医疗保险通常被认为具有类似的结构。

This narrative was never accurate.

这种叙述从来都不准确。

Social Security immediately began paying benefits to seniors who had never contributed significant payroll taxes (because the system had not existed during their working years), and benefit levels were never limited to an individual’s tax contributions.

社会保障立即开始向从未缴纳过大量工资税的老年人支付福利（因为该制度在他们的工作期间不存在），并且福利水平从来不限于个人的纳税额。

And despite a popular myth suggesting otherwise, Social Security can and does run significant budget deficits, as described in the appendix.

尽管有一个流行的神话表明情况并非如此，但社会保障可以而且确实存在巨大的预算赤字，如附录中所述。

On the Medicare side, only Part A (hospital insurance) benefits were tied to earlier payroll taxes.

在医疗保险方面，只有 A 部分（医院保险）福利与之前的工资税挂钩。

By contrast, Medicare Part B (physician care) and Part D (drug coverage) function not as social insurance, but rather as traditional welfare policies.

相比之下，医疗保险 B 部分（医生护理）和 D 部分（药物承保）并不是社会保险，而是传统的福利政策。

Seniors sign up at retirement, pay (typically) 25% of the Medicare Parts B and D premiums, and then taxpayers pay the remaining 75%.

老年人在退休时注册，（通常）支付 Medicare B 部分和 D 部分保费的 25%，然后纳税人支付剩余的 75%。

8 None of those Part B and D benefits are “earned” with earlier payroll taxes.

8 B 部分和 D 部分的福利均不是通过之前的工资税“赚取”的。

Because current payroll taxes fund current beneficiaries (rather than being saved in any fund), Social Security and Medicare Part A can remain financially stable only by maintaining a healthy ratio of workers to retirees, a sufficient payroll tax rate, and lifetime benefits that do not expand beyond the system’s financial resources.

由于现行工资税为当前受益人提供资金（而不是保存在任何基金中），因此社会保障和医疗保险 A 部分只有通过保持健康的工人与退休人员比例、足够的工资税率以及不超出系统财务资源的终身福利，才能保持财务稳定。

While payroll tax rates have gradually risen to 12.4% for Social Security and 2.9% for Medicare, benefit costs have grown significantly faster than revenues and the broader economy.

虽然社会保障的工资税率逐渐上升至 12.4%，医疗保险的工资税率逐渐上升至 2.9%，但福利成本的增长速度明显快于收入和整体经济的增长速度。

The first reason is demographics.

第一个原因是人口统计。

Since 1976, the share of Americans ages 65 and older has leaped from 10.5% to 18.8%—on its way to a projected nearly 24% in 2056.

自 1976 年以来，65 岁及以上的美国人所占比例已从 10.5% 跃升至 18.8%，预计到 2056 年将增至近 24%。

9 This has been driven by 77 million retiring baby boomers as well as expanding lifespans.

9 这是由 7700 万婴儿潮一代退休以及寿命延长推动的。

10 Among the generation that reached age 65 in 1950, only about 61% of those who had survived to adulthood went on to reach 65, and those who did lived an average of 14.7 more years.

10 在 1950 年年满 65 岁的一代人中，只有约 61% 的人能够活到 65 岁，而那些活到成年的人平均多活了 14.7 岁。

11 For the generation reaching 65 in 2030, average life expectancy at 65 rises to roughly 20.8 years—about six more years of benefits.

11 对于 2030 年年满 65 岁的一代人来说，65 岁的平均预期寿命将增至约 20.8 岁，即多享受约 6 年的福利。

12 And survival to retirement is far higher: under today’s mortality rates, about 84% of 21-year-olds reach 65.

12 退休后的生存率要高得多：按照当今的死亡率，大约 84% 的 21 岁年轻人活到 65 岁。

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While expanded life spans are obviously good news, this means the share of workers supporting each retiree—5.1 in 1960—has fallen to 2.6 in 2026, heading toward 2.0 over the next several decades.

虽然寿命延长显然是个好消息，但这意味着供养每位退休人员的工人比例（1960 年为 5.1）已降至 2026 年的 2.6，并在未来几十年内朝着 2.0 的方向发展。

14 This approximate 2-to-1 ratio means that, on average, each working-age married couple would have to support the Social Security and Medicare benefits of their own retiree—on top of typical family expenses like housing, childcare, and student loan repayments.

