Gov. David A. Paterson has muscled the legislature into its first significant budget-cutting of 2010 by forcing a choice: Approve deep reductions in health care spending or shut down state government. Call it the Paterson ultimatum.

He should use that unprecedented tactic as often as necessary to make fainthearted legislators finally confront the state's $9.2-billion deficit and pass a responsible budget.

The $775 million in cuts and savings approved Monday - including $18.8 million from Long Island hospitals - will mean program modifications and probably layoffs. But Medicaid is an unavoidable target as Albany struggles to balance its books. The massive program costs $50 billion a year in New York, including about $17 billion from state coffers. By putting the reductions into the emergency spending bills needed to keep state government operating for another week, the lame-duck governor gave feckless legislators political cover. They can blame him for making them do what had to be done.

New York spends twice the national average per person on Medicaid, more than any other state. That has to change, and while nipping provider payments and rooting out fraud are a start, they won't be enough long-term. Once past the immediate crisis, Albany has to take a hard look at who and what the program covers, including nursing home care for the elderly.

But for now, Paterson has moved the state one step closer to living within its means. That's progress. hN

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