In a recent study published in the journal PNAS, researchers propose a single-payer universal healthcare system in the United States (US) as a pandemic preparedness measure.
Study: Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic. Image Credit: Christopher Penler / Shuttterstock
It is a fragmented and inefficient healthcare system in the US, which has led to a high mortality rate and an unnecessary burden on the public health system during the Coronavirus disease pandemic 2019 (COVID-19). Further, the financial barrier to COVID-19 care delayed disease diagnosis among uninsured and underinsured Americans, which facilitated SARS-CoV-2 transmission.
Notably, in 2019, a year before the COVID-19 pandemic began, the US had 28 million uninsured adults. Moreover, as most working-age Americans depended on employer-sponsored insurance, COVID-19-imposed business closures and lockdown restrictions badly hit close to nine million individuals who lost their jobs following the emergence of SARS-CoV-2.
Life and cost-saving potential of universal healthcare
Amid such a grim scenario, a universal healthcare system in the US would have saved about 212,000 lives during the COVID-19 pandemic in 2020 alone. Additionally, it would have saved US$105.6 billion of medical expenses associated with COVID-19 hospitalization. Furthermore, even during a non-pandemic year, such a system could have saved US$438 billion.
A staggering 40,963,120 Americans were uninsured in 2019. The researchers accounted for the proportion of uninsured in each age group for 2019, its size, age-wise life expectancy, and the mortality rates. The calculations revealed that universal healthcare among individuals of all ages would have saved 76,064 lives and 2,094,548 years of life in 2019, much more than the estimates for 2017. Overall, a universal healthcare system would have compensated for a widened insurance gap and a rise in the average age of uninsured Americans during the pandemic.
Loss of employment and insurance coverage during the COVID-19 pandemic further contributed to increased mortality. Thus, after extrapolating the 2019 estimates, the authors observed 77,675 excess deaths and 2,099,133 excess years of life lost in 2020 due to lack of insurance. Notably, the researchers calculated pandemic-driven mortality impact specifically among those under 65 years of age, given the high Medicare coverage among the elderly in the US.
Mechanism of action of the proposed universal healthcare system
According to the authors, fully addressing the health disparities in the US requires a multifactorial strategy. Thus, public health policies in the US need to address and attempt to mitigate systemic health gaps and inequities in income, education, housing, nutrition, and mental health of all citizens. However, the implementation of a single-payer healthcare system is paramount. First and foremost, it would have alleviated the pressure on the hospitals during COVID-19 peaks and gave way for non-COVID-19 care. Further, it would have helped decrease racial and other disparities, thereby increasing vaccine uptake among the Black and Hispanic US residents.
Furthermore, the Medicare for all strategy would have addressed geographic inequities and expanded hospital capacity in rural areas. It is noteworthy that rural hospitals faced more shortages of ventilators, personal protective equipment, and healthcare personnel, thus, having more COVID-19-related mortality. Uninsured adults are more likely than insured adults to ignore their underlying health conditions and avoid seeking primary care because of their apprehension about costs. If a universal healthcare system were in place, it would have removed financial barriers to primary care and accelerated diagnosis, which would have increased the probability of recovery from COVID-19 and reduced viral transmission.
To conclude, a universal healthcare system for all in the US could have saved 211,897 lives in 2020 using US$459 billion, regardless of the emergence of the COVID-19 pandemic. Intriguingly, this is a much lower cost than that incurred by the current healthcare system.
The US spends a fortune on healthcare compared to other countries, on a per capita basis and overall; yet, the nation does not provide universal healthcare to all its citizens. As of March 2022, the country represented 16% of the documented worldwide mortality burden of SARS-CoV-2, with only 4% of the global population.
Indeed, inadequate health insurance coverage on both individual and population levels exacerbated the impact of the COVID-19 pandemic in the US. It delayed COVID-19 diagnosis and treatment, further elevating case fatality rates, which fueled uncontrolled SARS-CoV-2 transmission at the community level. Therefore, the researchers emphasized transition to a healthcare system that can better serve the American people, facilitate recovery from the ongoing crisis, and augment pandemic preparedness.
- Alison P. Galvani, Alyssa S. Parpia, Abhishek Pandey, Pratha Sah, Kenneth Colón, Gerald Friedman, Travis Campbell, JamesG. Kahn, Burton H. Singer, and Meagan C. Fitzpatrick, Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic, The Proceedings of the National Academy of Sciences (PNAS) 2022, DOI: https://doi.org/10.1073/pnas.2200536119, https://www.pnas.org/doi/full/10.1073/pnas.2200536119