Americans don’t particularly like government, but they do want government to subsidize their health care. They believe that health care spending improves their lives more than any other public good. In a Quinnipiac poll, typical of many others, Americans opposed any cuts to Medicare by a margin of 70 percent to 25 percent.

In a democracy, voters get what they want, so the line tracing federal health care spending looks like the slope of a jet taking off from LaGuardia. Medicare spending is set to nearly double over the next decade. This is the crucial element driving all federal spending over the next few decades and pushing federal debt to about 250 percent of G.D.P. in 30 years.

There are no conceivable tax increases that can keep up with this spending rise. The Democrats had their best chance in a generation to raise revenue just now, and all they got was a measly $600 billion over 10 years. This is barely a wiggle on the revenue line and does nothing to change the overall fiscal picture.

As a result, health care spending, which people really appreciate, is squeezing out all other spending, which they value far less. Spending on domestic programs — for education, science, infrastructure and poverty relief — has already faced the squeeze and will take a huge hit in the years ahead. President Obama excoriated Paul Ryan for offering a budget that would cut spending on domestic programs from its historical norm of 3 or 4 percent of G.D.P. all the way back to 1.8 percent. But the Obama budget is the Ryan budget. According to the Office of Management and Budget, Obama will cut domestic discretionary spending back to 1.8 percent of G.D.P. in six years.