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Scott Brinton

Why Berniecrats should embrace the public option


My most recent column, “Medicare for all could cost you a bundle,” was published in the March 6-12 issue. So much has transpired since then.

For one, the world turned upside down.

Two, the subject of that column, Bernie Sanders, ended his presidential bid and endorsed Joe Biden. So, you could argue, that column is no longer relevant. We no longer need to discuss Sanders’s Medicare for All proposal, a single-payer health insurance system controlled by the federal government.

Maybe. But I fear not.

In that column, I wrote that Medicare for All would likely dramatically raise federal taxes for most Americans to fund health insurance for everyone, whereas our current insurance system costs us less because our employers pick up the lion’s share of our premiums.

I compared the United States with Canada. The U.S., I noted, spends $13,722 per person on health care annually, compared with $6,448 in Canada. The average American family, though, pays $8,200 a year for health insurance, compared with $9,200 per individual in Canada.

From a purely economic standpoint, there is thus no incentive to move to a Canadian-style single-payer system — if you have health insurance through your employer, which 91 percent of Americans do, or at least did (I’ll get to that in a minute).

Biden has said he would expand the Affordable Care Act, a.k.a. Obamacare, if elected president, to make sure that a greater number of uninsured Americans are covered, with an eventual goal of insuring everyone.

Democratic presidential primary voters have overwhelmingly voted for Biden, effectively endorsing his centrist approach to solving the nation’s health insurance crisis — and, yes, there is a crisis, and it’s only getting worse by the day.

From 2010, the first year of the ACA, to 2016, the last year of Barack Obama’s presidency, the number of uninsured nonelderly Americans dropped from 46.5 million to just under 27 million, a decrease of nearly 42 percent, according to the Kaiser Family Foundation, which studies health issues. In 2017 and 2018, however, the number of uninsured people increased by about 500,000 per year, as the Trump administration sought to limit enrollment in Obamacare as it worked to dismantle the ACA.

Then the coronavirus pandemic struck. Now an additional 27 million Americans could lose their employer-based insurance because they are out of work, according to KFF. No job, no insurance.

It is, as Sanders points out, a fundamental flaw of our employer-based system. In Canada, if you’re out of work, you keep your government-sponsored insurance. And during a pandemic, you really don’t want people running around without insurance. Sick people need to see a doctor. Period.

The question is, how do we balance the clear economic benefit of employer-based insurance with making sure everyone is covered?

The public option.

Essentially, it would work like this: The federal government would create an insurance program that all Americans could buy into, which would compete with private insurers. Government subsidies would ensure that anyone, regardless of income or job status, could buy into the program.

It would be much like Obamacare, but rather than allowing states to control their own insurance exchanges, which has caused something of a hodgepodge system, there would be one program, run by the federal government, similar to Medicare. Pete Buttigieg proposed the plan during his presidential primary bid. It is not, however, a new idea. Obama touted it during his 2008 presidential campaign.

Obamacare was a compromise between what the president wanted and what Republican congressional leaders were willing to accept. Both liberal Democrats and conservative Republicans hated it, but it appealed to centrists in both parties — at least at first.

As the so-called bases of both parties came to hold greater sway in the years after the ACA’s enactment, it became the target of increased derision among far-left liberals and far-right conservatives.

Which brings me to this year’s presidential race.

Biden is an Obama-era centrist. Berniecrats despise centrism. I get it. They have embraced an ideal version of what a socialized state might look like — they bring up Norway again and again. Don’t get me wrong, I love everything about Norway, but the U.S. isn’t Norway, and won’t be anytime soon.

The U.S. is a vast, diverse, populous, socially fractured nation, with no political consensus save for a dogmatic belief in capitalism, even among many liberals. Try passing Sanders’s plan for socialized insurance through Congress right now. It would never happen.

So, what are Berniecrats to do? Do they, as so many did in 2016, sit out the election, or even vote for President Trump, as a protest?

They’ll have to vote their consciences. They should try this thought experiment, however: Imagine if our entire insurance system were currently under the purview of Trump — who labeled the coronavirus pandemic a “hoax” and suggested (perhaps sarcastically) that we inject people with disinfectant and shine ultraviolet light inside them to cure the disease.

Let that thought sink in. Then, come November, vote.

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.