In the past three years, talk of overhauling the U.S. healthcare system from its current patchwork of public and private coverage to one where the government assures coverage for all citizens has gone from the fringes of the progressive left to a popular platform point among Democrats. This summer, two separate plans to bring universal healthcare to Michigan have been proposed by gubernatorial candidate Abdul El-Sayed and state Rep. Yousef Rabhi, D-Ann Arbor.
Both El-Sayed’s “MichCare” and Rabhi’s similarly named “MiCare” plans would create a taxpayer-funded, government-administered health insurance system at the state level. The two plans are much the same in more than just their names. Both would ensure that all Michiganders would receive some level of health coverage that would be funded by a combination of federal Medicaid and Obamacare dollars, a new payroll tax and a progressive income tax where the rich are taxed more on their higher incomes.
On the surface, El-Sayed and Rabhi have great, if nearly indistinguishable, plans. According to the newest polls from Gallup, a majority of Americans (56 percent) believe that it is the government’s responsibility to ensure access to health insurance and a plurality of Americans (45 percent) view the healthcare industry either somewhat or very negatively. So, one could rationally expect that universal healthcare plans like Mich/MiCare would be a slam dunk with voters. Well, I am not so sure. Just as with previous attempts at healthcare reform like the Affordable Care Act, a statewide universal healthcare scheme will be a complicated sell to voters.
The biggest fights over any single-payer reform will be centered around cost. The belief that healthcare is a human right, one I wholeheartedly share, is all well and good—but, as they say, money talks. Both El-Sayed and Rabhi claim their plans will save Michigan billions of dollars; El-Sayed’s policy team projects that the average Michigan family will save $5000 a year under his MichCare plan. El-Sayed’s plan would, his campaign claims, also reduce Michigan’s sky-high auto insurance rates because it would take over much of the health coverage for auto accident survivors. However, conservative critics of single-payer assert that voters would not accept a tax increase.
I hope that Michiganders would realize that a payroll tax increase means that they no longer have to deal with ever-increasing private premiums and copays. Nevertheless, El-Sayed and Rabhi will have to give due attention to the taxation element of their plans. Per Pew Research in 2015, 61 percent of Americans say the feeling that the wealthy do not pay their fair share of taxes bothers them a lot. The common argument against publicly-funded benefits is that middle- and working-class families would subsidize healthcare, education, etc. for the rich. Now, the progressive income tax in both plans would be a potent antidote to this fear as the rich, not the middle and working classes, would be paying proportionally more. Therein lies the kicker: to move to a progressive income tax, an amendment to the Michigan Constitution would need to be passed by ballot initiative. That will not be easy. While the promise of universal healthcare could be enough of a carrot to get voters to the polls to vote on such an amendment, first Democrats would have to get a two-thirds majority vote in both the State House and State Senate, both of which are currently controlled by the GOP.
Another conservative argument, advanced by the Heritage Foundation, is that single-payer systems would create a government monopoly on healthcare that would reduce competition that keeps prices low. Well, to the Heritage Foundation I say: I do not see competition lowering prices in our current system. Instead, essential medications like insulin and EpiPens have had their prices skyrocket in recent years. In fact, price-suppressing competition would likely experience a boom under Mich/MiCare as drug and medical tech companies would be forced to compete with each other for contracts to be added to the state’s formularies — the list of things insurance will cover.
The biggest argument that will be used to spook voters out of supporting single-payer is also the toughest to circumvent. The claim—one used by President Trump last year—that a single-payer system would bankrupt the United States will also be used at the state level. Everyone knows that healthcare is expensive and getting even more so. In 2016, U.S. health spending was $3.3 trillion, and spending has increased by about four to six percent (132-198 billion dollars) every year for the past decade, according to the American Medical Association. While renegotiating drug prices and cutting expensive red tape will likely cut down on costs, there will still be fear that spending will continue to increase, and with it, drain Michigan’s coffers dry.
To truly reduce cost and prevent financial ruin, any single-payer plan must also invest heavily in public health. We must address issues like the opioid epidemic and obesity; not only do these problems ruin lives, they are also incredibly expensive. Switching to single-payer without addressing how clinicians prescribe opioids and increasing access to medication-assisted treatment will end up costing big.
Finally, there will be worry that moving to single-payer will cost jobs in the private insurance industry. This is a valid concern that I do not think advocates for universal health care have addressed nearly well enough. While MichCare and MiCare have already been drafted, perhaps a reasonable amendment would be to have the state contract out the administration of this plan to private, non-profit health management organizations instead of administering it themselves. This is similar to how France’s system, rated best in the world by the World Health Organization, functions.
State-level single-payer healthcare has been attempted before in California, Nevada and Vermont, but has so far failed to materialize. In order for either El-Sayed’s or Rabhi’s plans to become reality, Democrats would have to retake the governorship and both houses of the state legislature, a mammoth task considering gerrymandering. They would also have to contend with reluctance within their own party, an uphill battle to amend the state constitution and a White House that would most likely make rerouting federal dollars to a single-payer system difficult.
I am not saying that a single-payer system for Michigan is impossible. In fact, I sincerely hope it happens and happens soon. The challenge for advocates of these plans is selling single-payer to Michiganders. If they get the pitch right, though, it could make those obstacles a lot more surmountable.