Health Care

Medicare for All is not a solution and it is not something that can be "passed," as many are suggesting.  Instead, it is at best the result of what will happen if we do the hard work of addressing all of the problems in our health care system.  I don't see anyone discussing those hard issues.  

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Indeed, simply passing Medicare for All would be devastating to rural Michigan.  It would create immense pressure for doctors to move to urban centers where all the new activity would be.  

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STEP 1 is Addressing the Doctor Shortage

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Before even discussing a Universal Health Care solution, we have to address the massive structural doctor shortage. Here is the true scope of the crisis:

Our healthcare infrastructure is already facing a projected baseline deficit of 86,000 physicians by 2036 due to a rapidly aging population. Simply "passing" Medicare for All would immediately inject an additional 26 million Americans into the insured market. Based on standard metropolitan utilization ratios of 263 physicians per 100,000 people, providing adequate care for those new patients demands an additional 68,000 doctors.

That means a flash-cut policy overhaul creates an immediate, compounded shortfall of over 154,000 physicians.

Right now, even when counting both MD and DO paths, our entire national medical education system only graduates roughly 32,000 new physicians per year. When balanced against accelerating retirements and severe provider burnout, the math collapses. We cannot simply pass a law to generate 120,000 missing medical professionals out of thin air. Urban centers with massive corporate budgets would aggressively outbid rural areas for talent, stripping rural Michigan of its existing medical network.
 

We can't generate more doctors - We need to free up doctor time and availability.

Before changing the payment model, we must free up existing doctor time. Eliminating the predatory administrative burdens that steal over half of our physicians' working hours would instantly double effective medical availability without waiting decades for new graduates.

 

The first step in this process is to get our current doctors back to doctoring.  We actually have plenty of doctors - but they spend more than half their time on administrative matters not related to the patient. Eliminating that administrative burden by itself would essentially double the number of doctor hours available.

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Looked at another way, in the US, a doctor spends 29% of his or her time physically with a patient.  In Denmark and New Zealand, the same doctor spends 80% of their time with patients.  How did they do that? 

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They passed specific legislation to accomplish this miracle.  And it is not easy.  It is very difficult which is why you don't hear politicians talking about it.  

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I will bring this voice to the table.

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The free market will never be able to properly site a hospital

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The US funds its hospitals primarily through insurance payments.  But think about that.  The ideal number of patients in a perfectly healthy society would be zero.  (Other than births and accidents).  In the US, hospitals have no incentive to reduce the number of patients - indeed it is just the opposite. 

 

Perversely, if a community did a good job of making its citizens healthy, the result is that they would lose their hospital.  There just wouldn't be enough revenue.  

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You see that happening every day in rural America.

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Medicare for All would put extreme pressure on this and more hospitals would close.

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STEP 2 is figuring out how to locate and pay for rural hospitals

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The free market alone will never be able to properly site and sustain a rural hospital.

Under our current model, U.S. hospitals are funded primarily through volume-based insurance payments. But think about the perverse incentives that creates: in a perfectly healthy community, the ideal number of hospitalizations would be zero. In the U.S., if a small community does a phenomenal job keeping its citizens healthy, the reward is that their local hospital goes bankrupt from a lack of revenue. We see this tragedy playing out across rural America every single day.

Haphazardly passing a single-payer insurance change will not fix this distribution problem; it will accelerate closures by squeezing thin margins even further.

We must separate hospital funding and distribution from local market demand. Industrialized countries with massive geography—like Canada and Australia—have already figured this out. They federally mandate and centralize infrastructure funding to ensure a medical facility exists within a 1-hour travel window of nearly every citizen.

 

The free market can efficiently operate the internal logistics of these hospitals, but their geographic placement and basic baseline funding must be treated as a critical public utility.

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STEP 3 is reaching the last 5% of rural voters

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Even with centrally stabilized rural hospitals, thousands of families living in deep rural pockets will still reside more than an hour away from an emergency room. We must deploy innovative technology to bridge this final gap through two targeted initiatives:

1. Public Air Ambulance Networks: We must invest in comprehensive, publicly subsidized air ambulance coverage so that trauma-level transport is never dictated by a patient's zip code or out-of-network insurance caps.
2. Telemedicine Medical Pods: We need to fund and deploy automated medical pods driven by remote robotics and AI. By placing these modular, secure pods directly at local rural fire departments, we utilize an existing network of community control.

If a resident experiences a stroke or severe trauma, they can immediately access a local pod to be stabilized before a physical ambulance can arrive from an hour away. A remote physician, utilizing advanced robotic diagnostic tools and high-definition telemedicine, can examine the patient, run preliminary vitals, and safely authorize life-saving early medication.

Because these pods may sit empty for long stretches in remote areas, they cannot rely on insurance claims to survive. They must be publicly funded pieces of infrastructure—just like the fire truck parked next to them.

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There are dozens of other problems that have to be addressed

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What I have outlined here is just scratching the surface.  There are dozens of other problems that need to be addressed.  We have a convoluted, complex and burdensome medical system.  It will take an extraordinary leader to tear this down and rebuild it.  

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But it will happen.  Our trajectory is un-sustainable.  We are spending $6 Trillion on medical care and $1 Trillion on Defense.  At a time when our defense spending needs to double.  

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Think about it.  If we reduced medical spending to about $3.5 Trillion, we would still be spending more than every other country per capita.  But that saved $2.5 Trillion would be more than enough  to cover defense spending and to eliminate our deficit. 

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How to get there?  That is the tough nut to crack.  The current $6 Trillion in spending is made by thousands of unaffiliated parties and entities.  We face a herculean task in fixing this.  One politicians ignore. 

 

I will work to ensure that we actually address the issues at hand and don't haphazardly throw rural Michigan under the bus.

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