Yuval Levin reminds us that any grand bargain on the debt that doesn’t address the rising costs of health care will only delay the country’s fiscal reckoning, not resolve the fundamental long-term mismatch between spending and revenues. 

If we solved [the problem of rising government health care costs], we would still have too big a government and much spending to cut, but we could argue about that in the traditional way-by seeking some balance between spending and taxes. Our coming fiscal problems are just not amenable to that sort of approach. By debating one another as though that were not the case, as though the familiar old dynamics of our fiscal-policy debates still hold, our leaders are ignoring the debt problem, not addressing it. And by calling such dereliction a grand bargain and showering themselves with garlands for considering it, Republican leaders risk undermining their party’s own efforts to actually address the debt problem and allow our country to prosper in the coming decades. 

The solution, Levin argues is some kind of premium-support model for Medicaid, along the lines of the Ryan plan.