14 这一大约 2 比 1 的比例意味着，平均而言，每对工作年龄的已婚夫妇除了住房、儿童保育和学生贷款偿还等典型家庭开支外，还必须支持自己退休人员的社会保障和医疗保险福利。

Moreover, at least 30% of the generation reaching 66 today will live to age 90—and thus spend one-third of their adult lives collecting taxpayer-funded Social Security and Medicare benefits.

此外，如今年届 66 岁的一代人中，至少有 30% 将活到 90 岁，因此他们成年后三分之一的时间都在领取纳税人资助的社会保障和医疗保险福利。

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These demographic challenges are supplemented by the additional challenge of notably rising per-capita benefits and costs.

这些人口挑战还伴随着人均效益和成本显着上升的额外挑战。

Within Social Security, as mentioned earlier, the wage-indexing of initial benefit formulas results in inflation-adjusted Social Security benefit levels growing more generous for each successive generation.

在社会保障中，如前所述，初始福利公式的工资指数化导致通货膨胀调整后的社会保障福利水平对于每一代人来说都变得更加慷慨。

Within Medicare, per-capita health care costs have typically grown faster than inflation as well as the rate of economic growth, forcing the government to incur significantly rising costs over time just to provide the same benefits to a demographically similar population.

在医疗保险范围内，人均医疗保健成本的增长速度通常快于通货膨胀以及经济增长率，迫使政府随着时间的推移而承担大幅上升的成本，只是为了向人口结构相似的人口提供相同的福利。

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These factors explain why the typical-earning married couple retiring at age 65 in 2025 will receive Social Security and Medicare benefits that together exceed their lifetime contributions by more than 50%—even after adjusting to net present value.

这些因素解释了为什么到 2025 年 65 岁退休的典型收入已婚夫妇将获得的社会保障和医疗保险福利加起来超过他们终生缴款的 50% 以上——即使在调整净现值之后也是如此。

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17 号

Throughout the 1980s and 1990s, Social Security and Medicare had a combined federal budget imprint that was relatively neutral.

在整个 20 世纪 80 年代和 90 年代，社会保障和医疗保险的联合联邦预算印记相对中性。

Social Security ran annual surpluses that were approximately offset by Medicare’s annual shortfalls, which primarily resulted from Medicare Part B’s reliance on general revenues.

社会保障年度盈余大约被医疗保险年度短缺所抵消，这主要是由于医疗保险 B 部分对一般收入的依赖。

Then, in the 2000s, the baby boomers began retiring and Social Security surpluses were gradually replaced with deficits.

然后，在 2000 年代，婴儿潮一代开始退休，社会保障盈余逐渐被赤字取代。

Medicare shortfalls also began rising steeply due to those retirements, rising health care costs, and the 2003 enactment of Medicare Part D.

由于退休、医疗保健成本上升以及 2003 年 Medicare D 部分的颁布，Medicare 缺口也开始急剧上升。

By 2026, Social Security and Medicare’s combined annual shortfall has soared to 2.7% of GDP.

到 2026 年，社会保障和医疗保险的年度缺口合计已飙升至 GDP 的 2.7%。

18 Specifically, Social Security and Medicare are estimated to take in a combined $1,882 billion in dedicated revenues and spend $2,729 billion on benefits and interest.

18 具体而言，社会保障和医疗保险的专用收入预计总计为 18,820 亿美元，福利和利息支出为 27,290 亿美元。

The resulting $847 billion cash shortfall is responsible for nearly half of the estimated $1.8 trillion budget deficit.

由此产生的 8,470 亿美元现金短缺占估计 1.8 万亿美元预算赤字的近一半。

And even this figure understates Social Security and Medicare’s burden by excluding the share of rising federal interest spending that is directly attributable to these systems’ growing contribution to the federal debt.

即使这个数字也低估了社会保障和医疗保险的负担，因为它排除了联邦利息支出增加的份额，而联邦利息支出的增加直接归因于这些系统对联邦债务的贡献不断增加。

The aging of the population, automatic benefit increases, and rising health care costs are projected to continue driving up Social Security and Medicare’s annual shortfalls.

人口老龄化、自动福利增加和医疗保健成本上升预计将继续推高社会保障和医疗保险的年度缺口。

By 2036, Social Security and Medicare are projected to bring in $2,793 billion in payroll taxes and related revenues yet cost $4,717 billion in benefits plus $813 billion in resulting interest costs—for a total annual shortfall of $2,737 billion, or 5.9% of the economy.

