congolese friend once told me that you can judge the wealth of a nation
by the condition of peoples teeth. His words came to mind when
I met with Sonja Norris, the director of Ingham County Dental Clinics,
two facilities offering dental treatment on a sliding payment scale.
Norris says the teeth of low-income adults and children in Ingham County
are in horrible condition: Most children have severe decay in
the back and front teeth, so that many cant even bite potato chips
People who criticize the state of health in America, especially for
the poor, have demanded sweeping reforms in health care for decades.
One might still remember Bill Clintons election to office in 1992,
on the campaign promise of a national health care system. The United
States, after all, is the only wealthy industrial nation without one.
A decade after this unfulfilled campaign promise, affordable quality
health care remains a central political concern across the country today.
How do Mid-Michigan residents feel about this issue?
Sonja Norris, the director of Ingham County Dental Clinics, says
the teeth of low-income adults and children in Ingham County are
in horrible condition: Most children have severe decay in
the back and front teeth, so that many cant even bite potato
chips or burritos.
begin back at the dental clinic. Norris, a Lansing resident born in
Ann Arbor, thinks universal health care is the broader solution, and
says shes angry about the labeling of people without health insurance
as underprivileged: Its not a privilege to have
health care, or to be healthy. Its a right.
In 2001, the director and her 13-person staff treated 1,502 low-income
adults at the Cedar Street Center Dental Clinic, and 1,545 children
at the Healthy Smiles Clinic. Both clinics are subsidized by Ingham
County. The number of low-income patients has risen since 2002, when
she says 1,956 children were treated. Patients pay a $3 fee per visit,
and their treatment costs are reduced 50 percent to 100 percent, depending
upon family income and size.
Norris says that if dental problems remain untreated before children
develop their permanent set of teeth, this can severely influence their
overall sense of well-being: Children remember how they felt when
they were 4 years old. This is the time when we develop our self-love.
Children with painful memories will have trouble with low self esteem.
Bruce Miller, director of Ingham Countys Community Health Service,
thinks the area is in need of more subsidized medical care, particularly
dental care. Many people are not getting their broken teeth fixed,
because the dentists in town are busy seeing people who have money and
insurance. In contrast, residents covered under the Medicaid program
had very restricted access to dental care, and uninsured people must
wait for months to receive a dental appointment.
tells me that Ingham Countys cost-reduced clinics are currently
unable to catch up with the growing need for their services. And the
three private pediatric dentists in Lansing dont accept Medicaid
children. A nationwide epidemic of asthma is causing more work for an
already overworked staff. According to Norris, children suffering from
asthma frequently take medication that causes dry mouth, increasing
the risk of cavities and tooth decay. Without preventive care and education
as children, says Norris, adults often experience severe abscesses.
And poor oral health leads to many other health problems.
The dentist expressed worry that many more children and adults will
come to the low-income clinics when Gov. Jennifer Granholms 2004
proposed budget plan goes into effect. The Granholm administration proposes
cutting some optional benefits for the general Medicaid population.
About 130,000 so-called healthy adults will lose access to chiropractic,
podiatry and non-emergency dental care.
If Medicaid is cut, we have a problem, said Norris, a dentist
in a private practice before she became dental director in 2001. Our
dental clinics will be extremely full and very busy.
Some 30,000 Ingham County residents have no health insurance, and an
additional 20,000 are covered under the Medicaid program. In 1998, the
county government launched an effort to match the needs of the uninsured
and underinsured with a project called the Ingham Health Plan. Stepping
in to fill a need that state and national governments werent addressing,
Ingham became the first Michigan county to start an ambitious cost-reduced
medical care project.
The Ingham Health Plan targets low-income, uninsured working people
and their dependents, employed Medicaid recipients who have exhausted
their benefits, other low income uninsured individuals, and medically
indigent individuals. Benefits consist of primary care, specialist physician
services, laboratory, x-ray and pharmacy services. Hospital care is
provided by area hospitals as part of their charity care obligation
or community benefit programs. Ninety percent of the Ingham Health Plan
enrollees have incomes at or below 140 percent of the poverty level.
