It’s starting to look like a pattern. Back in 2006, Governor Pataki vetoed $1.3 billion in Medicaid spending, and New York’s hospital industrial complex of the trustees and the unions launched a spate of attack ads against him. They got most of what they wanted, and Mr. Pataki’s poll ratings sagged, though the Berger Commission did rein in some spending. Back in 2007, Governor Spitzer tried to slow the increase in the state’s health care spending. He was confronted by the “Healthcare Education Project,” a joint scheme of Local 1199 of the Service Employees International Union’s United Healthcare Workers East, led by Dennis Rivera, and the Greater New York Hospital Association, led by Kenneth Raske. It launched a campaign of television commercials and direct mail, along with a Web site aimed at blocking Governor Spitzer’s plan to slow the increase in Medicaid spending.

Mr. Spitzer responded by calling the ad campaign “distortion, scare tactics and mischaracterization,” as well as “demagoguery.” “We will not agree to protect special subsidies that have produced the highest health care costs in the nation without producing better care,” Mr. Spitzer vowed. The health care lobby got most of what it wanted, and Mr. Spitzer’s poll ratings sagged.

Now it is 2008, and Mr. Spitzer’s lieutenant governor, David Paterson, is trying to succeed at what both Mr. Pataki and Mr. Spitzer before him had a difficult time succeeding at. Yet again, the union and the hospital trustees are up in arms. Mr. Paterson’s proposed cuts would “devastate New York’s health care infrastructure” and “severely threaten access to care,” Mr. Raske said this time around in a statement released jointly with the new president of 1199, George Gresham.

If the union and the hospitals steamroll yet a third governor a third time around, next year at budget time, the governor may wonder if it is worth the bother. And so may the voters. Why bother even electing a governor? Why not just make Mr. Raske the governor and Mr. Rivera or Mr. Gresham the lieutenant governor, with the power to tax and spend without limit to fund New York’s hospitals and nursing homes?

It’s not that we are without sympathy for the health care workers and the institutions that employee them. They are doing fine work every day caring for and curing sick New Yorkers, training new doctors and nurses, and researching new treatments for deadly diseases. Their quality is the envy of the world. But with a state that already has the highest per capita state and local tax burden on its residents now facing a $6.4 billion budget gap, with health care spending composing a large portion of the state’s budget, and with New York’s Medicaid spending far exceeding that of other states, some restraint is necessary. Maybe Mr. Paterson can ask Mr. Pataki and Mr. Spitzer to appear with him and help plead the case.