Even casual readers of these columns will know we haven’t hesitated to find fault with Eliot Spitzer, either as attorney general or in his new capacity as governor, but here — at long last — is an issue on which the governor has it right and his critics are wrong. We speak of the alarm raised by the “Healthcare Education Project,” a joint scheme of Local 1199 of the Service Employees International Union’s United Healthcare Workers East and the Greater New York Hospital Association.

The unionized health care workers and the trustees and hospital executives represented by the association have launched a campaign of television commercials and direct mail, along with a Web site, stopthecuts.org, aimed at blocking Governor Spitzer’s plan to slow the increase in Medicaid spending. The campaign was reported by Jacob Gershman in yesterday’s New York Sun, ahead of its formal announcement.

Kenneth Raske, the president of the hospital association, warned in a press release yesterday that Mr. Spitzer’s cuts “will shatter the health system New Yorkers rely on.” The press release from Mr. Raske and the union president, Dennis Rivera, called Mr. Spitzer’s proposed cuts “hugely destructive.” Mr. Spitzer shot back with a press release of his own calling the Raske-Rivera 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,” the governor said. To which we say, right on. It’s ironical that the Raske-Rivera team chose to launch its ad campaign the day after the release of an Independent Budget Office Report showing that New York City had the highest combined state and local tax burden in the nation. The report laid the blame primarily on New York’s super-expensive Medicaid system.

The Raske-Rivera forces suggest Mr. Spitzer ought to cut health care costs from drug company and HMO profits rather than from Medicaid spending. But drug company profits fund innovation, and HMOs do a better job of controlling costs than does the government. Mr. Spitzer’s cuts, such as they are, are his way of funding an expansion of the ranks of the insured without increasing taxes.

In the middle of all the fighting between Mr. Spitzer and the Raske-Rivera team, it’s worth stepping back and asking how a program — Medicaid — that was supposed to be a safety net for the poor has expanded so much that it now pays for end-of-life care for the parents of upper middle-class New Yorkers. The program provides health insurance to the household staff of upper middle-class New Yorkers. Our Jill Gardiner reported in December that 52% of the city’s births in 2005 were paid for by Medicaid.

The heated reaction from Raske-Rivera shows the political risks of tapping even lightly on the brakes of the runaway train that is Medicaid spending in New York. Much was made — too much, in our view — of whether Mr. Spitzer would triumph over the status quo in Albany when it came to picking a comptroller. Here’s a fight where the stakes really matter, a test of whether Mr. Spitzer will succeed in his effort to bring change to Albany. The hospital trustees among our readers, many of whom backed Mr. Spitzer in his campaign for governor, may want to ask Mr. Raske, Do we really want to put the short-term interests of our hospitals ahead of the governor’s plans to rein in a Medicaid system that, left unchecked, will render the state undesirable for those patients and employers who can afford private insurance?