Several recent letters, articles and commentaries in The Post and Courier have addressed the failure of South Carolina to accept federal funds to expand health care for lower income citizens in the state by expanding Medicaid.

Compassion, health of the work force and public, as well as the economic impact of nearly a billion dollars per year were mentioned.

However, there are other aspects of this question that deserve discussion and consideration. The uninsured and aliens must he seen and cared for in virtually all hospitals with emergency facilities. This law was supported and signed by President Ronald Reagan in 1986 following exposes and outcry over deaths among those not seen in hospitals for financial reasons. It was a compassionate law, but largely an unfunded mandate.

Congress did eventually provide some funding to hospitals that cared for a "disproportionate share" of such patients. This partially offset the high costs of emergency care for a group that often lacks preventive care and frequently arrives with serious complications.

Studies have shown higher costs, longer hospital stays, and higher mortality for the uninsured. These uncovered costs have increased hospital rates for everyone and contribute to the unreasonable total health care costs in the United States in contrast to other developed nations of the world.

The new health insurance law envisions a reduction of direct federal funding to hospitals as more low income persons are added to state run Medicaid rolls. South Carolina has chosen not to receive the nearly $1 billion per year to expand insurance. This will undoubtedly increase costs to all hospitals and eventually result in higher rates and insurance costs.

Those of us who pay federal taxes contribute to those funds which now are returned to the federal government for use elsewhere. I am fully aware that most South Carolinians dislike President Obama and many really hate him. Giving back to his government $1 billion per year as "punishment" seems odd and not financially prudent. We are clearly the losers.

It is true that Medicaid money is not always used wisely or efficiently by the state bureaucracies managing them, but there are some new alternatives developed by Republican governors and legislatures in recent years. They use the federal dollars (with federal approval) to increase health insurance for low income workers by providing variable vouchers to purchase low cost private health insurance that includes preventive services. This was a plan endorsed by President Nixon in the 1970s with support of Republicans in Congress. It was defeated by Democrats at that time.

Perhaps the most imaginative new plan comes from Indiana which uses subsidies to provide private health insurance accounts that consumers must carefully use in paying for services. They propose to use the federal money to provide the subsidies.

What South Carolina needs is some imagination and leadership in using our fair share of federal funds, to enhance availability of health insurance for more of our citizens. The mandate in the new health insurance law (ACA) requires all who are able to buy private health insurance.

There is no government health insurance plan in so-called "Obamacare."

It seems reasonable to use a private insurance mechanism, rather than Medicaid, for other groups as well.

I am confident that the free market can do better than state government in designing health insurance for the hundreds of thousands unable to do so entirely on their own.

Harold J. Fallon, M.D.

Marsh Edge Lane

Johns Island