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Celerity

(47,773 posts)
6. here
Thu Dec 5, 2024, 09:50 PM
Dec 5


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

Alison P. Galvani alison.galvani@yale.edu, Alyssa S. Parpia https://orcid.org/0000-0002-9083-1929, Abhishek Pandey, +6, and Meagan C. Fitzpatrick Authors Info & Affiliations

Contributed by Burton H. Singer; received January 12, 2022; accepted April 22, 2022; reviewed by David Fisman and Brian Wahl

June 13, 2022

119 (25) e2200536119

https://doi.org/10.1073/pnas.2200536119

https://www.pnas.org/doi/full/10.1073/pnas.2200536119

Significance

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. Universal healthcare could have alleviated the mortality caused by a confluence of negative COVID-related factors. 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 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 Medicare for All system.

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. Despite spending more on healthcare than any other country, both overall (1) and on a per capita basis (2), the United States does not provide universal healthcare, resulting in preventable deaths and excessive costs (3). In 2019, prior to the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), over 28 million adults were uninsured, an increase of 2.2 million from 2016 (4).

Since 2020, the COVID-19 pandemic has underscored the public health, economic, and moral repercussions of widespread dependence on employer-sponsored insurance, the most common source of coverage for working-age Americans. Business closures and restrictions led to unemployment for more than 9 million individuals following the emergence of COVID-19 (5, 6). Consequently, many Americans lost their healthcare precisely at a time when COVID-19 sharply heightened the need for medical services. With over 973,000 reported deaths attributed to COVID-19 as of 14 March 2022, the United States represents 16% of the documented worldwide mortality burden of the virus (7), while only composing 4% of the global population (8). Inadequate health insurance coverage has exacerbated the COVID-19 pandemic on both individual and population levels. At the individual level, concerns over medical expenses delay diagnosis and treatment (9), elevating case fatality rates (10). At the population level, postponement of diagnosis, and thus of case isolation, fuels transmission. In addition, fear of losing employer-sponsored health insurance during a pandemic may make it untenable for people to miss work even when they feel unwell. We quantify the financial benefits and lives saved if the United States had provided universal healthcare coverage to all individuals during the COVID-19 pandemic. As proposed by the Medicare for All Acts of 2019 (11) and 2021 (12), a major feature of such reform would be elimination of the high deductibles and copays that currently make medical services unaffordable even among many who are nominally insured (13).

Ramifications of Pandemic-Driven Unemployment for Health Insurance Coverage.

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 (14), the measures also led to spikes in unemployment. For employees, a layoff often results in insurance loss or the need to switch to a different type. To determine the changes in coverage by insurance type over the course of 2020, we combined data on monthly Medicaid/Children’s Health Insurance Program (CHIP) enrollment (15), monthly employment (16, 17), and employer-sponsored health insurance plan participation rates (18), as well as insurance exchange enrollment during both the standard (19) and special enrollment periods (20). We calculated the difference in insurance enrollments for each month of 2020 compared to December 2019, the final month prior to pandemic disruptions. In March 2020, employment dipped slightly, followed by a steep drop in April, precipitating a loss of 14.5 million employer-sponsored insurance enrollments compared to December 2019 (Fig. 1A). Employment gradually rebounded but remained below its December 2019 level throughout 2020.


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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Recommendations

10 members have recommended this reply (displayed in chronological order):

Not to quibble but that's just a screenshot of the headline and no link to the source tenderfoot Dec 5 #1
I think you SHOULD quibble. Abolishinist Dec 5 #3
NOT ONLY A DEAD END... BUT FREQUENTLY BS WarGamer Dec 5 #5
here is the study Celerity Dec 5 #8
I brought it back to life................. Celerity Dec 5 #7
Number four will drop your jaw! (nt) Orrex Dec 6 #23
here Celerity Dec 5 #6
Thank you for this timely reminder. Timely for me, because I was just niyad Dec 6 #22
Guy writes for Fierce Healthcare. applegrove Dec 5 #13
he's just a journo, I put up the actual peer-reviewed study that was published in PNAS, a world class scientific journal Celerity Dec 5 #18
Thanks for the study. applegrove Dec 6 #19
And how many would they let die? choie Dec 5 #2
'Universal Healthcare', not UnitedHealthcare Celerity Dec 5 #9
As many as it takes/they can. dchill Dec 6 #28
So says Leon Stink, an Elon Musk Parody account. Abolishinist Dec 5 #4
Maura -resister ‪@maurar.bsky.social‬ was the OP, Leon Stink just re-Blued it Celerity Dec 5 #10
you should have posted the study, instead of relying on posters like me to come in and white knight the OP Celerity Dec 5 #11
You are correct. Sorry. applegrove Dec 5 #14
Don't doubt people died uninsured. Not sure about saving $450 B. Silent Type Dec 5 #12
U.S. health care spending grew 4.1 percent in 2022, reaching $4.5 trillion, and increased to 4.8 trillion USD in 2023 Celerity Dec 6 #20
Still confused about $450 B savings in Report. HC spending has exceeded GDP growth in Silent Type Dec 6 #21
One major reason our healthcare is stunningly more expensive than other developed nations Voltaire2 Dec 6 #29
Oh, so we'd have saved less than 10% ? Big deal ! {SARCASM} nt eppur_se_muova Dec 6 #25
but they are not INTERESTED in "savings" Skittles Dec 5 #15
Now imagine how much and how many lives it would've saved over the last 4 years alone. Karasu Dec 5 #16
But that is actual government efficiency, and we cannot have that. onecaliberal Dec 5 #17
It also occurs via the removing of the profit-extracting, wealth extracting/transferring middlemen, ie private, for Celerity Dec 6 #24
Yes. Lobbyists are the only reason we don't have it. Passages Dec 6 #26
Rob Portman of Bush jr administration Blue Full Moon Dec 6 #27
How many lives would it have ended from denying coverage?? Vinca Dec 6 #30
comment deleted by the person who posted it. ThreeNoSeep Dec 6 #31
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