The Medicare debate has been postponed, to some extent, by the recent fiscal consolidation and a slowdown in health care cost inflation. But inflation should rise again as the Obamacare money sluices into the system, and even with a lower rate it would be hard to envision a future for Medicare that doesn’t involve some combination of price controls, benefit reductions and tax increases — all on a much larger scale than the numbers involved in recent debates.

What’s more, the political salience of this debate will rise for the same reason that the costs of Medicare will be rising: because the country will be older over all, and health policy inevitably matters more to the old than to the young.

Which means that the future almost certainly holds more cries of “death panels,” more ads featuring Paul Ryan clones pushing seniors over a cliff, and no doubt as-yet-undreamt-of forms of demagogy. And it means, as well, that if it’s hard to get Washington to focus on other issues now — tax reform, education, family policy, you name it — just wait awhile: It will get much worse…

But there’s a reason that golden ages can diminish into twilight — because the demands of the present can crowd out the needs of the future, and because what’s required to preserve and sustain is often different, in the end, from what’s required to grow.