OECD nations face particularly powerful fiscal pressures over the coming decades. To handle these pressures without lapsing into fiscally irresponsibility, they will need to make courageous decisions on both the expenditure and tax sides. This paper looks at the implications of this for budgeting. It focuses particularly on reallocation and expenditure discipline, including the role of spending review, and the design and implementation of expenditure ceilings. The question of the relevance of net worth as a fiscal policy measure is also discussed, as is the potential for efficiency savings to relieve the fiscal pressure on governments.