Residents with an income under 250 percent of the poverty level who
dont receive other coverage are eligible. Once accepted, members
have access to a defined set of benefits through 31 offices in the area.
Patients pay $5 per visit to one of several primary care providers (in
Lansing there are six locations), $10 for specialist visits, $5 for
outpatient x-rays, and usually $5 per prescription.
By the end of 2001 nearly 13,000 uninsured Ingham County residents were
enrolled in the plan. Meanwhile nine other counties have copied the
model: Barry, Eaton, Mar-quette, Jackson, Kalamazoo, Kent, Clinton,
Gratiot and Montcalm.
Another 3,600 low-income residents are enrolled in the Capital Area
Prescription Program (CAPP), designed for any residents of Ingham, Clinton,
and Eaton counties who do not have other drug coverage. Owners of a
CAPP card can get prescription drugs at participating pharmacies with
an average discount of 20 percent.
In April 2003, Ingham County applied for a $500,000 federal grant to
receive funding for a third subsidized dental clinic. If built, the
facility would become the eighth in a network of reduced-cost medical
clinics in Lansing. The new dental clinic would be established at the
St. Lawrence Community Health Center, located in a professional building
next to the former St. Lawrence Hospital. The federal grant would also
provide funding for staff, a new mental health program, and seed money
for an expanded medical clinic.
Miller believes the application has a good chance of being approved,
because the health care needs in the targeted area of Lansings
westside neighborhoods are apparent. A project summary shows dramatically
that 60 percent of St. Lawrences health center users are uninsured.
The report concludes that the evident health disparities are disturbing,
especially for newborns. The mortality rate of African-American infants
in the area is 15.1 per 1,000, as compared with mortality rate of 4.0
per 1,000 for caucasian infants. The overall infant mortality rate is
7.6 in per 1,000 Lansing and 6.8 in Ingham County.
Norris said that a third clinic would be the only way to accommodate
the communitys needs if Medicaid cuts are to occur. The new facility
could be in operation as early as October 2003, providing service to
another 1,500 patients. Although the county government is doing all
it can to provide help for the underinsured, Miller believes that building
a new clinic is only the tip of the iceberg.
Asked whether he found the Ingham Health Plan a sufficient means of
meeting the needs of the underinsured, Michigans Green Party chairman,
Marc Reichardt, answered: Its hard to say that its
not a good thing, as the county is responding in the only way it currently
can. Reichardt argues that too many programs are designed to treat
symptoms, while nothing is being done to improve the entire health care
system. Added Reichardt: What happens to Ingham County finances
as the income gap continues to rise and the economy continues to suffer?
What will they do when the number of low-income residents doubles or
triples in a short period of time?
Reichardt said Granholms recent plan to provide Medicaid to an
additional 62,000 residents was an example of what he called poking
away at the symptoms.
Those residents have income levels at or below 35 percent of the federal
to federal poverty level measures, a family of four that makes less
than $18,400 per year is considered impoverished. Noting the income
limitations, Reichardt feels Granholms plan has little to do with
reality: Anyone with a shred of common sense knows that its
difficult to survive alone at that level, much less with a family of
four. What the governor is suggesting for the new state Medicaid
budget is that a family of four must make no more than $6,440 per year
to qualify for free health care. Added Reichhardt: Many people
who enjoy annual incomes in the $20,000 range and have family units
of one to two to support still cannot afford regular doctor visits.
I dont think this measure is anything more than a feel-good effort
for public consumption.
Ray Ziarno, Michigans Green Party candidate for secretary of state
in 2002, said that the states difficult financial position is
no excuse for a budget cut of this nature. The North Lansing resident
added that: The longer we wait to change the system, the longer
we forego the benefits of universal coverage. Waiting for the perfect
time to make the change is a losing approach, and displays a lack of
When asked what they thought of universal health care, physicians, legislators
and other area professionals generally showed enthusiasm but did not
seem to think this was a realistic option. Norris said that like many
other physicians, she believed universal health care was a wonderful
idea but that it might be too difficult to implement.
