Tired of defending an increasingly shrinking patch of land, New York Republicans have decided it’s smarter to attack Governor Spitzer from the left than from the right.

That’s the sense one gets from talking with the new chairman of the state Republican Party, Joseph Mondello, who has made alliances with Charles Rangel and Al Sharpton on the most important policy debate of Governor Spitzer’s first term: the future of Medicaid.

In the inverted politics of New York, a Democratic governor is advocating spending restraint while the Republican Party’s top boss along with Messrs. Rangel and Sharpton have taken the side of the hospital industry in its battle against Mr. Spitzer. The industry is demanding that lawmakers spend hundreds of millions of dollars to roll back cuts proposed by the governor, such as a temporary freeze on hospital and nursing home Medicaid reimbursement rates.

Mr. Mondello, who was nursing a cold, says his heart goes out to all of New York’s senior citizens who, he says, are the targets of Mr. Spitzer’s callous health care plan.

“It shows a lack of feeling to the elderly and people in need of care. … I propose finding another way to save the money, not at the cost of human beings. It just jeopardizes the elderly to a tremendous degree,” he said.

Contrary to conventional belief, Democrats don’t have a monopoly on human empathy, he said. “Republicans aren’t people without a heart. They aren’t people without concerns for a fellow human being. I’m arguing that we’re dealing with people here.”

Mr. Mondello said his party’s position on Medicaid isn’t inconsistent with traditional Republican values; it’s more like a humane exception to the rule.

“We stand for cutting taxes. And we stand for less government and not more government. There are other ways to cut taxes. There’s a lot of things out there that can be looked at. I just don’t like picking on the elderly,” he said.

No one does. We all reacted in horror to the mugging of the 101-year-old woman in Queens. So, what should Mr. Spitzer cut from the budget? “Maybe he should cut staff and patronage,” said Mr. Mondello, an odd piece of advice from a man who has pulled the strings of Nassau County’s Republican patronage system for almost 25 years and whom Mayor Giuliani once dubbed the “chairman of patronage.”

If Mr. Mondello is concerned about how the elderly make out in Mr. Spitzer’s budget, he might peruse a new report on Medicaid by Tarren Bragdon and published by the Empire Center for New York State Policy.

Among the facts in the report: The elderly represent 7.5% of Medicaid recipients but consume 25% of the budget. The average elderly recipient costs the state $27,200, compared to $11,300 in the rest of the country. Between 1999 and 2004, New York increased spending on home-health and personal care by $788 million but saw no decrease in nursing home usage. Mr. Bragdon concludes that Mr. Spitzer’s steps are justifiable but only “scratch at the surface of the problem.”

Yet, there was Mr. Rangel in Washington on Thursday decrying Mr. Spitzer’s budget as “disastrous.” And there was Mr. Sharpton in a radio ad paid for by the hospital industry saying, “It’s unreal to me that Governor Spitzer would pick on underpaid nurses and health care workers in order to meet his bottom line.”

The Rangel-Sharpton-Mondello alliance isn’t the strangest to emerge in this topsy-turvy environment. As Mr. Spitzer takes on the health care union and the hospital trade groups, he has an ally, Michael Long, in the Conservative Party, which is filling in the gaps left by Republican migration leftward.

“Spitzer’s on target,” the chairman of the Conservative Party in New York, Mr. Long, who owns a liquor store in Bay Ridge, said. “I think he should be thinking to cut more. It has to be done because it’s pretty hard for taxpayers to pay their bills as it is. Spending is really the cause of high taxes.”

Mr. Mondello and the person he answers to, the Senate majority leader, Joseph Bruno, though, would like to have it both ways — they seek to market themselves as tax cutters while declaring Medicaid off limits.

But that assumes the state can cut taxes without cutting Medicaid. Mr. Spitzer and any budget expert will tell you that it’s impossible — no matter how much money you throw at the School Tax Relief program, which only shifts the burden to the income tax base from the property tax base.

Republican inconsistency on this issue is the prime reason why Republicans in the Legislature have lost their advantage over Democrats on the issue of taxes. After 12 years of Governor Pataki, voters have smartened up.

One could argue that on a strategic level, Republicans cannot survive in an increasingly Democratic state without making political compromises and accepting the money and troops delivered by special interest groups like Dennis Rivera’s 1199 Service Employees International Union. John Faso ran on a streamlined platform of limited government, spending restraint, and lower taxes. And look what happened to him.

One reason New York spends so much on health care is because its system is organized around a network of large brick-and-mortar institutions that has become antiquated as fewer people are turning to hospitals when they become sick. Mr. Spitzer understands this trend and is staking his governorship on his ability to modernize New York’s health care.

One wonders whether Mr. Mondello will have any success in reviving the party in New York by looking backward.