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Since 1998, budgeting reforms at the federal level have unraveled extensively. The budget process has become ad hoc, fragmented, and opaque, balance has been elusive, and the failure to prioritize has become endemic. One cause was the mismatch between the budget process in 1998, which was designed to eliminate deficits, and the emerging budgetary surpluses of that time. A second contributing factor was the desire to reduce taxes while expenditures were increasing as a result of wars and natural disasters. The consequences of this great unraveling include the failure to fund Medicare and Social Security adequately when the opportunity was presented, as well as threats to constitutional and democratic governance. Renewed reform may require greater transparency and a willingness to embarrass elected officials with iconic stories.