It's helpful to think of the debt crisis as three separate points of tension.
-- First, in the next year, the tension is about spending: Liberals want a lot more; most of Washington wants a lot less.
-- Second, in the next ten years, the tension is about spending and taxing: Democrats want to fix the budget with mostly tax increases while Republicans want to fix the budget with mostly spending cuts.
-- Third, in the next few decades, the tension is about health care: Democrats largely want to keep Obama's health care reform; Republicans want to repeal it; and Congressional Republicans, led by Rep. Paul Ryan, want to turn Medicare into a "premium support" program that basically takes the government out of the insurance business.
With that trio in mind, take a look at these excerpts from Rep. Paul Ryan's speech to the Economic Club of Chicago (lines in bold are my emphasis):
By the end of the decade, we will be spending 20 percent of our tax revenue simply paying interest on the debt - and that's according to optimistic projections. If ratings agencies such as S&P move from downgrading our outlook to downgrading our credit, then interest rates will rise even higher, and debt service will cost trillions more.
If you look at what's driving our debt, the explosive growth in spending is the result of health care costs spiraling out of control.
The first bold sentence is about this decade's debt crisis, which can only be solved with domestic spending cuts and tax increases. The second sentence addresses the future's debt crisis, which comes from higher health care spending. Remember: These are separate crises. You can't reduce the deficit this decade from inside Medicare (Ryan's Medicare plan debuts in 2022) just as you can't reduce long-term health care costs by cutting defense spending.