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The authors of this paperlongtime federal budget and policy expertswere drawn together by a deep concern about the nation's long-term fiscal outlook. Despite diverse philosophies and political leanings, they found solid common ground and agree that unsustainable deficits in the federal budget threaten the health and vigor of the American economy and the first step toward establishing budget responsibility is to reform the budget decision process so that the major drivers of escalating deficitsSocial Security, Medicare, and Medicaidare no longer on autopilot. The paper provides specific policy recommendations and outlines the reasons action is critical.