Tyler Cowen outlines some basic principles:

The path toward long-run fiscal balance involves recalibrating Medicare, Medicaid, and Social Security to lower rates of indexation, reimbursement, benefit increase, and so on.  We need to start that process now.  It cannot be done overnight or even over a few years' time.  It takes a long time for those gains to come in, cumulatively.  No one is going to vote for a "thirty percent cut to Medicare, today," although they might vote for changes in rates, which over time would amount to large reductions.  

The CBO put out a report today with more than a 100 ways to cut spending or raise revenue:

If federal debt continued to grow relative to the nation’s output and income, investors would require the government to pay higher interest rates on its securities to compensate for the risk that they might not be repaid or that the value of the securities might be eroded by inflation. Interest rates might rise only gradually to reflect such growing uncertaintybut other countries’ experiences suggest that a loss of investors’ confidence can occur abruptly and might well come during an economic downturn. To resolve the resulting fiscal crisis, lawmakers would need to make fiscal policy choices that would be much more drastic and painful than if policies had been adjusted sooner. 

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