As the number of people on Medicaid decreases, some people may die, but the number seeking care in emergency rooms also increases. The emergency rooms cannot absorb the increased amount of uncompensated care, so they shift the cost to either self-pay individuals or to insurance companies. The latter in turn increase premiums, co-pays and deductibles for those who are insured. As these increase, more individuals and companies are priced out of the market to send more people to the emergency room to shift more costs. This what the Institute of Medicine, the medical branch of the National Academy of Sciences, had in mind about fifteen years ago when it said that the health care system in the United States is not sustainable in the 21st Century. The only sustainable system is a national Medicare for all program. However, we will not have it nationally until we have it in a state or two. As Supreme Court Justice Louis Brandeis said in the 1930s, “The states are the laboratories of democracy.” Several states are working toward that goal-- California, New York, Colorado, Nebraska, and Ohio (SPANOhio.org); perhaps some others. Sooner or later, the richest country will join the remainder of the industrial world that now provide health care for all of their citizens.