Great fact sheet from Pew Charitable Trust on how we went from a projected surplus in 2001 to our current projected debt situation. A very nice figure summarizes:
About two-thirds of the change was due to policy choices made in the past decade. If we are going to ever have a balanced budget, it will take a mix of tax increases and spending reductions over the status quo as it exists today. In other words, policy choices. There are multiple approaches, and all sorts of plans. Addressing health care costs is a necessary, but not a sufficient condition to ever having a balanced budget. The next step is a political compromise that lets us move ahead.