A HANDFUL OF hospitals across the country have started identifying uninsured patients who show up frequently at their emergency rooms and offering them free preventive care. The programs are not altruistic; they’re an attempt — successful so far — by increasingly squeezed hospitals to save money.

If that sounds crazy, it’s because you’re not familiar with one of the biggest reasons the cost of medical insurance is spiraling out of control: A federal law makes it impossible for most hospitals to turn away patients who need care, regardless of whether they can pay.

The result is that when people who can’t pay for medical care need it, they go to the emergency room, where their care is not only free but more expensive to provide than anywhere else they could go.

The hospitals have to cover their losses by increasing the prices they charge to insurance companies, which increase the prices they charge to companies that provide medical insurance, which either charge their employees more or drop that benefit altogether. Of course, when companies stop offering insurance, or price it out of reach of their employees, we end up with more uninsured people, who show up in the emergency room....

It’s easy to see where this is leading. “Eventually,” says S.C. Hospital Association president Thornton Kirby, “there won’t be enough insured to pay for the uninsured.”

It is for this reason that Mr. Kirby has made what truly is a modest request of state legislators: Have a thoughtful discussion about possible solutions. By thoughtful, he means no one screaming “socialized medicine” and using other scare tactics to abort the conversation before it even begins — you know, as we saw when the Democrats tried to talk about universal coverage at the federal level a decade and a half ago.

A good place to start the conversation might be by acknowledging that it is inherently unfair (not to mention contrary to the free-market approach that critics of universal coverage genuflect to) to force one sector of the economy to give away its services. As Mr. Kirby notes, we don’t require grocery stores to give away food just because we think everyone ought to be able to eat.

Of course, the General Assembly can’t do anything about federal law, which is one of the many reasons we need a national approach to health insurance. But since the Congress has no intention of acting, more states are desperately seeking solutions to a problem that not only hurts a growing number of their citizens but also drives up business costs, making it harder for their businesses to compete in a global market.

What the General Assembly can do is decide that it is in the best interests of our state to find a better way to distribute the cost of that medical care that’s being provided to the uninsured.

We don’t know what that better way would be. It might involve using the federal government’s generous Medicaid match to cover more children or to help businesses provide employee health insurance at a lower cost. It might involve a Massachusetts-style mandate that everyone purchase medical insurance, much as we require drivers to purchase auto insurance. Or it might involve something no one has even thought up yet.

What we do know is that we won’t find a better way unless we look for it, and we won’t be able to look for it if people refuse to come to the table with an open mind.