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Scott Brinton

‘Medicare for all’ could cost you a bundle


I’ve resisted writing about the Democratic presidential primary, lest readers interpret my criticism of a candidate as an endorsement of Donald Trump. It isn’t.

That being said, I am compelled to write about Sen. Bernie Sanders — specifically, his prescription for socialized health insurance, known as “Medicare for all.”

The phrase is catchy. Most Americans love Medicare. Most understand that the system is efficient and effective. So, Sanders’s logic goes, why not extend the system to all Americans?

It’s a tempting idea. The lure of Canadian-style medicine is strong. We hear how cheap it is, how universal it is. Millennials, saddled with tens of thousands of dollars in student loan debt and yearning to break free of their parents (who can blame them?), are buying into Sanders’s message big time. In a recent Quinnipiac poll, 53 percent of Democratic voters under age 35 supported Sanders, compared with 3 percent who supported former Vice President Joe Biden.

Is anyone, though, taking the time to study the implications of Sanders’s proposal? If you haven’t, hear me out.

The bottom line is this: Medicare for all could cost you thousands of dollars a year. And after Trump’s 2017 tax “reform” plan, which is costing many Long Islanders thousands (owing to the loss of the state-and-local-tax deduction), we can’t take any more additional costs.

Let’s begin with the false notion that socialized medicine is free. It isn’t. It must be paid for through taxes. Sanders (and Sen. Elizabeth Warren) are suspiciously fuzzy in their math. Essentially, they plan to tax the rich to pay for socialized health insurance, among other programs.

That, too, is a tempting notion, except if you’re rich. The trouble is, we should spend our federal dollars to cut our deficit and debt — both of which, thanks to Trump’s profligate spending, combined with a massive corporate tax cut — have risen exponentially, and are unsustainable long-term.

Yes, a hundred times yes — Republican budget hawks were right to want to curb spending and reduce the deficit and debt. I say “were,” and not “are,” because Washington’s fiscal conservatives mysteriously disappeared when Trump took office in 2017.

Anyway, let’s assume for a moment that the U.S., under a President Sanders, adopted Canadian-style socialized medicine. Canada is an excellent country to study for comparison’s sake. It’s close to the U.S. It’s a highly developed, Democratic, largely middle-class nation, like the U.S. — the average per capita income here is $53,000 a year, compared with $50,000 a year in Canada.

According to the Canadian Institute for Health Information, Canadians, on average, pay $6,604 a year in taxes that go toward health care. There isn’t a specific health tax, so the figure is an estimate. They also pay an average of $2,830 a year in out-of-pocket expenses — the Canadian health insurance system doesn’t cover the cost of drugs (except in hospitals) or eye and dental care.

So, the average Canadian pays over $9,400 a year for health care. Wealthier Canadians pay more than that. Poorer Canadians pay less.

Seventy percent of Canadian health care costs are paid for through public funding — tax dollars — and 30 percent through private dollars — one’s personal budget.

In the U.S., 49 percent of health costs are covered by public funding — Medicaid, Medicaid and Affordable Care Act subsidies (tax dollars, that is). Fifty-one percent are funded through employer-based insurance, according to the CIHI.

According to Investopedia, the average insurance premium for a family of four here is $20,576 a year, 71 percent of which — or $14,608 — is paid for by an employer. That leaves said family with an average premium of $5,968 a year.

With out-of-pocket costs factored in, the average American family — not individual — pays $8,200 for health care, according to the Kaiser Family Foundation. Individuals pay less. That’s important to remember, because the $9,400 figure cited above for the average Canadian is the cost per individual.

Even with about a thousand dollars a year in Medicare/Medicaid payroll taxes factored in, the average American family pays less than an individual Canadian.

There is no question that the United States spends more — a lot more — on health care than Canada —$13,722 per person here compared to $6,448 there, according to the CIHI. However, the average American household assumes less of the cost of health care than does the average Canadian household — largely because, in a majority of cases, our employers assume the lion’s share of the cost.

If we suddenly switched to a Canadian-style health insurance system, do Sanders and Warren supporters believe U.S. employers would give the money they saved in insurance premiums to their workers, even in part? Many might, but many might not, particularly big corporations that can invest those dollars in overseas operations.

Enough talk of revolution. The ACA — a.k.a. Obamacare — was a sound step in the right direction toward insuring a greater number of Americans. It was evolution.

Next time: Why does the U.S. spend so much on health care, and what can we do about it?

Scott Brinton is the Herald Community Newspapers’ executive editor and an adjunct professor at the Hofstra University Herbert School of Communication. Comments about this column? SBrinton@liherald.com.