According to the Kaiser Commission on Medicaid and the Uninsured, a
Washington-based policy institute analyzing health care coverage and
options for reform, universal health care is not so much a matter of
money. A Kaiser study recently published in Health Affairs estimates
the cost of medical care for the nations 41 million uninsured
at roughly 3 percent to 6 percent of total health care spending. The
study concluded that universalizing national health care would range
from between $34 billion and $69 billion per year, depending upon the
approach taken. According to the Kaiser Commission, this would be a
very worthwhile investment when considered against the benefits of improved
health, increased longevity, and potentially greater national income.
Reichardt points out that we spend $350 billion per year on the
Pentagon, and need to shift priorities. In fact, plain numbers
show that the cost of universal medical coverage for the entire country
would be less than the approved 2003 budget increase for military spending
($46 billion). Reichardt just may have a point.
One of the Democratic candidates running for 2004 presidential nomination,
Dennis Kucinich, has announced that he would adopt a policy of Medicare
for All a universal, single-payer system of national health
insurance that could be carefully phased in over a 10-year period. Kucinich
wants to remove private insurance companies from the system, along with
their waste, paperwork, profits, excessive executive salaries,
advertising, and sales commissions and to redirect resources into
actual treatment. Funding would come primarily from existing government
healthcare spending (more than $1 trillion), and a phased-in tax on
employers of 7.7 percent (almost $1 trillion). According to Kucinich,
companies with private insurance plans currently spend more than 8 percent
of their budget on employee health care costs.
The presidential candidate points out that publicly financed, privately
delivered health care has worked well in other countries, none of which
spend as much per capita on health care as the United States. Were
already paying for national health carewere just not getting
it, Kucinich said. He points to a study conducted by the General
Accounting Office, which concludes that if the United States were to
shift to a system of universal single payer coverage, as Canada has,
the savings in administrative costs (10 percent for private insurers)
would more than offset the expenses.
Ann Arbor resident Reichardt agrees, pointing out that initiatives at
the local and state level were easily attainable. He mentioned recent
legislation in Maine, where two weeks ago Gov. John E. Baldacci signed
Dirigo Health, the nations first universal health
care plan, into law, establishing a new public-private agency. The plan
works with private insurers to provide health care coverage to 180,000
uninsured Maine residents by 2009, according to the Bangor Daily News.
to expanding Medicaid eligibility, the plan provides coverage to self-employed
residents, and people whose employers do not offer health insurance.
To finance the universal health care plan, Baldacci is using $52 million
of Maines share of state aid (packaged with recent federal tax
cuts), a 4 percent fee on state insurance company gross revenues, premiums
paid by employers and the self-employed, and Medicaid funds.
While the State of Michigan no longer has the basic funds needed to
keep schools open, or clean up its pollution, another $10.3 billion
in tax dollars from state residents were paid to the Pentagon in 2002.
County Commissioner Lisa Dedden, who chairs the Ingham County Human
Services Committee, said she was aware that even recent attempts to
establish new clinics for underinsured residents were not a general
solution for Inghams health care problems. In a way were
only filling the gap, Dedden said.
