David Walker, the outgoing comptroller general of the United States, admits he has not studied the health care plans of Sens. Barack Obama and Hillary Clinton, but warns that all politicians make promises they don't want to pay for, and younger generations get stuck with expensive programs and compound interest.

"In my view, it is not prudent to expand health care until you recognize the reality that we have already made $34 trillion in promises that we haven't figured out how we are going to pay for yet," Walker said. He and three other federal budget analysts addressed a crowd of about 350 Wednesday night in the Union Theater as part of the Distinguished Lecture Series.

"If you are going to provide for coverage, you need to do it in conjunction with restructuring the existing promises so we don't end up digging the hole deeper again," said Walker, who led the U.S. Government Accountability Office during the Clinton administration.

The speakers are part of the Fiscal Wake-Up Tour, sponsored by the Concord Coalition, the Heritage Foundation and the Brookings Institution.

Robert Bixby of the Concord Coalition said one of the key criteria for evaluating the candidates is whether they understand the magnitude of the nation's fiscal challenges.

"To begin with, the new president will take office with a government that is spending on an annual basis about $400 billion more than it takes in," Bixby said.

He said the biggest challenge the country faces is the unprecedented and permanent transformation of the U.S. into an older society, with rising health care costs and low national savings. The first of the 78 million baby boomers now qualify for Social Security retirement benefits. By 2010, the Social Security cash surplus will begin declining. In 2011, baby boomers will begin to qualify for Medicare.

That means a permanent rise in the cost of Social Security, Medicare and Medicaid, which already make up 42 percent of the federal budget, Bixby said.

Demographic change is only one part of the problem. For the past several decades, health care spending has outpaced economic growth substantially. Federal spending is on track to go from about 20 percent of the national gross domestic product currently to about 30 percent by 2030.

"Ultimately, it really isn't a matter of partisanship or ideology, it's a matter of arithmetic," Bixby said.

Why newborns cry

The panel also included Paul Cullinan of the Brookings Institution and 1998 UW-Madison graduate Brian Riedl, a Heritage Foundation fellow.

Walker said total liabilities of unfunded promises for Social Security and Medicare in the last seven years have gone from $20 trillion to $53 trillion, a current burden of about $175,000 and for every man, woman and child in America.

"No wonder newborn babies cry -- because when they come into this world they are given a bill of $175,000," said Walker, who leaves his post next month.

He said he favors universal health care coverage under certain conditions.

First, it needs to include wellness and preventive care services and protection against financial ruin if there is an unexpected catastrophic illness or accident. Beyond that, people would be able to purchase additional insurance at group rates.

Second, the country would need to budget for health care so it doesn't go bankrupt, he said.

Third, there would need to be universal evidence-based practice standards for medicine and prescription drugs to reduce costs, enhance quality and dramatically reduce litigation risk.

And fourth, people would need to increase personal responsibility and accountability for their own health and wellness, Walker said.

"Those are pretty dramatic things," he said. "You can't do them all at once, but if we do those things, I think we can design a system that over time gives us better outcomes for a lot better value and at reduced costs."