Exactly zero COVID deaths would have been prevented by Medicare for All

For single-payer partisans, government-only Medicare for All - which, if passed, will allow the next Donald Trump to make all kinds of fun decisions about your health care - is the best thing since sliced bread and the panacea to everything. If you believe some of the various quasi-religious chants they engage in, a single payer system will equalize all things in health care, cure cancer, and probably bring lasting peace to the middle east.

During the pandemic, one such talking point being pushed by the devotees of single payer is that untold deaths from COVID-19 would have been prevented had the United States adopted a system of centralized, government-only Medicare coverage for all Americans during it. The argument is that x number of people die each year from lack of health care coverage, and therefore if everyone had coverage, fewer people would have died from COVID.

This morning, one of the most prominent Medicare-only spokespeople tweeted a version of that, quoting an "analysis" by Public Citizen.

The problem with this claim, and this so-called "analysis" by a wholly ideological group, is that it falls apart like a house of cards to even an iota of critical reasoning.

From the very beginning, Public Citizen flunks the test of being an objective arbiter of data by using a debunked, false number on the "underinsured" in the United States. They say 87 million Americans were "uninsured or underinsured" prior to the pandemic, and while some people with health insurance may still be considered underinsured because of premiums and out-of-pocket costs being too high, this particular 87-million number is created out of whole cloth from an arbitrary and stunning claim that anyone who has a health insurance plan with a deductible that exceeds 5% of their income is "underinsured," and they are considered so-underinsured even if they don't have to cover the deductible out-of-pocket. As I pointed out in my analysis of this figure when it was first released, this would mean a couple making $250,000 a year with a health insurance plan deductible of $12,500 would be considered 'underinsured,' and they'd be so-considered even if the deductible is covered by their employer's contribution to a Health Savings Account.

Needless to say, no objective analysis should ever accept this bone-headed definition of 'underinsured.'

But even beyond this, Khanna and others' zeal to use the pandemic to push a political agenda misses the fact that people who have died of COVID are among the least likely to be uninsured and hence, having universal government Medicare would have zero impact on the number of Americans who have died from the coronavirus. And it's pretty easy to prove.

The vast majority - according to CDC data, 81% to be exact - of COVID-19 deaths in the United States have been among people 65 and over. Generally, when people turn 65 in the US, they become part of this national health insurance system called... Medicare. Nursing home residents account for about 40% of the deaths, and they often have not one but two government-sponsored or provided health care plans, both Medicare and Medicaid.

COVID-19 also exposed a pre-existing problem in our health care system: the disparate care that Black Americans and other racial minorities get compared to their white counterparts. But while single-payer ideologues see access as the primary issue in health disparities, the real problem lies in the medical system itself.

For example, since the advent of Obamacare, the coverage gap between white and Black Americans have shrunk significantly, but the gap in quality of care has not. Black people die from HIV, for example, at a rate that is 7 times higher than whites, but the Black uninsured rate (11.5%) is only 50% higher than the white uninsured rate (7.5%). Black maternal mortality is more than 3 times higher compared to pregnant white women.  On COVID itself, Black and white infection rates have been roughly the same, and Hispanics have been infected at a slightly elevated rate (1.3x the rate of whites), but Blacks and Hispanics have been hospitalized at three times the rate as whites, and died at twice the rate of whites. The hospitalization and death parity among Black and Hispanic Americans is of even more note, since Hispanics are twice as likely to be uninsured as Black people. Asians have been hospitalized and died from COVID at the same rate as whites, despite their coronavirus infection rates being a good 30% lower than that of whites.

Clearly, racial health disparities, especially when it comes to COVID, are, at best, minimally explained by insurance status, if at all. Khanna and others' argument in favor of a public-only health insurance system is undermined further by the fact that non-elderly Black and Hispanic Americans are more than twice as likely than white Americans to be covered by Medicaid, a public health insurance program. If we want to address racial health disparities, Medical School - where an astonishing 40% of Med students today believe Black people don't feel pain like white people do - is a much better place to start than government insurance dogmatism.

Even more evidence exists globally that health care coverage, or government's heavy role in it, has not been determinative factors in saving lives during the pandemic. United Kingdom, Hungary, and Italy - all with the type of health care coverage much closer what government-only hardliners are pushing, have seen more COVID-19 deaths per 100,000 population than the United States, while the countries with the lowest COVID deaths per 100,000 people - Indonesia and India - have no strong national health coverage to speak of, let alone single-payer.

But let's not miss exactly what made the pandemic in the United States so much worse than it had it be: the fact that for most of its duration, we had a president who consistently downplayed its deadliness, spread misinformation at a massive scale, belittled public health measures, undermined state and local efforts to contain the spread, and sought only political gain by trying to artificially align the vaccine development timeline with the election to give himself a boost. 40% of deaths could have been prevented were it not for Donald Trump's catastrophic mismanagement of the crisis. Does Ro Khanna seriously believe that Donald Trump would have been transformed into an exemplary public health leader if only everyone got their health insurance from the federal government?

If not, then let's stop with this despicable use of dead people to advance an agenda based purely on political ideology with zero scientific evidence that such agenda would have fared even marginally better during the pandemic.

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