By Scott Harris
Between the Lines, June 29, 2022
Over the two-and-a-half years of the coronavirus pandemic, more than 1 million Americans have died of the disease, the highest per capita death toll of any wealthy industrialized nation in the world. A recent study led by Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health, concluded that had a universal healthcare system been in place in the U.S. during the pandemic, more than 338,000 COVID deaths could have been prevented.
The study also found that $105.6 billion could have been saved in health care costs associated with pandemic hospitalizations if the U.S. had a system of universal healthcare insurance coverage. An estimated 30 million Americans currently have no health insurance.
Between The Lines’ Scott Harris spoke with Dr. James G. Kahn, professor at the Institute for Health Policy Studies at the University of California at San Francisco and co-author of the study. Kahn talks about the clear advantages of a universal health care model and the failings of the U.S. for-profit health care system that contributed to more than 338,000 needless deaths during the coronavirus pandemic.
DR. JAMES G. KAHN: What we did is two steps. First, we did an empirical analysis. This was actually published in a separate paper that looked at COVID death rates in comparison with the percentage of the population that’s uninsured. And what we found is that in areas with high levels of lack of insurance or uninsurance, there were more deaths.
And if you adjusted and sort of did a model were it said, well, what if all of these areas had 100 percent insurance coverage, it would have reduced the estimated deaths by 26 percent. And then in step two, we took that 26 percentage and we applied it to the estimated number of deaths up to that point with COVID. And that’s how we estimated more than 338,000 extra deaths because we don’t have universal insurance.
And the added COVID costs that we could have avoided are over $100 billion. But that’s on top of about $400 billion that we could save every year, pandemic or not, by having universal health insurance. And most of that is because we spend a lot of money, more than $600 billion a year on unnecessary paperwork. Everyone experiences it, whether you’re a provider or a patient, you know what that’s about. And between the insurers and the doctors’ offices and hospitals, we are wasting more than half a trillion dollars a year in unnecessary paperwork, which none of us likes anyway.
SCOTT HARRIS: Absolutely right. Dr. Kahn, I wanted you to explore for our listeners, how our current health care system, our current for-profit health care system contributes to higher mortality rates for Americans compared to other wealthy, industrialized nations. And I’m not just talking about the period of the pandemic these last two and a half years, but more generally. I know the focus of this study concentrated on the pandemic, but the mortality rates for Americans are way off from what we see in other industrialized nations. Am I right on that?
DR. JAMES G. KAHN: You’re absolutely right. And no matter how you cut it, no matter what statistic you look at, whether it’s expected lifespan or number of deaths, if you compare our country to other countries in the world of wealthy countries, which we refer to as the OECD — Organization for Economic Co-operation and Development — that’s the wealthy countries in Europe, Asia, around the world.
We stand out as paying 50 percent more or even twice as much as some countries on health care. But we have higher death rates and lower lifespans. And the estimated number of deaths that are added because people are uninsured is in the order of 60,000 to 70,000 by one method. By another method, it’s over 150,000. So there are a lot of added deaths because people are uninsured.
And then there are also lots of added deaths because people are under-insured. That is, they have big deductibles and because of those big deductibles, they delay or skip seeking care. We don’t have a good tally on that, but it adds substantially. So there are a lot more deaths and that’s year in, year out. And you are right, it is related to the fact that our system is designed to maximize profits rather than maximizing access to care.
The health insurance companies are doing very well year in, year out. And during the pandemic, they did especially well because even though people were getting sick with COVID, a lot of discretionary or non-urgent care was postponed. And so the actual billings submitted by providers to the insurance companies decreased during the pandemic. And one of the most egregious problems with that is that the federal government was continuing to pay insurance companies to deliver services under what’s called Medicare Advantage. It’s the privatized part of Medicare. So the insurance companies continued to receive the money. They paid for fewer services because, as I said, you know, people weren’t seeking non-urgent care and the providers needed government bailouts to avoid going bankrupt.
So essentially, the government paid two times — once to the insurers and once to the providers — for care that was not received. This is really not the way to run a health care system.