Congress' budget reconciliation bill, saving $39 billion in entitlement programs over five years, has made it a lot easier for Gov. Mark Sanford to move ahead on his controversial health savings accounts plan for South Carolina's Medicaid recipients.

The state has applied for a waiver from the federal government to make the changes in Medicaid, the federal-state program that pays health care bills for the poor, blind and disabled. It is one of the nation's fastest-growing entitlements - driving up federal deficits and eating up state budgets. The Palmetto State's latest Medicaid bill ran to a whopping $4.6 billion.

The switch does not require a vote from the General Assembly, and Sanford is optimistic the program could be in place by next January. If health savings accounts work as their proponents expect, it could revolutionize the health care system in this country well beyond Medicaid.

Health savings accounts are designed to make the system consumer-driven, resulting in better health care at lower cost. That's where state and federal governments hope to make some savings, or at least slow Medicaid's growth.

Most health care plans, in both public and private sectors, are paid for by third parties; hence, patients have little interest in the costs beyond their co-pays and deductibles. Sanford's plan would give many of the state's 850,000 Medicaid clients accounts of their own - several thousand dollars to shop around for health care plans.

They would then have greater control over their own health care needs, says the governor, and have incentives to take better care of themselves. Insurance companies and HMOs would have to compete for the health care dollar by tailoring their plans to meet individuals' needs.

Recipients who still have money in the account when they leave Medicaid could spend those savings on other constructive programs, such as education or job-training - another incentive to save.

Critics of the program are mostly Democrats and some advocates for the poor who are concerned that many people won't understand the new program, or what will happen to them if they're still sick when they run out of HMO or insurance benefits.

Of course, no plan is perfect - and a new plan, especially, will run into problems and require mid-course corrections. But that's no reason not to move ahead with reforms. Something must be done to rein in the soaring cost of Medicaid and the Sanford plan is a good place to start. It deserves a fair trial and scrutiny, which it will surely get.