In 2008, Nevada's governor formed the Nevada Spending and Government Efficiency (SAGE) Commission to make recommendations on providing quality services to its citizens for the least money. He appointed business leaders to form the most knowledgeable commission in Nevada's history. Rather than a voluminous report at the end, he asked the Commission to forward recommendations to him every 90 days, so that changes could be implemented expeditiously. He told commissioners not to be concerned with fiscal crises, or the political implications of its recommendations. Over 18 months, the SAGE Commission made 44 recommendations that, if implemented, will save or enhance state revenues by approximately two billion dollars over five years, while resulting in hundreds of new efficiencies. The SAGE Commission is proud of its work, which has not cost the state a single dollar because it was funded by a private, non-profit corporation. What disappointed these volunteer commissioners was the reluctance to implement the vast majority of its recommendations. Although the SAGE Commission was not designed to solve the short term revenue crises facing the state, if any of its key recommendations had been enacted in 2009, savings from them would be evident in the 2011-13 budget cycle, where the state faces a $3 billion deficit in an $8 billion budget. This book outlines the ten most important Commission recommendations. It describes how they and other recommendations were developed and discusses why they were not enacted. The author then opines about Nevada's fiscal future if recommendations like these are not approved. He concludes that a "grand bargain" between those who oppose any new taxes and those who think they are essential may well be necessary. The SAGE Commission has already addressed the essential first step of evaluating tax expenditures. Appendices include unabridged versions of all 44 recommendations.