As a private pediatrician whose practice is 50% public aid, I was touched by the editorial by Dr Rivara “Sustaining Optimism,”1 which highlighted the loss of philanthropy by physicians toward needy patients in our own country. In my community, as in his and many others, only a few providers accept Medicaid. I was, however, surprised that he advocated expanding our unsuccessful publicly funded health insurance to cover even more people. The failure of the system is not simply the failure of physicians to be generous. Perhaps young doctors like me are not more enthusiastic about universal health care because of the obvious failings of Medicaid, as evidenced by the small fraction of physicians who participate. Let's make the program work for doctors, patients, and government budgets alike before we talk about expanding its enrollment.