The Medicare payment formula is one of a number of fiscal time bombs that will need defusing soon: the alternative minimum tax, the Bush tax cuts, the estate tax, other expiring tax provisions. These are costs — huge costs — that the administration would, for the most part, prefer to assume away; it wants to exempt itself from the responsibility of having to come up with a way to ensure that dealing with them does not add to the deficit.
This is an enormous problem, practically and politically. It requires a comprehensive solution — one that probably cannot be achieved within the existing political framework but that will require some kind of bipartisan commission to craft. A president who says that he is serious about dealing with the dire fiscal picture cannot credibly begin by charging this one to the national credit card, with no concern for the later generations who will have to pay the bill.