This paper continues to spin the thread of previous analyses of the bleakness of the budgetary outlook in the United States and the difficulty of change. The budget remains mortgaged by actions in previous years, and the economic outlook is uncertain. "The politics of frugality" has come to dominate the American political scene, but the President's choices to reduce spending on human resource programs by $18 billion are more apparent than real. The new Congressional review procedures, a reaction to the Watergate years, interrelate budget with health policy and highlight the necessity for action to control medical care prices if any new federal initiatives, e.g. national health insurances, are to be budgetarily feasible.