A panel recommending cuts to Medicaid may have provided opportunity to Congress this week when its major savings came not from cutting services but from getting lower prices for prescription drugs and extending drug rebates to Medicaid’s managed-care plan. Those are the sort of changes advocates for expanding government health care have been suggesting for years, but have been rejected in Washington. Now they could be back before lawmakers.

The commission was formed by the president after he and Congress agreed on a $10 billion reduction in social-service spending, likely Medicaid, over the next five years. The reimbursement and rebate programs would save more than half of the total sought, and a third recommendation, to raise co-payments on some expensive drugs to steer people to less-costly options, would save another $2 billion, according to the commission.

The reimbursement plan has a number of components, not all acceptable to Congress, and relies on cuts to manufacturers as well as pharmacists. It isn’t clear, however, the latter group can cut significantly and stay in business.

In total, the commission, led by former Tennessee Gov. Don Sundquist and former Maine Gov. Angus King, made a half-dozen suggestions to save $11 billion in Medicaid spending; by the end of 2006, it is expected to report on long-term reforms to keep Medicaid affordable.

The proposed cuts will be considered by the Senate Finance Committee, where Republican Sens. Olympia Snowe and Gordon Smith have rejected the idea of taking the entire $10 billion savings from Medicaid. Other senators may join them as the thought of cutting benefits to the poor sinks in with an election year coming up and New Orleans in ruins.

The commission, assuming its numbers hold up, provides some fairly painless ways to pare funds. Sen. Snowe, whose vote will be important on whatever cuts the Finance Committee chooses, remains skeptical: “While these recommendations taken individually may seem worthwhile,” she said in a statement Friday, “they must be looked at through the prism of how they would impact the entire program and the beneficiaries that the program is intended to help.”

That is, of course, true, but in a short time she and other committee members will be forced to choose cuts. No choice will be easy; some of the ones suggested by the panel already have support.

The president assembled the commission after both Democrats and the National Governors Association declined to participate in choosing members. The fact that it recommended reforms that could affect manufacturer prices, with added oversight for ensuring accurate reporting of prices, suggests how far the government is from paying the right price now.

Whatever the specifics of the eventual reforms, finding savings on drug prices is the place to begin debate.