How many US Covid-19 deaths could have been prevented by Medicare-for-all?

There is plenty to blame for the poor US performance during the Covid-19 pandemic, from the highly contagious virus itself to the Trump administration’s slow response to deep rifts in American politics and culture. But a new study by a group of scientists from Yale and UMass-Amherst says the US had more deaths per capita than most economic counterparts because of something more specific: the lack of universal health care.

According to that sheet published this month in PNASAt least 212,000 Americans would have died from Covid-19 in 2020 alone if the U.S. had a single-payer health care system, similar to the Medicare-for-all plan proposed by Senator Bernie Sanders (I-VT). The country is also said to have saved $105 billion in pandemic-related health care costs.

The researchers reviewed several factors that would have reduced the number of Covid-19 deaths under a system where the government insures everyone and pays nearly all of their health care costs:

• No one would have lost health insurance as a result of job losses from the pandemic shock to the economy. (The study estimates that about 14.5 million Americans lost employer coverage in March and April 2020, although some of those people would eventually be covered by Medicaid.) has repeatedly shown being uninsured causes patients to delay healthcare and worse health outcomes. More policyholders would have meant more cases were diagnosed and treated earlier, reducing the likelihood of serious illness or death.
• Vaccination rates probably would have been higher — and therefore there would have been less severe cases and deaths — if more Americans had dated a primary care physician, which one in four people in the US don’t†
• And by reducing the number of Covid-19 hospitalizations through increased vaccinations and earlier diagnoses, US hospitals would have come under less pressure. That would have made it easier for them to treat all their patients, rather than the situation last summer — after vaccines became widely available — when people showed up at hospitals with no room or staff to treat them. Some of those people died.

The logic of the article’s conclusions makes sense. I wrote in the midst of the Spring 2020 peak that all the problems of the fractured US health system were fully exposed due to a failure to adequately respond to Covid-19. And if you look at countries with universal health care systems — the UK, Taiwan, Australia and the Netherlands, countries we covered in our “Everybody Covered” series on universal health care, plus France and Germany — they’ve had fewer deaths per year. capita than the US has.

Our world in data

All of these countries do have universal health care, but not all of them have a single-payer system along the lines of Sanders’ Medicare-for-all proposal. Taiwan does. But Australia uses a hybrid program where some people rely on public health insurance and other people use private plans. The Netherlands and Germany depend on private health insurance, which is heavily regulated and subsidized by the government. The UK’s National Health Service goes beyond just pay and is fully socialised: the government not only pays for care for everyone, but also runs hospitals and directly employs doctors.

Indeed, countries with universal health care outperformed the US during the pandemic — that part of the paper’s conclusion seems indisputable. But they have deployed several programs to achieve that goal. It is not clear to me that Medicare-for-all would necessarily lead to better outcomes than, say, a system modeled on the Australian or Dutch approach.

Other factors may play a role outside of the specific type of healthcare system. As Damien Cave wrote for the New York Times in Australia, social trust appears to have been a decisive difference between the US and Australian experiences during the pandemic. The two nations share a lot of sociocultural DNA, but Aussies have far more faith in people in general, and their health care system in particular, than Americans, Cave wrote. When I reported on South Korea’s successful Covid-19 response, Korean sources partially pointed out that people there generally had a high level of trust in the government.

This is also somewhat intuitive. It follows that people in more confident societies are more likely to wear masks or stay at home or get vaccinated, not only for their own benefit, but also for the health of those around them and society as a whole.

In a sense, social trust and universal health care boil down to the same thing: a society’s willingness to come together and care for one another. The US does not have the same culture of collective responsibility as these other rich countries. That lack of social cohesion is reflected both in failure to adhere to public health measures and in failure to build a health care system that cares for all.

Universal health care is a choice, a reflection of a country’s values. While reporting on the Everybody Covered series, I found this quote from Princeton health economist Uwe Reinhardt. It was in his most recent book Priced outwhich was published after his death in 2017:

Canada and virtually all European and Asian developed countries decades ago reached a political consensus to view healthcare as a social good.

In contrast, we in the United States have never reached a politically dominant consensus on this issue.

While traveling in Taiwan or Holland, people asked me about US health care and I had to tell them that millions of Americans were uninsured and people could be charged thousands of dollars for medical care. That was incomprehensible to the people I met. They lived in a country where people agreed that such things should never happen.

America has never made that collective commitment to provide healthcare for everyone. The country paid the price for that short-sightedness during the pandemic, as this new study helps show. Whatever form it took, a universal health system would likely have prevented tens of thousands of deaths from the novel coronavirus.

Now it’s too late.