In the United States, death rates from COVID-19 are higher than in any other high-income country—and our fragmented and inefficient health system may be largely to blame, Yale researchers say in a new study.

If the U.S. had had a single-payer universal health care system in 2020, nearly 212,000 American lives would have been saved that year, according to a new study. In addition, the country would have saved $105 billion in COVID-19 hospitalization expenses alone.

The research team further calculated that in a non-pandemic year, some $438 billion would be saved by single-payer universal health care, like Medicare for All.

The results make a powerful case for health care reform, according to lead author Alison Galvani, Ph.D.

“Americans are needlessly losing lives and money,” said Galvani, director of Yale’s Center for Infectious Disease Modeling and Analysis and an endowed chair in the Department of Epidemiology (Microbial Diseases) at the Yale School of Public Health. “Medicare for All would be both an economic stimulus and life-saving transformation of our health care system.”

Methods

The researchers compared people with and without health insurance, examining death rates from COVID-19 and overall. Building on earlier research, they calculated that 131,438 COVID deaths in 2020 could have been avoided with universal single-payer health care.

Overall, including both COVID and non-COVID patients, 211,897 lives would have been saved in 2020 with universal care. From the start of the pandemic in the U.S. to March 2022, those preventable deaths mount to 338,594.

Far from financially burdening the nation, universal single-payer health care would not only have saved lives, it would have also avoided hundreds of billions of dollars in costs. Medicare for All would reduce costs by improving access to preventive care, reducing administrative overhead, and empowering Medicare to negotiate prices, the researchers said. Single-payer health care would also eliminate pricy insurance premiums and reduce fraud.

“A single-payer health care system would be much more economically efficient than our current fragmented structure and would save over $450 billion per year,” Galvani said.

A better alternative

The United States currently spends more on health care than any other nation—both per person and overall. Despite such heavy spending, the piecemeal nature of the U.S. medical insurance system worsened COVID-19’s effects, the researchers argue in the study. Many people without access to adequate health care delayed necessary medical treatment, postponed isolation, and kept working when they felt sick. These factors can fuel infections and deaths.

Most working-age Americans rely on employer-sponsored plans, with each enrollment typically covering more than one person. That system still left 41 million Americans uninsured before the pandemic.

Universal single-payer health care is both economically responsible and morally imperative.

Alison Galvani

Then, during the pandemic, over 9 million workers became unemployed. As a result, many people became uninsured including, in some cases, entire families.

Medicare for All would save lives in a number of ways, according to the researchers:

• It would make it easier to access primary care, which helps people prevent or stay on top of chronic conditions like diabetes or high blood pressure. Such conditions can raise the risk of death, including from COVID.
• It would lower financial hurdles to seeking care for illness.
• It would support rural health care facilities and ease pressures on hospitals that are forced to reduce care for other conditions, such as cancer, when COVID infections surge.

“Universal single-payer health care is both economically responsible and morally imperative,” Galvani said.

Meagan C. Fitzpatrick, formerly of the Yale School of Public Health and now with the University of Maryland, is last author on the study. Other co-authors are Alyssa S. Parpia, Abhishek Pandey, Pratha Sah and Kenneth Colón, all of the Yale School of Public Health; Gerald Friedman and Travis Campbell of the University of Massachusetts, Amherst; James G. Kahn of the University of California, San Francisco; and Burton H. Singer of the Emerging Pathogens Institute. Mr. Colón is also affiliated with Syracuse University.

The study appears online in the Proceedings of the National Academy of Sciences. The research was funded by the National Institutes of Health, the Notsew Orm Sands Foundation, and the National Science Foundation.