We identify the effective theory describing inflationary super-Hubble scales and show it to be a special case of effective field theories appropriate to open systems. Open systems allow information to be exchanged between the degrees of freedom of interest and those that are integrated out, such as for particles moving through a fluid. Strictly speaking they cannot in general be described by an effective lagrangian; rather the appropriate `low-energy' limit is instead a Lindblad equation describing the evolution of the density matrix of the slow degrees of freedom. We derive the equation relevant to super-Hubble modes of quantum fields in near-de Sitter spacetimes and derive two implications. We show the evolution of the diagonal density-matrix elements quickly approaches the Fokker-Planck equation of Starobinsky's stochastic inflationary picture. This provides an alternative first-principles derivation of this picture's stochastic noise and drift, as well as its leading corrections. (An application computes the noise for systems with a sub-luminal sound speed.) We argue that the presence of interactions drives the off-diagonal density-matrix elements to zero in the field basis. This shows why the field basis is the `pointer basis' for the decoherence of primordial quantum fluctuations while they are outside the horizon, thus allowing them to re-enter as classical fluctuations, as assumed when analyzing CMB data. The decoherence process is efficient, occurring after several Hubble times even for interactions as weak as gravitational-strength. Crucially, the details of the interactions largely control only the decoherence time and not the nature of the final late-time stochastic state, much as interactions can control the equilibration time for thermal systems but are largely irrelevant to the properties of the resulting equilibrium state.