The government's latest economic forecasts leave no doubt that the United States faces a debt crisis of mindboggling proportions. The big question now is what that means for President Obama's push for comprehensive health care reform.

Some fiscal conservatives saw the projections released last week by both Congress and the White House as a wooden stake through the heart of health reform. With the nation facing record-shattering budget deficits, they say, this is no time to spend another trillion dollars to cover the uninsured.

These critics have it exactly backwards. The federal government's ballooning debts endanger U.S. prosperity, but they are no reason to postpone health care reform. On the contrary, as President Obama has emphasized, getting medical costs under control is a prerequisite for restoring fiscal responsibility in Washington.

The CBO and OMB figures, in fact, argue for redoubling White House efforts to pass health care reform this year - if that reform includes credible measures for "bending the (health care) cost curve down."

Admittedly, that's a big "if." None of the bills under consideration in either the House or Senate yet meet the curve-bending test.

In fact, lawmakers still haven't agreed on how to pay for expanding coverage, much less on the tough steps necessary to curb medical cost inflation. The president rightly insists both are necessary, and he's gotten support lately from fiscally hawkish Senate Democrats. "It's not good enough that it's just paid for; it actually has to start driving long-term costs down," Virginia Sen. Mark Warner said last week

The reason is simple: Medicare and Medicaid, along with Social Security, are the principal drivers of the nation's fiscal crisis. The CBO report noted that spending on the three programs, nine percent of GDP last year, could swell to 17 percent of GDP by 2035. That's how much the federal government today collects in taxes. In other words, if we don't curb their spending growth, either the Big Three eventually will either absorb every penny Washington raises in taxes, or we'll have to raise taxes dramatically to pay for everything else government is supposed to do.

It's the automatic growth of entitlements, not today's colossal budget deficits, that pose the gravest threat to our economic future.

CBO forecasts a 2009 budget deficit of $1.6 trillion, or over 11 percent of GDP, the highest since World War II. This eye-popping number stems from emergency aid to failing financial institutions, stimulus spending and ebbing tax revenue from the ailing economy. It's a lot of money, but if spending it kept the recession from turning into a depression, most Americans will call it a bargain.

But here's the rub: budget deficits are supposed to subside once the economy picks up and revenues start gushing back into the U.S. Treasury. Not this time. CBO projects that the deficit in 2019 will equal 8.5 percent of GDP, more than twice its level before last fall's double whammy of the credit crisis and recession. It estimates the national debt will grow to about 68 percent of GDP over the next decade (it was about 40 percent last year.)

And that's a very conservative estimate, since CBO assumes, among other things, that all of George Bush's tax cuts expire on schedule - something President Obama has ruled out. Many budget analysts believe it's more likely the debt ration will exceed 80 percent over the next decade.

In short, absent budget and entitlement reform, America is on track to become the mother of all banana republics.

But timing is everything. We can't jack up taxes or clamp down on all government spending in the midst of a severe recession. That's why President Obama is right to focus now on restraining health costs, and save more comprehensive tax and entitlement reform for when the economy recuperates.

So instead of wallowing in irrelevant debates over death panels and public options, lawmakers and the White House need to rivet public attention on the key question: what must be done to slow the unsustainable growth of health care costs, which threaten both household and public budgets?

There's more than one answer. But we'll know we're having a serious discussion when lawmakers confront the tax exclusion for employer-paid health insurance. Economists say this unlimited federal subsidy fuels medical cost inflation, and is inequitable to boot, since it benefits high-bracket taxpayers more than others. Budget geeks point out that eliminating or limiting the exclusion, which costs the government $245 billion in lost revenue each year, would help defray the costs of covering the uninsured.

Yet Republicans can be relied upon to demagogue such sensible steps as "taxing your health benefits." And because labor unions have negotiated generous health plans, many Democrats have back away from the cutting the subsidy as well.

This is a perfect illustration of the Washington syndrome that has saddled us with today's debt crisis: the bipartisan evasion of hard choices. To achieve an historic health care reform that doubles as fiscal reform, President Obama will have to confront this syndrome head-on.