The May 11 editorial titled “Medicaid has a price, too” deserves a response. Yes, it is true that Medicaid, health insurance for the poor, is not free. It is no more free than the highways we drive on, our public schools or even weekly trash pick-up. We can all agree that thanks to all of us who pay taxes, these services appear to be “free.”

The point is this: In order to expand health-care coverage for those below 138 percent of the federal poverty line (annual income less than $32,500 for a family of four) to afford it, the federal government has offered to pay 100 percent of the cost of Medicaid expansion for three years. So, for the state budgets, that cost is zero. That is about as free as it gets.

Thereafter, the state would pay a maximum of 10 percent of the cost in perpetuity. The cost of coverage not paid by the state would be borne by taxpayers across the entire country. Our South Carolina leadership declined the offer because they felt that 10 percent cost after three years could not be sustained.

Medicaid, like Medicare, has problems of inefficiency. Having spent a career in medicine, both on the clinical and business side, I understand these existing inefficiencies. But I also know they can be corrected.

Nearly 200,000 adult South Carolinians who would be eligible for this coverage wake up every day hoping not to get sick and, if they do, wondering how to pay for it. Politicians cannot imagine this feeling since our tax dollars pay for their insurance. Nor do they offer an alternative solution.

Meanwhile scores of volunteers at such places as the Barrier Islands Free Medical Clinic offer a shred of dignity and, yes, free health care as a meager alternative for these unfortunate individuals. The local hospitals generously augment this free care.

But who pays those hospital costs when all is said and done? You guessed it — the rest of us, as costs are shifted to insurance payments. How else to keep the doors open?

Is this the kind of non-system we want for health care in South Carolina? Is this how we want to treat those citizens in need? If there is a better solution than the Medicaid expansion program, albeit imperfect, I have not heard the critics come forward with it.

One thing is clear, ignoring the problem will not make it go away.

Bernard Mansheim, M.D.

Water Street

Charleston