The US could have saved more than 338,000 lives and more than $105bn in healthcare costs in the Covid-19 pandemic with a universal healthcare system, according to a study.
More than 1 million people died in the US from Covid, in part because the country’s “fragmented and inefficient healthcare system” meant uninsured or underinsured people faced financial barriers that delayed diagnosis and exacerbated transmission, the report states.
The US had the highest death rate from the virus among large wealthy countries and is also the only one among such countries without universal healthcare. It spends almost twice as much on healthcare per capita as the other wealthy countries, according to Kaiser Family Foundation data.
“The current healthcare system in the US is economically inefficient and leaves millions of Americans without adequate access to medical treatment,” said Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health and the lead author of the study, published in the Proceedings of the National Academy of Sciences.
The authors recommend that the country adopt Medicare for All, a single-payer healthcare program, to “facilitate recovery from the ongoing crisis and bolster pandemic preparedness, as well as safeguard well-being and prosperity more broadly”.
To determine how many Covid deaths were potentially preventable, the authors built upon previous studies of the insurance gap and mortality rate in the US with data on how many people lost employer-sponsored insurance due to Covid-related business closures and restrictions that led to unemployment.
“While stay-at-home orders and temporary closures of nonessential businesses curbed the immediate spread of Covid-19 and prevented catastrophic demands on hospital capacity, the measures also led to spikes in unemployment,” the report states. “For employees, a layoff often results in insurance loss or the need to switch to a different type.”
The authors calculated potential cost savings from universal healthcare in part by reviewing the average Medicare and Medicaid costs for a Covid-19 hospitalization that required mechanical ventilation, which were $57,822 and $47,396, respectively, according to the report. The average charge to private insurance was $114,842.
The study also asserts that fear of losing health insurance during a pandemic might have caused people to still go to work even when they didn’t feel well.
“Universal single-payer healthcare is both fiscally responsible and morally imperative for the US,” Galvani stated.
David Rosner, who studies public health and social history at the Columbia University Mailman School of Public Health, described the study as the “ultimate condemnation of a health system from a public health point of view”.
“It was clear that the essential workers who were delivering our food [and other items] to the middle class were being exposed disproportionately,” Rosner said. “I’m not surprised that they found that these folks were dying at a higher rate.”
A single-payer healthcare system could prevent such deaths because it would improve access to primary care, which would lead to quicker diagnosis of a virus and better treatment of co-morbidities such as diabetes, the study states.
Ann Keller, an associate professor of health policy and management at the University of California, Berkeley, said the lack of a single-payer healthcare system is not the only reason the country has high rates of chronic diseases. She also blamed a weak welfare state, poverty and food deserts.
“But all other things being equal, if you provide people with consistent healthcare, they are better able to prevent chronic disease and or manage it once it’s present,” said Keller.
Recent Democratic efforts to implement a single-payer health system or expand the Affordable Care Act have stalled.
“Results of studies like ours are up against a Goliathan healthcare industry that contributes heavily to political campaign financing and lobbying,” said Galvani. “Legislators who sway under such influence are not working for the health or prosperity of their constituents.”
