UPDATE: Michigan: Abdul El-Sayed releases detailed Single Payer proposal

2018 MIDTERM ELECTION

Time: D H M S

UPDATE: OK, it looks like El-Sayed's campaign has already released his plan details after all. I'm reading it over now and will update with my thoughts later today.

UPDATE Midnight Wednesday: Scroll down for my initial thoughts (more tomorrow)

Later today, Michigan Democratic gubernatorial candidate Abdul El-Sayed is expected to release his plan for a state-level single payer healthcare system for my home state of Michigan:

A Democrat running for governor in Michigan is supporting a tax increase to pay for a statewide government-run health-care system, going further than his party’s candidates in other parts of the country who are also calling for expanded coverage.

Abdul El-Sayed, a physician and former Detroit health director running in a three-candidate Aug. 7 primary, said he’ll unveil a detailed plan Wednesday that seeks to place residents with private health insurance or Medicaid into a single-payer system run by Michigan. Recent polls show El-Sayed in third place among Democrats in the primary.

Full disclosure: I've been openly supporting one of the other Democratic candidates, former state Senate Minority Leader Gretchen Whitmer for Governor for quite some time now for a variety of reasons. However, I've also said that I'd be fine supporting El-Sayed in November if he manages to win the nomination in August, and I'm interested in seeing what he has in mind today.

...El-Sayed is doing what many other candidates have avoided by spelling out his plan and saying which taxes he’d raise to finance it. He said it would be disruptive to the health-care system and move many off existing plans, but emphasized that it would save money on health care for businesses and families.

I give him credit for being up front about both the cost and disruption factors...in fact, as anyone who's followed me for a long time knows, it's the disruption factor which I've always found to be more problematic re. other single payer proposals than the cost side (I have no problem eliminating the massive tax cuts we've provided at both the federal and state level on the wealthy & corporations over the decades, after all). If El-Sayed is completely frank and realistic about both of these issues--including the fact that yes, there would be a tax increase for the rest of us as well--I'll give him major props for honesty regardless of what I think about the plan or its feasibility itself.

...In Michigan’s race for governor, the other two Democrats are backing expanded health coverage but don’t go as far as El-Sayed. Entrepreneur Shri Thanedar vows on his website to “fight for universal health care coverage” without getting specific, while former state Senate Minority Leader Gretchen Whitmer says she’ll “work with anyone who wants to expand coverage.”

With the caveat that I'm supporting her, it should be noted that Whitmer was the one who, as Senate Minority Leader, championed and helped push ACA Medicaid expansion for 680,000 Michiganders through a completely Republican-controlled state government, which was one hell of an impressive accomplishment (granted, GOP Gov. Rick Snyder supported Medicaid expansion at the time as well, but the Michigan GOP has become one of the most extreme in the country over the past couple of decades).

I should further note that 5 years later, even as El-Sayed was announcing his new plan, those very same Republicans just sabotaged that very Medicaid expansion program by adding pointless, onerous work requirements to the program which will likely result in tens of thousands of those people being kicked off their healthcare coverage...and Whitmer isn’t in office anymore to fight back against it. There's still hope that Gov. Snyder will veto the bill.

Anyway, back to El-Sayed’s proposal:

...In a move sure to draw fire from his Republican rivals, including front-runner and state Attorney General Bill Schuette, Ed-Sayed’s plan would raise billions of dollars from a tax on business earnings and a surtax on incomes across the spectrum, but heavier on top earners.

Again: Depending on the specifics, I'd be fine with doing this...but the devil will be in the details, and obviously this would be a lightning rod for political attacks.

The single-payer plan would face opposition in the state legislature, controlled by the GOP. Democrats would have to win control of the state House, and possibly the Senate, for his plan to have a chance, he said. If the state were to approve the plan, the Trump administration would have to grant waivers from federal rules; President Donald Trump opposes single-payer health care.

This is something which I don't think most people understand: Any plan which requires repurposing federal funding (i.e., shifting the money currently going towards Medicaid, ACA subsidies, etc.) would have to be signed off on by whoever's running the show at the Centers for Medicare & Medicaid...which of course would be Trump appointee Seema Verma at the moment.

“This is a serious plan, and it’s upfront about the tax increase required, which is often just an asterisk in single payer proposals,” said Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation. “A single payer plan like this has the potential to provide universal coverage while saving money.”

I have great respect for Larry Levitt; if he takes it seriously...I'll take it seriously. However...

...The proposal is unlikely to succeed given a maze of obstacles, especially at the state level, said Timothy Jost, a professor emeritus of health law at Washington and Lee University School of Law. He said that any single payer system would probably need to be implemented at the federal level, where it’s opposed by Republicans and many Democrats.

...I also have great respect for Tim Jost.

El-Sayed said advocates of single payer systems in Vermont and California haven’t succeeded because they weren’t upfront about the tradeoffs and "failed to properly message this and build public support."

Again, good for him for making this point, although there are also other, more tangible obstacles which Vermont in particular had to deal with (not only does it have a tiny tax base to work with, it's also physically very small, meaning a high percentage of out-of-state workers/companies, etc, which would've made the logistics very tricky).

It actually occurs to me that while the article mentions Vermont and California, it didn't mention Colorado's recently-failed single payer initiative ("ColoradoCare"), which seems like a closer parallel given that of those three states (VT, CA, CO), Michigan is closest to Colorado both geographically and population-wise (9.9 million vs. CO's 5.6 million, as opposed to VT's 620,000 or CA's 39.5 million).

Anyway, consider this post a placeholder for now; I'll update it with my thoughts once El-Sayed actually rolls out his full plan.

UPDATE: Given how long this entry was getting, I've moved my actual analysis of the Michicare proposal to a separate blog entry.