On May 27, Tarren Bragdon wrote on these pages, “Maine’s Medicaid system is big, expensive and poised to expand due to Maine’s changing demographics.” The truth is it’s our health care system that is “big, expensive, and poised to expand…”

We don’t have a Medicaid problem. We have a health care cost problem. Maine’s higher-than-average Medicaid costs are a symptom of that larger problem. So are the higher-than-average private health insurance costs that most of the readers of this column are paying.

Contrary to Bradgon’s assertions, the solution is not to reduce health care services for low-income children, elderly, and working families, or expose them to unaffordable cost-sharing. That would only make matters worse.

Restricting access to care for people on Medicaid doesn’t mean their health care needs go away. Instead they end up seeking care later resulting in worse health outcomes and more expensive care. The cost of that care is then shifted to everyone else who uses the health care system.

Numbers can be deceiving. For example, Bragdon claims that Maine has the “second-highest spending per child on Medicaid.” While we can disagree with this and other numbers in his column, he also fails to tell the whole story.

Our spending for children is higher than average. But that is the result of deliberate decisions made over many years to shift services once paid entirely from state funds to the Medicaid program – a wise strategy since the federal government provides $2 for every $1 of state spending. In other words, a mental health visit for a child 15 years ago would have been paid for entirely from state funds. Today it is purchased for 36 cents on the dollar under the Medicaid program.

This strategy works and has allowed us to serve children in need more cost-effectively. Instead of overspending, this example illustrates Maine is spending tax dollars prudently, and taking advantage of every federal dollar available.

Bragdon asserts we can save a billion dollars in Medicaid without reducing the number of people served – but fails to calculate the human and financial costs that would result. Can we find cost efficiencies in Medicaid? Of course. We can do a better job of coordinating care for those with chronic illnesses. We can do a better job of collecting money owed to Medicaid by private insurers. Legislators have included both of these strategies in the proposed state budget.

But the real solution is to tackle this country’s health care problem. Most now agree this begins with covering the uninsured. Maine’s success in providing Medicaid coverage to the uninsured is clearly a step in the right direction.

Christine Hastedt, Augusta

Public Policy Director, Maine Equal Justice Partners