I've said it before and I'll say it again: Any politician touting fiscal hawk credentials isn't for real unless Medicare cost controls are on the table.

The latest reminder of that came Tuesday in the form of a frightening annual report from the Medicare Board of Trustees detailing the financial health (or lack thereof) for the important but increasingly expensive government health care program for senior citizens.

Trustees for the Social Security program also issued their annual report Tuesday, and while that retirement program also has a cash flow problem, Medicare is in much more dire shape.

"As was true in 2008, Medicare's Hospital Insurance Trust Fund is expected to pay out more in hospital benefits and other expenditures this year than it receives in taxes and other dedicated revenues,'' said Medicare trustees' message to the public. The grim news continued as the trustees warned the fund will exhaust its reserves in 2017, two years ahead of projections made just last year.

The problem? The economy, partly. Millions of people have lost their jobs. That's a problem when payroll taxes fuel this $455 billion a year program. Fewer people working mean fewer dollars coming in. At the same time, health care costs are soaring. "Underlying health care costs are projected to rise faster than the earnings per worker on which payroll taxes and Social Security benefits are based,'' the report said.

Keep in mind that the Medicare entitlement program does not include the costs of nursing home care for the nation's elderly; those costs are typically borne by the separate Medicaid program providing health care for low-income individuals. Here's where things get really scary: the demographic Baby Boomer tsunami is ready to retire and collect benefits.

Talk-show hoopla about earmarks and stimulus borrowing irresponsibly ignores the real ticking time bomb: out-of-control entitlement costs. True stewards of the taxpayer's dollar will be easy enough to identify in the weeks and months ahead. They'll be the ones courageous enough to step up and tell the truth. Medicare, as it is, is simply not sustainable. And difficult changes lie ahead for two of the nation's most powerful lobbying groups : the health care industry, which must dramatically cut costs, and the nation's seniors, who may have to pay more for benefits or wait longer to collect them.

It won't be a popular message but it's a vital one. Nothing less than the nation's future is at stake. Authentic fiscally responsible leadership is welcome and long overdue.