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. 2022 Jun 21;119(25):e2200536119.
doi: 10.1073/pnas.2200536119. Epub 2022 Jun 13.

Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic

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Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic

Alison P Galvani et al. Proc Natl Acad Sci U S A. .

Abstract

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.

Keywords: costs saved; lives saved; pandemic preparedness; universal healthcare.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1.
Fig. 1.
Insurance enrollment, excess deaths, and years of life lost during the pandemic year 2020: (A) Monthly estimated enrollment in employer-sponsored insurance (green) and reported enrollment in Medicaid/CHIP (orange). (B) Monthly total enrollment in all insurance types (blue) compared with total enrollment in any insurance type in December 2019 (black). (C) Monthly excess deaths among those below age 65 due to pandemic-driven insurance loss between March and August 2020. (D) Years of life lost in each month between March and August 2020 due to pandemic-driven insurance loss.

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