As America's population ages, the federal budget will be under increasing pressure due to the cost of social programs like Medicare and Social Security.

Medicare Part A Hospital Insurance Trust Fund has been "broke" since 1992 -- that is, the annual operating costs have exceeded income. Part B faces the same fiscal challenge. But bankruptcy is not an option; gaps are met with general budget funding : in effect, a surcharge paid by all taxpayers.

Since 1970 real per-beneficiary Medicare spending has grown at the rate of about 5 percent per year. However, the Trustees made projections in 1999 based on this rate slowing to 1 percent; some believe this is extremely unrealistic.

In 1984, Medicare and Medicaid spending accounted for 9 percent of the federal budget; it was 20 percent of the 2004 budget.

In 1972, health expenditures accounted for less than 8 percent of Gross Domestic Product. In 2002 it jumped to 15 percent and should be about 18 percent by 2012 - long before the full impact of the Baby Boomers is felt.

Politicians on both sides of the aisle realize that the current social programs -- Medicare, Medicaid and Social Security -- are not sustainable. But the political will to do something about the problem is missing. There are basically three choices: reduce payments to providers, shift costs to retirees, or increase taxpayer fees.

Some questions leaders should be asking - and media should be reporting:

• How can Medicare and the health care system each be reformed to make them solvent and sustainable?

• Should programs like Medicare be reformed to make encourage citizens to work longer? If so, what kind of jobs will provide health insurance coverage?
• What are the consequences of employers that cease providing health care benefits to their retirees?