While attention has been focused on the broad struggle for budget control, the House Ways and Means Committee has quietly marked up changes in Medicare and other programs that are expected to reduce the deficit by roughly $19 billion over the next three years. About $10 billion of that would come from changes in Medicare, primarily added restrictions on payment rates for hospitals and doctors.

These new restraints are likely to increase concern that Medicare pressures are already translating into poor quality care for elderly patients. But other features of the committee bill attempt to alleviate the worst side effects of that pressure. For example, tough penalties are provided for hospitals caught "dumping" uninsured patients who need emergency care. Hospitals serving a disproportionate number of low-income patients would be allowed slightly higher Medicare payment rates to take account of the fact that poor people tend to have more complicated ailments.

Another sensible reform would require new state and local government workers to pay for the Medicare benefits that many of them now receive free -- a provision that the Senate Finance Committee might wisely extend to all current workers as well. States would be given needed relief from unrealistically tough requirements to reduce welfare payment errors. And at long last, all states would have to extend welfare to poor families with unemployed fathers -- a much-needed reform that turns out, thanks to the miserly level of welfare in most states, to cost surprisingly little.

Perhaps most important contribution to the country's health is the committee's decision to keep the federal tax on cigarettes at its current level -- instead of letting it drop by 50 percent next fall as current law provides. Could the budget-conscious Senate be so intimidated by the tobacco lobby as to fail to take similar advantage of this chance to help the public health while cutting $5 billion from the deficit?

Congress may not have made much progress on the larger budget question. But that shouldn't keep it from acting promptly on a measure that would make a significant contribution to the health of both the general public and the Treasury.