THE HOUSE'S ATTEMPT at making the state's health and human services programs more efficient and accountable packs in a number of important provisions. The bill is, for the moment, the vehicle by which a cigarette tax increase might be revived. It includes several proposals for streamlining the Medicaid program.

But those pale in comparison to the part of the bill that is being largely ignored by the public and, to date, most legislators: a restructuring of a few of the state's myriad health-related agencies.

The House is to be commended for tackling the problem of rising health-care costs. It's a complex and politically charged topic. But the House proposal, currently before a Senate subcommittee, needs the addition of two crucial steps: Put the governor in control of the state's health and human services agencies, and merge the agencies into a logical and reasonable number of departments.

The first task is fairly straightforward. While some will argue that it's important to maintain the independence that many agencies' autonomous boards provide, the fact is that that isn't the way government is supposed to operate, except in the most sensitive and easily abused of areas. Someone elected by all the people needs to be able to set priorities -- within the constraints of the laws passed by our General Assembly -- and make decisions about policy direction.

The second task is dicier, because it's not always clear which functions should be in which agencies, particularly in this area. There are strong arguments for putting health and environmental programs in separate agencies, as reformers usually recommend, and strong arguments for keeping them together. Should the Department of Social Services be merged into a mega-health and human services agency, or left separate? And what about programs for those with various types of disabilities? While there is no justification for a stand-alone Commission on the Blind and Vocational Rehabilitation Agency and Department of Disabilities and Special Needs, should they be part of a general health agency or a separate department?

Fortunately, these questions don't all have to be answered now in order for legislators to make improvements. While we believe that just about any trimmed-down configuration would be an improvement over the one we have, a reasonable approach would borrow from the House's idea of letting the governor move programs around within his Cabinet agencies: Do that, and increase the number of Cabinet agencies. If a governor were in charge of DHEC, for example, he could decide whether some or all of its health programs should be moved to the health agency.

What's important is that, one way or the other, legislators position us to be able to run effective, accountable health and human services programs. Combining related agencies can save money, by cutting down on duplicative administrative functions and overlapping service delivery programs. It can lead to improved services, by, for instance, allowing people to work with a single case manager and a single qualification form and receive services at a single location. The result: For less money, we can do more good for those who need help, thus making it more likely that they'll be able to become self-sufficient, and we can have programs that focus on the problems our elected officials believe most deserve attention. Lawmakers need to keep those goals in mind as they work on this legislation.