Official Washington has an ingrained habit of ignoring big problems until they become full-blow crises. One of the current big problems is federal spending, and the debt backing it up.

Waiting for this to become a crisis would be particularly foolish. How to fix it? The Manhattan Institute’s Brian Riedl writes that any serious effort to avoid fiscal doom must include reforming the two biggest items in the budget: Social Security and Medicare. But doing so will require busting some myths, and facing some very tough choices:

There is a popular myth that Social Security and Medicare are funded entirely by payroll taxes and senior Medicare premiums. In reality, those sources are insufficient to finance all annual benefits — and the Treasury must transfer general revenues into the Social Security and Medicare systems to plug the gap. As the 74 million baby boomers retire and health costs also soar, these general revenue transfer costs will grow rapidly. Over the next three decades, CBO data show that Social Security will require $21 trillion in general revenues, and Medicare will require $46 trillion. Much of these costs will be financed by government borrowing, which itself will be responsible for $45 trillion in projected interest costs. Altogether, these Social Security and Medicare shortfalls (and the resulting interest expenses) will cost the Treasury $112 trillion over three decades — which matches the entire projected 30-year federal budget deficit. In other words, if not for these Social Security and Medicare bailouts, the 30-year federal budget would be balanced.

His reform prescription:

…includes bringing a premium support system to Medicare that allows seniors the option of shopping around for a private plan using a generous federal subsidy that would cover the cost of the average plan (minus the standard enrollee premium). Next, lawmakers should begin trimming Social Security and Medicare benefits for wealthy seniors. The Social Security eligibility age could rise faster, and wealthy seniors could face higher Medicare premiums and slower growth of Social Security benefits. Lower-income seniors should be protected from these reforms. Some new taxes will also likely be necessary, such as modest upper-income tax rate increases, a slight increase in the payroll tax rate, and a gradual halving of the tax exclusion for employer-provided health care. These reforms could keep Social Security and Medicare from driving unsustainable deficits, and ultimately maintain fiscal space for other priorities.

A tall order even in the best of times. But here we still have a choice: maintain the status quo, and use even greater amounts of debt to pay for entitlements. Or, make reforms now to prevent a crisis over which we have no control.