If the GDP grows at 4% or more, and if we use the increased revenue wisely (to reduce the debt), we may survive.
If not, and the debt grows exponentially, we are doomed.
I believe Pres Trump understands this.
But does Congress?
"If" is the biggest word in the English dictionary.
I think medical costs have to be brought under control.
Split most hospitals into two so the US hospital system is generally competitive.
Drug expenditures, at least at the federal level, have to be controlled say by a federal price schedule by drug type and volume. If sellers don’t sign up to the schedule, then patients will get issued purchase orders at the schedule price.
biologic, unique - $500/month/patient
biologic, me too - $400/month/patient
...
breakthrough, chemical - $200/month/patient
....
premiums by volume for unique, breakthrough drugs, to be cumulatively applied:
[for fast financial returns on new drugs]
under $10 million in penultimate year program purchases +50%
under $20 million in penultimate year program purchases +50%
under $50 million in penultimate year program purchases +20%
[for multi-year fast financial returns on newer drugs]
under $50 million in total program purchases +50%
under $100 million in total program purchases +50%
under $1 billion in total program purchases +20%
There would be co-pays by drug type, cut in half for children, Medicaid and under 65 Medicare (i.e. disabled) patients.
Each US licensed medical doctor and pharmacist would get to vote on say $4,000 to be allocated for schedule buy-ins for up to 10 biologic, breakthrough and orphan drugs, pending or approved, of their choice to be made by electronic voting with voted sums shown.
The voting would be done in July. The buy-in would have to be done before the third Friday in August (or 30 days after the drug finally gets approved).