到 2036 年，社会保障和医疗保险预计将带来 27,930 亿美元的工资税和相关收入，但福利成本为 47,170 亿美元，加上由此产生的利息成本 8,130 亿美元，年度缺口总额为 27,370 亿美元，占经济的 5.9%。

19 Over three decades, Social Security and Medicare face a projected cumulative shortfall of $157 trillion, 20 with the annual shortfall reaching 12.4% of GDP by 2056.

19 三十年来，社会保障和医疗保险预计将面临 157 万亿美元的累计缺口，20 到 2056 年，年度缺口将达到 GDP 的 12.4%。

21 These cash shortfalls (including resulting interest costs on the debt) total $109 trillion for Medicare and $48 trillion for Social Security.

21 医疗保险现金短缺（包括由此产生的债务利息成本）总计 109 万亿美元，社会保障现金短缺 48 万亿美元。

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If not for Social Security and Medicare’s staggering cash shortfalls, the federal budget outlook would appear dramatically better.

如果不是社会保障和医疗保险惊人的现金短缺，联邦预算前景似乎会好得多。

Outside of these two programs, budget deficits over the next three decades are projected to average just 2.8% of GDP under a current policy baseline that assumes a continuation of all current tax cuts and spending levels.

除了这两个计划之外，在当前政策基准（假设继续实行当前所有减税和支出水平）下，未来三十年的预算赤字预计平均仅占 GDP 的 2.8%。

Because deficits of that size would grow more slowly than the nominal economy, they would gradually reduce the federal debt as a share of the economy.

由于这种规模的赤字增长速度将慢于名义经济，因此联邦债务占经济的比重将逐渐减少。

Instead, Social Security and Medicare shortfalls are projected to comprise 77% of total federal budget deficits over the next three decades.

相反，未来三十年，社会保障和医疗保险缺口预计将占联邦预算赤字总额的 77%。

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It is fair to ask why Social Security and Medicare should be held to a standard of funding themselves through payroll taxes, premiums, and other dedicated trust fund revenues.

公平地说，为什么社会保障和医疗保险应该遵守通过工资税、保费和其他专用信托基金收入为其自身提供资金的标准。

After all, Medicare Parts B and D are designed to be majority-reliant on general revenues, and virtually no one demands that the Department of Defense, for instance, fund itself outside of general revenues.

毕竟，医疗保险 B 部分和 D 部分的设计主要依赖于一般收入，而且几乎没有人要求国防部等在一般收入之外为自己提供资金。

However, Social Security and Medicare Part A were designed and promoted based on fully funding themselves within these (reasonably generous) dedicated revenue constraints to limit costs and preserve general revenues for other federal priorities.

然而，社会保障和医疗保险 A 部分的设计和推广是基于在这些（相当慷慨的）专用收入限制内充分资助自己，以限制成本并为其他联邦优先事项保留一般收入。

More importantly, the cost trajectory is the problem.

更重要的是，成本轨迹是问题。

If Social Security and Medicare consistently required an outside revenue stream of perhaps 1 or 2% of GDP, such a cost could be reasonably incorporated into the federal budget and financed by other means.

如果社会保障和医疗保险始终要求外部收入流占 GDP 的 1% 或 2%，则此类成本可以合理地纳入联邦预算并通过其他方式融资。

Instead, as a federal budget line item, these general revenue costs have leaped from zero to 2.7% of GDP and are projected to further swell to 5.9% of GDP within a decade and 12.4% of GDP within three decades when including the resulting interest costs.

相反，作为联邦预算项目，这些一般收入成本已从占 GDP 的零跃升至 2.7%，并且预计在 10 年内将进一步升至 GDP 的 5.9%，在 30 年内将占 GDP 的 12.4%（如果包括由此产生的利息成本）。

24 Giving any federal program—including defense—a blank check for such steeply swelling costs is not sustainable.

24 为任何联邦计划（包括国防计划）提供空白支票来应对如此急剧膨胀的成本是不可持续的。

These shortfalls will require some combination of steep tax increases, substantial reductions to other spending programs, or rapidly rising government debt.

要解决这些缺口，就需要大幅增税、大幅削减其他支出计划或迅速增加政府债务。

The result could be a European-level tax burden without the European social benefits for working families.

结果可能是欧洲水平的税收负担，而工薪家庭却没有欧洲的社会福利。