Table 2

Programmatic mandatory spending (which excludes net interest and undistributed offsetting receipts) accounts for the largestpart of the growth in total Federal spending as a percent of GDP since the 1950s. Major programs in this category include Social Security, Medicare, unemployment compensation, deposit insurance, and means-tested entitlements (Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income, the refundable portions of a variety of tax credits, including the Earned Income and Child Tax Credits, and other programs subject to an income or asset test). Prior to the start of Medicare and Medicaid in 1966, programmatic mandatory spendingaveraged 5.5 percentof GDP between 1962 and 1965 (less than half the size of total discretionary spending), with Social Security accounting for nearly half. Within a decade, this category was comparable in size to total discretionary spending, nearly doubling as a percent of GDP to 10.3 percent by 1976and remained between 9.4 percent of GDP and 11.4 percent of GDP for the next 30 years.

I know that many readers (especially more liberal readers) believe that Medicare and Social Security do not contribute to the country’s fiscal problems. I’m aware of no reading of the budget that supports that view. Left unchanged, Medicare and Social Security will quite likely create large deficits or require large tax increase or require large cuts to the rest of the federal government.

The CBO has indicated that: "Future growth in spending per beneficiary for Medicare and Medicaid—the federal government’s major health care programs—will be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costs—which will be difficult, in part because of the complexity of health policy choices—is ultimately the nation’s central long-term challenge in setting federal fiscal policy."

Certain entitlement programs, because the language authorizing them are included in appropriation bills, are termed "appropriated entitlements." This is a convention rather than a substantive distinction, since the programs, such as Food Stamps, would continue to be funded even if the appropriation bill were to be vetoed or otherwise not enacted.

As an article in NPR highlighted, lobbyists may target Capitol Hill, but PR folks often swoop in first to “conditioning the legislative landscape”—in other words, shape public perception. Another key difference between lobbying and PR is that lobbyists are required to disclose their activities (subject to the criteria mentioned earlier), while PR specialists are not.

Internal communications (such as relaying the performance of a company to its employees) Communicating the performance of a publicly-traded company (investor relations)