The latest one- and ten-year outlook for health care spending from the Center for Medicare and Medicaid Services projects health care spending growing 50 percent faster than growth in the overall economy. By 2018, health care will account for fully one in every five dollars of gross domestic product, according to the projection. The biggest jump in health's share of economic activity will come in the next two years as the sector continues to grow while the rest of the economy shrinks.

And that's the good news.

There were several unrealistic assumptions built into the projections. First, the CMS economists assumed Medicare's physician payments will be cut by 20 percent at the end of next year when the current payment fix expires. As anyone who follows that issue closely knows, that never happens. Congress always steps in and restores the cuts.

The second major assumption was that health care expenditure growth will average around 6.2 percent per year over the next decade, which is about equal to last year, the slowest growth in the past decade. It's possible, but only if some form of health care reform is enacted, and the reforms include an effective health care cost containment strategy. That's a lot of ifs.

One eye opener in the data, which was published on the Health Affairs website, was the increasing role that public sector finance plays in health care. All public sector programs -- Medicare, Medicaid, public health, the Veterans Administration, etc. -- will surpass half of all health care spending in 2016, according to the projection, and reach 51.3 percent by 2018. When you subtract individual out-of-pocket spending from the total, what's covered by private insurance will shrink to about a third of spending.

The projections serve as an interesting backdrop to yesterday's fiscal summit organized by the Obama administration, which wound up focusing almost exclusively on health care as the "entitlement" problem. That's accurate. Social Security is a paragon of fiscal health compared to Medicare and Medicaid. Peter Orszag, the chief of the Office of Management and Budget, told the forum that "the path to fiscal responsibility must run directly through health care."

So here's my prediction: Based on my reading of the Congressional Budget Office health care "options" report issued last December, the Obama administration will make a move toward putting budget caps on Medicare and Medicaid spending sometime during his first term.

Everyone knows there is a tremendous variation in utilization around the country and the system everywhere deploys a tremendous amount of wasteful medical procedures, tests, drugs, devices, and durable medical equipment. Comparative effectiveness research, properly deployed, is one way to wean the system from wasteful expenditures. That's the scientific carrot.

But budget caps are the fiscal stick. If officials knows that spending can't go over a certain level, they will be forced to make decisions about what constitutes high quality, affordable care. That's how it's done in other advanced industrial countries grappling with aging societies and skyrocketing health care costs.