Blue Cross and Blue Shield is Michigans largest health insurance
provider, providing coverage for more than half of the states
working population. Referred to as the Blue Whale because
of its size and political influential, the not-for-profit health care
provider is a major contributor to both Republican and Democratic candidates
A 2001 report issued by the Michigan insurance commissioner, Frank Fitzgerald,
found that BCBSM had serious problems, including $400 million in losses
in its small group market, archaic technology, and a cumbersome board
and management structure. Fitzgerald criticized an apparent conflict
of interest in which representatives of medical providers sat on Blue
Crosss 35-member board. Also, the board is dominated by
self-insured interests who only use Blue Cross Blue Shield of Michigan
for administrative services, yet they set policies concerning Blue Cross
Blue Shield of Michigans underwritten book of business,
Ingham Health Plan
Member Services at (517) 887.4465, or 1-866-291-8691 (toll free)
Community Health Centers in Lansing
Health Services, 5303 S. Cedar St. (517) 887-4302
Plaza (Teen Services), 306 W. Willow St., (517) 484-9292
Wellness Center, 500 E. Thomas, (517) 484-2352
Clinic, 100 B S. Main Street, (517) 589-9585
Hospital, 1320 E. Michigan, Ste. 308, (517) 487-2341
Lawrence Hospital, 1100 W. Saginaw, Ste. 500, (517) 482-1123
Smiles Dental Clinic, 2815 S. Pennsylvania Ave., (517) 272.4150
Area Prescription Program
Ingham County Health Department, Registration and Enrollment
Unit, 5303 South Cedar St., Lansing, MI 48911.
Right to Independent Review Act
Most health benefit policies from health insurers, Health Maintenance
Organizations, Alternative Finance and Delivery Systems, and
Blue Cross/Blue Shield of Michigan are eligible for review under
Michigan law. If you are denied a service that you think should
be paid for, call the company that handles your health insurance
and request an internal review.
Step 1: Internal Review Process. The health insurance
company will review the decision and get a final decision back
to you within 45 days. If youre still denied the medical
service, you may request an External Review.
Step 2: The External Review Process is done by Michigan
Office of Financial and Insurance Services staff. Fill out the
external review form that your health insurance company sent
with your Final Adverse Determination. You can get a free copy
from 877-999-6442 (toll free) or (517) 373-0220, or email to:
resident Sylvia Chappell-McCollough is no fan of the Blue Whale. When
we began to discuss the Michigan Green Partys proposal to cut
out the middle man, and Maines example of universal health care,
she said enthusiastically.
The long-time Democrat said that the straw that broke the camels
back was her visit to a doctor last fall. Waiting in line at the hospital
pharmacy counter, she stood behind a senior citizen whod just
received a $250 prescription bill. The little lady practically
fainted. She left the office saying that she really couldnt afford
this, recalls Chappell-McCollough.
this country theres no excuse for not letting everyone receive
coverage and get the drugs they need to stay healthy, she said.
The political consultant emphasized that she preferred pure politics
and hated the heavy-handed power-games that usually dominate the state
capitals political landscape.
She found the health care situation in Michigan upsetting because of
its apparent socio-economical disparities. While 964,900 uninsured Michigan
residents have no idea how to get their teeth fixed or pay for expensive
medication, retired state politicians whove served at least five
years in legislature are guaranteed free dental and health care, with
just a 10 percent prescriptive co-pay. The health premium is operated
through BCBS, and the first generation of politicians aged 55 and older
will start receiving benefits in 2004.
As the former wife of state senator, Patrick McCollough, Chappell-McCollough
has insider knowledge. When the legislature voted to make Blue Cross
and Blue Shield a tax exempt nonprofit insurer as a last resort
in 1980, Chappell-McCollough remembers how the former Michigan attorney
general, Frank Kelley, helped BCBS lobbyist Richard Whitmer (now BCBSMs
president) draft the bill.
According to the annual report of the Michigan Legislative Retirement
System, 247 retirees, spouses, and dependent children received benefits
in 2002. The total benefit package, which includes coverage for medical,
survivor, death, dental and health benefits, was $9,942,870 for 2002,
which is more than double the cost of the program in 1993.
A huge number of politicians and their spouses will receive free
health care for their entire lives, commented Chappell-McCollough.
She pointed out that the Blue Cross and Blue Shield Program was originally
put in place to provide health insurance for low-income people, but
that with growing political influence during the 1990s, its agenda has
completely mushroomed. Added McCollough: Meanwhile
our senior citizens cant even afford prescriptive medicines, and
we have to have a taxpayer-subsidized health care system to take care
of the poor.