Americans spend more on health care than people in any other country. However, in any given year, the piecemeal nature of the American health insurance system causes many preventable deaths and unnecessary costs. Not surprisingly, COVID-19 only exacerbated this already dire public health issue, as evidenced by the elevated mortality in the US compared to that of other high-income countries.
A new study quantifies the severity of the pandemic’s impact on Americans who lacked access to health insurance. According to the findings published on Monday in Proceedings of the US National Academy of Sciences, from the start of the pandemic to mid-March 2022, universal healthcare could have saved more than 338,000 lives from COVID-19 alone. The US also could have saved $105.6 billion in health care costs related to hospitalizations from the disease — on top of the estimated $438 billion that could have been saved in a non-pandemic year.
“Health care reform is long overdue in the US,” says lead study author Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health. “Americans are needlessly losing lives and money.”
People who don’t have insurance usually don’t have a primary care doctor, which means they’re more likely to suffer from preventable diseases like type 2 diabetes. They also tend to wait longer to see a doctor when they get sick. . These two factors already contribute to higher mortality rates in non-pandemic years, and they exacerbated the impacts of COVID-19. Comorbidities exacerbate the risk of disease, and waiting to seek care increases the likelihood of transmission to other people.
Before the pandemic, 28 million American adults were uninsured and another nine million lost their insurance as a result of unemployment due to COVID-19. “Many Americans feel secure in good health insurance from their employer, but employer-based insurance can be cut off when it’s most needed,” Galvani points out.
In the new study, Galvan’s team compared the mortality risks of COVID-19 between people with and without insurance, as well as their risks from all other causes of death. The researchers compiled population characteristics of all uninsured Americans during the pandemic, taking into account things like age-specific life expectancy and increased mortality associated with lack of insurance. They calculated that a total of 131,438 people could have been saved from dying from COVID in 2020 alone. And more than 200,000 additional deaths from COVID-19 could have been avoided since then, bringing the total by March 12, 2022, to more more than 338,000.
The researchers also estimated the cost to insure the entire American population—and the savings that measure would produce. They found that a single-payer health care system would generate savings in three ways: more efficient investment in preventive care, reduced administrative costs, and increased bargaining power for pharmaceuticals, equipment, and fees. This would ultimately produce a net savings of $459 billion in 2020 and $438 billion in a non-pandemic year, the authors found. “Medicare for all would be an economic stimulus and a life-saving transformation of our health care system,” says Galvani. “It’s going to cost people a lot less than the status quo.”
The findings of Galvani and her colleagues are “very compelling” and “the methodology seems exactly right to me,” says Robert Reich, a professor of public policy at the University of California, Berkeley, who was not involved in the work. “The savings estimates are in line with every other estimate I’ve seen.”
Ann Keller, an associate professor of health policy and management also at UC Berkeley, suspects, however, that the new study likely underestimates deaths that could have been avoided through universal health care because it does not take into account lower rates of chronic diseases that often accompany single-payer systems. “Having continued access to care can prevent the onset of chronic disease and can ensure that patients who develop chronic disease manage it better,” says Keller, who was also not involved in the research. “I would think that, if one took that into account, the estimates of deaths avoided would be greater than the numbers reported here.”
Whatever the exact numbers, Galvani says the message from the new study is clear: “Universal single-payer health care is both economically responsible and morally imperative.”