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December 2024, Book Chapter: "This paper examines the current US fiscal situation and outlook through eight key questions. It finds that the fiscal trajectory is unsustainable, with deficits and debt projected to rise indefinitely. An adjustment of 0.7 to 4.6 percent of GDP in higher taxes or lower spending is likely needed to stabilize the debt. The consequences of inaction are potentially severe but highly uncertain. The paper reviews possible catalysts for fiscal reform, including shifts in public opinion, legal/accounting events like trust fund exhaustion, or economic pressures. The paper emphasizes that fiscal projections and their economic impacts are highly uncertain. This uncertainty argues for taking some precautionary action soon, while retaining options to adjust course as the outlook evolves. Based on this analysis, the paper recommends targeting primary budget balance (that is, the budget excluding interest) by 2030. The four elements of a framework to achieve this goal are: (1) let the tax cuts expire or replace them with revenue-increasing reform; (2) establish Super PAYGO so that each law slightly reduces the deficit; (3) reform Social Security and Medicare to eliminate their actuarial deficits; and (4) allow limited exceptions for economic and other emergencies."