Dr. Paul Thomas Says 'Insurance Isn't Enough in Michigan' in Op-Ed

By: Paul Thomas, MD, FAAFP

Michigan’s primary care infrastructure is under enormous strain. Across our state, access is worsening, physician shortages are growing, administrative burdens continue to rise, and the financial foundation supporting primary care feels increasingly unstable. 

I recently wrote a guest column for the Detroit Free Press, and I wanted to share it with you because I believe family physicians have an essential role to play in rebuilding a more affordable, accessible, and functional health care system in Michigan.

Because right now, health care costs are crushing working people across our state. Below is the op-ed:

Bus drivers. Factory workers. Childcare employees. Restaurant staff. Hair stylists. Truck drivers. Paraprofessionals. Early education workers. Small business employees.

These are the people who keep Michigan running every single day. And increasingly, many of them cannot afford to access the health care system built to serve them. Even when insurance is offered through an employer. Even when that insurance is subsidized by state or federal programs. Even when people are doing everything “right.”

We need a different approach.

We need affordable, accessible primary care available to every person in Michigan. We need transparent pricing so patients understand what care will cost before they receive it. We need same-day and next-day appointments that keep patients out of expensive emergency rooms. We need stronger relationships between doctors and patients, with fewer administrative barriers standing in the way.

And we need policymakers, employers, physicians, and communities willing to rethink the status quo.

At the end of April, I was able to visit our beautiful state Capitol Building in Lansing and meet with elected officials, state representatives, and other appointed leaders. The trip made me think critically about what we can all do to improve access to primary care and lower the cost of health care overall.

Because the numbers tell a troubling story.

Roughly 35% to 45% of workers offered employer-sponsored health insurance decline coverage altogether, frequently because premiums, deductibles, and out-of-pocket costs are simply too expensive. Workers earning under $40,000 annually have some of the lowest enrollment rates, largely because they cannot afford the plans placed in front of them.

And here is the cruel irony: Even workers who do purchase insurance often still cannot afford to use it.

Millions of Americans delay care because they fear copays, deductibles, surprise bills, or lost wages from taking time off work. About 40% of workers with employer-sponsored coverage report difficulty paying medical bills or other out-of-pocket costs.

Think about how broken that is.

You work full time. You pay hundreds of dollars every month for health insurance. And you still hesitate to see a doctor because you are afraid of what it might cost.

That is not health care security. That is financial anxiety wrapped in an insurance card.

We are living through a crisis of confidence in the American health insurance system.

As family physicians in Michigan, we see the human consequences of this every day.

Working people with health insurance delay care for high blood pressure because they are worried about copays and deductibles. They ration medications because they cannot afford refills. They postpone imaging studies, specialist visits, and preventive screenings because they fear surprise bills.

And sometimes those delays become catastrophic.

I recently read a Detroit Free Press article about a 34-year-old childcare worker who ignored blood in her stool because she feared the cost of medical care. By the time she finally sought treatment, she had stage 3 colon cancer and overwhelming medical debt.

That story has stayed with me. Not because it is rare. But because it is increasingly common. And because it was preventable.

Colon cancer screening, early evaluation, and affordable access to primary care can save lives. But those interventions only work if people feel financially safe enough to access the system in the first place.

Unfortunately, too many Michiganders do not.

We have created a health care system where access is technically available, but practically unaffordable. Insurance cards do not guarantee care, and health insurance does not equal health care.

Primary care shortages make appointments difficult to obtain. Many offices are booked weeks or months in advance. Patients increasingly turn to urgent care centers and emergency departments because they cannot access timely longitudinal care with a primary care physician who knows them.

This is not sustainable for families, employers, taxpayers, or our broader health care system.

Primary care is one of the few areas in medicine consistently shown to improve health outcomes while simultaneously lowering overall costs. Communities with strong primary care systems see fewer emergency department visits, fewer hospitalizations, fewer unnecessary specialist referrals, and lower downstream health care spending overall.

Yet despite this evidence, the United States dramatically underinvests in primary care. Only about 7% of total health care spending in America goes toward primary care services, while many healthier developed nations invest closer to 14%.

That imbalance has real-world consequences, and we are feeling it in our rates of chronic disease, our life spans, and our health spans.

We spend enormous sums treating preventable complications of diabetes, hypertension, heart disease, and cancer while underfunding the very part of the health care system best equipped to prevent, detect, and manage those conditions early.

In Michigan, those priorities are visible everywhere.

The largest health system in our state operates 20 hospitals, more than 300 outpatient locations, and employs roughly 60,000 people — yet it does not have a single primary care office located within the city limits of Detroit.

At the same time, another major health system is investing $2.2 billion into a gleaming new tower centered around expanded emergency services, oncology, and orthopedics — areas of medicine that generate some of the highest reimbursement rates in the current system.

This is often marketed as “the future of health care.”

But too often, it is really the future of sick care.

Michigan can do better.

The goal should not simply be building larger towers or expanding the most profitable service lines. The goal should not simply be handing people insurance cards.

The goal should be making health care genuinely affordable, accessible, and available where and when people need it.

Real health care looks like having a trusted primary care doctor in your neighborhood — somewhere you can walk or bike to for an annual physical. Somewhere a neighbor could take you for a same-day visit when you are sick. Somewhere you can receive preventive care before small problems become catastrophic ones.

Imagine if we invested $2.2 billion into expanding primary care access across Detroit and throughout every health professional shortage area in Michigan.

We need policymakers willing to invest more aggressively in training and supporting primary care physicians, and ensuring reimbursement is competitive with other specialties. Family medicine physicians are specialists too — specialists in prevention, continuity, chronic disease management, and whole-person care.

We need nonprofit health systems willing to boldly invest in robust primary care networks, especially in low-income communities that have historically been underserved.

We need major health insurers to reimburse primary care at sustainable rates that allow physicians to spend meaningful time with patients rather than racing through rushed visits to satisfy volume metrics.

We need large employers to invest more heavily in preventive care and primary care services for their employees, because healthier workers, healthier families, and healthier communities benefit everyone.

Improving health care access and affordability in Michigan cannot fall on any one group alone. Physicians, hospitals, insurers, employers, policymakers, and communities all have a role to play in rebuilding a system that people can actually trust and access.

As family physicians, we are uniquely positioned to help lead meaningful reform in American health care. We see patients across every stage of life, across generations of families, and across the full spectrum of illness and wellness. We witness firsthand how delayed access, administrative burden, unaffordable care, and fragmented systems affect our patients every single day.

That perspective gives family physicians both the responsibility and the opportunity to work toward robust, sustainable solutions that improve access, strengthen relationships, lower costs, and restore trust in the health care system itself.

Imagine if every working family in our state could access affordable preventive care without fear of financial ruin.

Because no one working full time should have to choose between paying rent, buying groceries, paying for childcare, or seeing a doctor.

No working adult should delay care for rectal bleeding because they are terrified of medical bills.

And no one should go bankrupt because they got sick.

This is one of the defining economic and moral issues of our moment, yet there remains a profound lack of leadership and urgency around it.

As family physicians, we have the opportunity to help reshape the future of health care in Michigan. By working together, advocating together, and investing in robust primary care systems, we can improve outcomes, lower costs, and restore trust in health care for the patients and communities we serve. 

Will you join me in this work?