There’s a lot of blame for the poor U.S. performance during the Covid-19 pandemic, from the highly contagious virus itself to the Trump administration’s slow response to deep cracks in U.S. politics and culture. But a new study by a group of scholars from Yale and UMass-Amherst says the United States has had more deaths per capita than most business peers due to something more specific: a lack of universal health care.
According to that document, published this month in PNAS, at least 212,000 fewer Americans would have died of Covid-19 in 2020 alone if the United States had a single-pay health system similar to the Medicare-for-all plan proposed by Sen. Bernie Sanders. (I-VT). The country also reportedly saved $ 105 billion in pandemic-related health costs.
The researchers analyzed several factors that would have reduced the number of deaths from Covid-19 in a system where the government insures everyone and pays almost all healthcare costs:
- Nobody would lose health insurance due to job losses due to the shock of the pandemic to the economy. (The study estimates that about 14.5 million Americans lost employer coverage in March and April of 2020, though some of those people would end up being covered by Medicaid.) Research has repeatedly shown that the lack of insurance leads patients to delay health care and worsen health outcomes. More insured people would have meant more cases diagnosed and treated earlier, reducing the likelihood of serious illness or death.
- Vaccination rates would likely have been higher – and therefore there would have been fewer serious cases and deaths – if more Americans had been in a relationship with a primary care physician, something that one in four people in the United States don’t.
- And by reducing the number of Covid-19 hospitalizations through more vaccinations and early diagnosis, US hospitals would be less stressed. This would have made it easier for them to manage all of their patients, rather than the situation last summer – after vaccines were widely available – when people showed up in hospitals with no space or staff to treat them. Some of those people have died.
The logic of the document’s conclusions makes sense. I wrote in the midst of the spring 2020 surge that all of the problems in the fractured US healthcare system had been fully exposed by the lack of adequate response to Covid-19. And if you take a look at the countries that have universal health systems – the UK, Taiwan, Australia and the Netherlands, countries we covered in our Everybody Covered series on universal health care, plus France and Germany – have seen fewer per capita deaths compared to the United States.
All of these countries have universal health care, but not all of them have a one-off system in the wake of Sanders’ Medicare for all proposal. Taiwan yes. But Australia uses a hybrid program where some people depend on public health insurance and other people use private plans. The Netherlands and Germany rely on private health insurance, which is heavily regulated and subsidized by the government. The UK NHS goes beyond the one-off payment and is fully socialized – the government not only pays for treatment for everyone, but also runs hospitals and hires doctors directly.
Countries with universal health care overtook the United States during the pandemic – that part of the document’s conclusion appears out of the question. But they have implemented several programs to achieve this. It is not clear to me that Medicare-for-all would necessarily lead to better results than, for example, a system modeled after the Australian or Dutch approach.
Other factors may be at play beyond the specific type of health care system. As Damien Cave wrote for the New York Times in Australia, social trust appears to have been a decisive difference between the American and Australian experiences during the pandemic. The two nations share a lot of sociocultural DNA, but Australians have a much deeper trust in people in general and their health system in particular than Americans, Cave wrote. When I reported on South Korea’s positive response to Covid-19, Korean sources partly indicated that people there have a generally high level of trust in the government.
This also makes intuitive sense. As a result, people in more confident societies would be more likely to wear masks or stay at home or get vaccinated not just for their own benefit, but for the health of those around them and society at large.
In a sense, social trust and universal health care boil down to the same thing: a society’s willingness to unite and care for each other. The United States does not have the same culture of collective responsibility that these other wealthy nations have. This lack of social cohesion is reflected both in the failure to comply with public health measures and in the failure to build a health system that cares for everyone.
Universal health care is a choice, a reflection of a country’s values. When I brought back the Everybody Covered series, I found this quote from Princeton health care economist Uwe Reinhardt. It was in his most recent book Price outpublished after his death in 2017:
Canada and virtually all developed nations of Europe and Asia reached a political consensus decades ago to view health care as a social good.
On the contrary, we in the United States have never reached a politically dominant consensus on the issue.
While traveling to Taiwan or the Netherlands, people would ask me about health care in the United States and I should have told them that millions of Americans were not insured and that people could be charged thousands of dollars for medical care. He was unfathomable to the people I met. They lived in a country where people agreed that such things should never have happened.
America has never made that collective commitment to provide health care for all. The country paid the price for that myopia during the pandemic, as this new study shows. Whatever form it took, a universal health system would likely have prevented tens of thousands of deaths from the novel coronavirus.
It’s too late now.