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by WES CLIMER
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If you live in South Carolina and have ever paid a hospital bill, a health insurance premium, or even a co-pay at a Medical University of South Carolina (MUSC) clinic, have you ever thought about the fact that you’ve already paid for MUSC once with your state income taxes?
That’s the core injustice of the current system. Every year, the S.C. General Assembly writes MUSC a check for roughly $250 million in direct appropriations — money taken straight from plumbers in Lancaster, teachers in Fort Mill, and retirees across our state on fixed incomes. Many of those same taxpayers then turn around and pay full freight (or close to it) when they or their families receive care at MUSC facilities. It’s double-billing by government fiat.
Think about it: private hospitals and physician practices get zero direct state subsidies. They must cover every dime of their costs through patient revenue, charity care, and philanthropy. MUSC, by contrast, gets to offset its expenses with a massive taxpayer subsidy before it ever sends you the bill.
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This isn’t just unfair; it’s a hidden tax on every South Carolina family. When MUSC uses your tax dollars to build new towers, recruit high-dollar specialists, or absorb losses on money-losing services, it can then turn around and bill your insurance company — which raises your premiums. You pay on your April 15 tax return, and then you pay again at the registration desk. In fact, South Carolina’s overall hospital system already shoulders $3.2 billion in uncompensated care annually, much of which falls on unsubsidized providers, while MUSC’s $4.7 billion operation leverages state support to expand aggressively.
And that’s the rub as the S.C. Senate begins debating the 2026-27 state budget. MUSC is asking for even more in hopes of spending your money to acquire private facilities. This has been a recurring spin-cycle. Since 2020 alone, MUSC has received from the taxpayers of our state: $389 million for a Children’s Hospital in Charleston; $325 million for a new Medical Center in Nexton; $300 million for a Medical Pavilion in Indian Land; $1.1 billion for a new Cancer Hospital; $111 million to purchase Palmetto Primary Care facilities in the Lowcountry, Midlands and Myrtle Beach. And the list goes on.
Since 2020 alone, that’s more than $1.9 billion of your tax dollars!
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RELATED | MORE SCRUTINY OF MUSC
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Meanwhile, rural and community hospitals that receive little or no recurring state money struggle to keep their doors open. South Carolina has seen six rural hospital closures since 2010, with eight more (31% of the state’s rural facilities) now at risk.
We’re subsidizing the 800-pound gorilla in Charleston — which dominates the market with nearly $2.5 billion in net patient revenue and a statewide network of 16 hospitals and 2,700 beds — while independent providers across our state fight for survival.
That’s not pro-healthcare; it’s pro-monopoly.
We can fix this without reducing access to care and without propping up one favored institution. Here’s how:
- Refocus the mission of MUSC – providing necessary health care services in areas where private hospitals and practices struggle to even break even.
- Replace blanket appropriations with competitive, performance-based grants that reward outcomes (new rural clinics opened or primary-care doctors placed in underserved counties to name a few) instead of handout.
- Offer tax credits to private hospitals and practices that expand charity care or locate in high-need areas — letting the market deliver services instead of the bureaucracy.
South Carolina families shouldn’t have to pay twice for the same hospital bed. As the Senate debates 2026–27 budget in the next few weeks, let’s end double-billing taxpayers, and build a healthcare system where tax dollars supplement care for the truly needy.
I’m ready to lead that fight in the General Assembly, and I hope my colleagues will join me. Our people deserve healthcare that costs them once — not every April 15 and again every time they walk through the door.
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ABOUT THE AUTHOR…
Wes Climer is a candidate for the U.S. Congress. He represents the citizens of S.C. Senate District 15 in the S.C. General Assembly. He resides in Rock Hill with his wife and five children.
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9 comments
I’ve built my business in healthcare and Sen. Climer is 100% correct here.
Mike, remind us how much of your business is built on billing the federal or state givernment.
Yeah, but I don’t think you’ll find Burkhold’s businesses on the State appropriations budget, IN ADDITION TO billing fed and state programs for services rendered- which is the main issue with MUSC that Climer is pointing out. It would be like having a construction company that obtains and performs on federal and state DOT contracts, but also gets direct appropriations from the gov’t that its competitors don’t receive.
Great article Sen. Climer. MUSC needs to divest itself of all its metro-area media facilities outside of its core campus in Charleston and focus on the poor rural areas that don’t have sufficient care, instead of gobbling up facilities in the Midlands, Myrtle Beach metro, and the greater Charlotte metro areas in SC and competing unfairly with private enterprise.
I can’t wait for him to get to US Congress!
I have been on Medicare for a year now, and it is the absolute best, least expensive, most comprehensive coverage I have had my entire life. The problem with Mr. Climer and all Republicans is that they are doing nothing to lower the cost of health care for average Americans. In fact, in the last year, we have seen health insurance premiums soar, and all Republicans seem to care about is how we can cut benefits for middle-class Americans so that we can cut more taxes for rich people. Our country is in a mess. We are running up massive deficits, and the only options the Republicans can come up with are hurting middle-class working people and cutting taxes on rich people and corporations. In the realm of health care, the average middle-class working American pays more for health care than the people of any other country in the world, and they have nothing to show for it. We have a shorter life expectancy, higher infant mortality rates, and our people are generally less healthy than those of most other first-world countries. Yes, people in Canada and Europe pay a little more in taxes than we do, but we are paying more for health care than they are in higher taxes, and experiencing substandard results.
Our current health care model is not working for most Americans. I spent most of the last thirty years afraid to go to the doctor because, as a small business owner, being diagnosed with a pre-existing condition was an insurance nightmare, as it was for any person who lost their job and insurance coverage. After the ACA, I no longer had to fear losing health insurance, but I was paying huge premiums for insurance with a high deductible. Only when I was able to go on Medicare did I see my cost of care drop significantly.
To Mr. Climer and other Republicans, you are totally missing the point. This whole article was a complaint about MUSC, but nothing you are bitching about and proposing would reduce the cost of health care for the average person in South Carolina. And please don’t give me that spurring competition BS. You guys have been selling that scam for decades, and not one time have Americans seen their cost of health care go down; and Americans don’t want to call around to doctors all over the country to see who will give them the cheapest brain surgery. Politicians are on the health insurance industry payroll. Insurance industry executives are making billions of dollars every year on the backs of Americans forced to buy their overpriced, inferior products. It’s time to open Medicare to everyone and let the private insurance industry compete with that.
Obama and Butthead sure made a mess
Typical communist supporting communisism
As long as no other country wants to copy or emulate our health care system, I think that’s a good indication that maybe America needs to copy or emulate other health care systems.
I don’t care. If someone gets healthcare because of the maybe… $150 a year that I pay in taxes that could (assuming if my math is correct) go directly to MUSC, good. I don’t care that they recruit specialists or build more facilities. In the long run it’s better for the state. And plenty of MUSC grads stay in the state and work outside of Charleston.
Even in rural areas.