There is a knee-jerk reaction among proponents of a single-payer system for health insurance who keep mindlessly reciting the mantra, Medicare For All! The problem is that even though Medicare is one of the most popular government programs–a veritable sacred cow politically–the fact is expansion of the plan to cover all Americans would never work. If you doubt me, do the math.

What supporters fail to take into account is basic actuarial science. This is the backbone (or at least should be) of insurance pricing decisions, but the public rarely considers the statistical work that goes into making an insurance policy financially sound.

You see, we all pay Medicare premiums from the moment we start working–meaning we usually pay premiums for 40 or more years before ever drawing a benefit after hitting 65. Not to mention the fact that those people who die before 65 never draw a benefit, no matter how long or how much they paid into the insurance fund.

This is a good thing, because it means we should be able to finance our health care for our so-called “Golden Years”–a time when we are most likely to incur massive medical expenses–at an affordable rate. It’s the same theory behind Social Security–having the worker and employer set aside a relatively modest sum each year to partially finance our retirements down the road.

However, if we were to open up the Medicare plan for all Americans of any age, that would blow the acturarial calculations right out of the window, since we are not paying a premium level anywhere near what would be required to finance medical care for our 20s, 30s, 40s or 50s.

Some might flippantly say, fine, just adjust the rates upward so that the damned actuaries can sleep at night! But I don’t believe most people have a clue how much health insurance really costs.

Of course, the 50 million or so without coverage have a pretty good idea, and they realize they cannot afford it. However, those who have insurance through their employers lack any idea what is being paid on their behalf. It can cost employers well over $10,000 per year, per employee, to offer decent coverage, and that is on top of the employee paying some of the premium. That is much, much, much more than what is deducted for Medicare right now (and what would still have to be deducted to pay for care when we get old).

Sure, if we offer everyone bare-bones coverage with huge deductibles, co-payments and exclusions, we might be able to lower the cost. But would the 100-million plus lucky enough to have coverage not scream bloody murder if they saw their premium bills go up for less coverage? Try to campaign on that platform if you are a member of Congress and see how far you go!

In addition, covering everyone would certainly remove a lot of the cost-shifting that goes on today, lifting a burden on those who are insured and those who insure them. But such savings would not be nearly enough to make a huge difference in terms of total cost.

And even if we did adopt Medicare For All, remember that Medicare leaves huge gaps in coverage–particularly on prescription drugs.

Thus, the conundrum facing the Obama administration and Congress. Getting everyone covered affordably appears to be a paradox, as every “solution” comes with fatal political liabilities. 

So the Democrats agonize over what form of political suicide to choose–whether to tax health benefits, for example, and thereby “punish” those who have coverage to finance costs for the uninsured. That’s a step Candidate Obama swore he wouldn’t take, and a distinction that helped sink John McCain’s campaign.

Meanwhile, the Republicans sit on the sidelines, tossing bricks at every passing Democrat, rejecting every reform option, leaving the burden and political liabilities squarely with the Democrats. Will that backfire on the Republicans during next year’s midterm congressional elections? Only if the Democrats deliver a plan the public can live with.

I don’t envy them their task.

How would you solve the health care crisis?