Medicare for All in Michigan
What would it look like?
LANSING — With the recent introduction of a health care bill in the Legislature and a continued national discussion, the concept of “Medicare for All” remains promoted by progressives as a way to deal with a health system that some believe is inherently flawed.
The term “Medicare for All” refers to government-run and funded, single-payer health insurance that is free to individuals. Some versions include expanding Medicare coverage to include mental health care, dental care, limiting the cost of prescription drugs and more.
The policy is often discussed at the national level, but various statewide legislatures have pursued the idea to some degree.
The recently unveiled state House health care proposal doesn’t address the issue of expanding insurance coverage, but would institute targeted changes to services already available through private and public insurance.
Plan components include capping insulin monthly copays at $50, requiring drug manufacturers to report price increases for designated prescription drugs to state regulators and expanding telehealth by covering services from out-of-state providers.
The legislation is sponsored by 11 Republicans and five Democrats, including Speaker Jason Wentworth, R-Farwell.
Other Republican sponsors are Reps. Sue Allor of Wolverine, Andrew Beeler of Fort Gratiot; Ryan Berman of Commerce Township, Ann Bollin of Brighton Township, Julie Calley of Portland; Bronna Kahle of Adrian, Luke Meerman of Coopersville, Daire Rendon of Lake City, John Roth of Traverse City and Mary Whiteford of Casco Township.
Democratic sponsors are Reps. Sara Cambensy of Marquette, Abdullah Hammoud of Dearborn, Karen Whitsett of Detroit, Angela Witwer of Delta Township and Stephanie Young of Detroit.
John Goddeeris, a professor specializing in health economics and insurance at Michigan State University, said he doesn’t anticipate the plan having much of an effect on the average consumer if it becomes law.
“Some of them may be good ideas and may have important effects on individuals or groups of individuals, but I would say on the whole we’re talking about something much less ambitious than single-payer,” he said.
“I just don’t see a lot here that would have a big impact on the way the system works.”
Those changes are far less extensive than what most single-payer advocates would like to see instituted, like Dr. Abdul El-Sayed, a proponent of Medicare for All.
Nationally, the Medicare for All proposal has gained attention in the last two years with the COVID-19 pandemic and political figures like U.S. Sen. Bernie Sanders, I-Vermont, spotlighting what many advocates say is the need for a better organized U.S. health care system.
El-Sayed, a former Democratic primary candidate for governor and co-author of “Medicare for All: A Citizen’s Guide,” said such a system would benefit both individuals and the economy as a whole.
“Number one is health security,” he said. “That everyone in the country would have a secure source of health coverage that they wouldn’t have to worry about losing if they turned 26, or got married or started or lost a job.”
On the financial front, El-Sayed, a former Detroit health commissioner, said, “We know that 67% of personal bankruptcies are attributable to health care costs, and so taking that off of people’s shoulders is huge as well.” He referred to a 2019 study in the American Journal of Public Health that found that 66.5% of all personal bankruptcies were tied to medical costs,often combined with other financial factors like debts or foreclosures.
The American health care system is already “the most expensive in the world per capita by far, and all of those dollars come out of somebody’s pocket,” he said.
He added, “But also, overall reducing the cost of health care, the amount of money that we pay collectively to provide health care in this country, would drop, and that is a big deal and something that we have to really pay attention to and be thinking about.”
Professor Allen Goodman, who specializes in health economics at Wayne State University, emphasized the large scope of the health care market across the country.
“The U.S. health care industry over the last 15 or 20 years has been somewhere about 18% of the entire economy,” he said. “So between one dollar in five and one dollar in six is spent on health care.”
MSU’s Goddeeris agreed with Goodman’s figure and singled out the cost of insurance-related administration.
“Just the administrative cost is maybe 3-4% of GDP. That’s a lot,” he said. “I wouldn’t say that that’s all wasted, but it is a lot higher than what you see in countries that have a single-payer type system.”
Goddeeris’s estimate of 3-4% of U.S. GDP means that the administration of health care in the country costs between $643 billion and $857 billion annually.
He said the complicated system of private insurance providers and exclusive networks disorganizes the process.
“A lot of that cost is a result of the fact that we have so many different payers,” Goddeeris said.
Experts acknowledged the most common criticisms of single-payer systems, most often centering around the wait time for care, the quality of care and the cost of a nationalized medical system.
Goodman acknowledged that the first concern is likely valid. “You have issues in places like Canada, where for some elective surgeries you do have longer lines, and you may have to wait more for some kind of elective surgeries.”
Goddeeris agreed that such criticism may become a reality if the U.S. initiated a single-payer system.
“If you give everybody free access to health care, then you’re probably going to run into a situation where the number of people that want to get care is higher than it is now and maybe more than the system can handle,” he said.
“Then the question is, how does it get determined who gets care?” Goddeeris said. “Everybody can’t get all the care, probably, that they might like to get, so then you may start to run into things like longer waiting times for services.”
However, Wayne State’s Goodman said, “There’s no evidence internationally that (a) single-payer (system) is going to lead to a decreased quality of care.”
As for objections based on the cost and quality of care, El-Sayed said, “We (already) ration health care in this country. We just decide that we ration it by income rather than by need.
“So, if you are low income in this country, you’re just not getting any health insurance at all.”