In a January Gallup poll, voters ranked health care the top issue for the upcoming U.S. presidential election.
As Michigan votes in its presidential primaries next Tuesday, March 10, northern Michigan health care workers say local health care challenges are similar all over the country.
It signals a system in need of fixing, some say.
Access is the big obstacle to health care in the region, doctors say.
They also add that there’s a shortage of primary care doctors and specialists. There’s not enough psychologists and psychiatrists, to name a few.
And being in a rural region, there’s scant resources for treating opioid use disorder. For some, it’s even a challenge to get to the doctors office.
Traverse City Ophthalmologist Dr. Peter Sneed says he often schedules longer appointment times so he can fit in procedures for his patients.
“They have to drive three hours from Alcona or Rogers City or something like that and to come into my office and be told, ‘Ok this is what you have and we need to do something for you and we’ll schedule that,’” he says. “They’re like, ‘I just took a day off work, I drove all this way and I have to come back again?’”
Sneed says he hears a lot about patients’ struggles to afford their health care.
Area doctors report fielding calls from patients surprised by the price of their prescriptions or have patients bemoan the rising cost of their deductibles.
Sneed says he’s trying to cut costs for his patients. As the president of the Northern Michigan Physicians Organization, he’s helping build a medical imaging center.
“That is a lower cost but still high quality (option) for people to get cat scans and MRIs and things like that,” he says. “Right now there’s a lot of people who will leave the area because the cost (of imaging) is so high in northern Michigan.”
On the provider side, Medicaid rules pose a challenge for some doctors.
Cadillac Allergist Dr. Martin Dubravec says the current system limits Medicaid patients to doctors who are Medicaid-enrolled providers. He says those doctors are subject to rules that complicate their practice.
While he’s not an enrolled provider, Dubravec says he’s tried to see Medicaid patients anyway, because he’s the only pediatric asthma specialist in the region.
“I would often see these patients either at a reduced rate or free of charge if need be,” he says. “I cannot take care of those patients anymore because (Medicaid) won’t honor these prescriptions.”
Dubravec says Medicaid wouldn’t accept the prescriptions, laboratory orders, or X-rays, so the full cost falls on the patient.
Michigan hospitals also struggle with Medicaid reimbursement rates that don't fully cover the cost of patient care, says Laura Appel, senior vice president at the Michigan Health & Hospital Association (MHA).
“The people who serve our patients, the nurses and other attendants who are in our hospital and do amazing work,” Appel says. “If you are paying less than the cost of delivering those services, how do you keep up with the salary and benefits those who are delivering patient care deserve?”
Still, she says her hospitals are grateful for the state’s expanded Medicaid program called Healthy Michigan.
“The number one thing my members would say is don’t take that away,” Appel says.
That’s something the current leading Democratic candidates say they’ll protect.
U.S. Senators Bernie Sanders and Elizabeth Warren are running on a Medicare-for-all platform, or a single-payer government program.
Former Vice President Joe Biden wants to build on the existing system under the Affordable Care Act and expand Medicaid access.
President Trump says he wants to repeal the Affordable Care Act and replace it with a plan that allows private insurance companies to compete for customers.
Northern Michigan doctors say it’s important to ask questions about what these plans would mean for patients.
Sneed says he wants to know more about what single payer system candidates have proposed.
“Does it mean I will be able to get medications?” he says, “Does it mean I will be able to see whatever doctor I want to see?”
Dubravec says people should look at other national health care systems and compare the standard of care. He says Canadians are generally happy with their national health care, but it has problems, like long wait times.
“In Canada the average time to read an MRI by a radiologist is over 90 days,” Dubravec says. “That’s just not acceptable.”
He wants the focus of reforms to start at the doctor-patient experience.
“So what is it that is interfering with a relationship a patient has with his or her physician?”
Dubravec says he’s taking a hard look at the plans and how the federal government could pay for services northern Michigan needs.
Editor's note: A version of this story that aired Monday March 2nd and Tuesday March 3rd incorrectly said U.S. Senators Elizabeth Warren and Bernie Sanders are running for president on a Medicaid for all platform. They are in fact running on a Medicare for all platform. The story has been corrected.