Why Didn't the Covid-19 Pandemic Result in Medicare for All?

In 2002, the American economist Victor R. Fuchs wrote that “national health insurance will probably come to the United States in the wake of a major change in the political climate, the kind of change that often accompanies a war, a depression, or large-scale civil unrest.”

You couldn’t have designed a crisis much better suited to deliver us this outcome than Covid-19. In 2020, the U.S. faced the largest public health emergency in its history, at a time when 28 million Americans did not have health insurance and millions more were underinsured.

The faulty, patchwork nature of our health care system greatly compounded the effects of the pandemic. In fact, a study by the Proceedings of the National Academy of Sciences (PNAS) found that the U.S. could have seen around 338,000 fewer deaths from Covid-19 if we’d had universal coverage and we could have saved billions in health care costs associated with hospitalizations from the disease.

Nobody should die in the richest country on Earth because they can’t afford health care. The Covid-19 pandemic should have made clear once and for all how irrational and cruel our system is. We are the only developed nation that doesn’t guarantee health care to all citizens. As a result, tens of millions of Americans every year suffer without access to basic medical care, while insurance companies are allowed to make record profits. There are people in America who have to ration prescription drugs, while a few miles over the border in Canada, they could get these same pills at a fraction of the cost. There are people who have to forgo life-saving surgeries, because they can’t afford the procedures. Roughly a third of all GoFundMe campaigns in the U.S. go to people raising money for medical treatments.

In April, 2020, a nurse in the intensive care unit of a New York City hospital named Derrick Smith, wrote on Facebook that one of his patients asked “who’s going to pay for this?” before being intubated and placed on a ventilator, seemingly more concerned about the cost of the procedure than what the outcome would be. These would end up being his last words.

Meanwhile, the CEOs of 300 health care companies collectively made more than $4.5 billion in 2021, according to Stat News. The obvious conclusion is scathing.

Lockdown orders during the pandemic led to a massive spike in unemployment, yet despite significant job losses, the number of insured Americans actually increased, primarily due to emergency Medicaid eligibility policies. This amounted to the government (at least, partially) performing the function of a national health care system – i.e. filling gaps in coverage left by the private insurance industry. Unfortunately, as pandemic-era emergency measures ended, millions of Americans lost this coverage and private insurance returned to business as usual.

A number of factors contributed to America’s poor pandemic performance relative to other countries; a slow government response in terms of travel and testing, PPE shortages and delays in testing rollout. But it’s almost certain that addressing Covid-19 would have been easier if everyone had health insurance. According to the consumer health advocacy organization Families USA, roughly 40% of Covid-19 infections were associated with lack of health insurance.

In general, gaps in insurance coverage tend to accelerate the spread of diseases. People are less likely to get tested if they don't have insurance for fear of large medical bills. The more people who have insurance and a relationship with a primary care physician, the more cases can be diagnosed and treated quicker, thus reducing the likelihood of serious infection. Slowing the spread also reduces the strain on hospitals, making it easier to treat all patients.

There were some countries with single-payer that fared poorly during the pandemic. Italy, for instance, was hit very hard, in part because they had a lot of people in the vulnerable age range. However, many of the best-performing countries, particularly outside of Europe (New Zealand, South Korea), were those with single-payer systems. Taiwan, which transitioned to a single-payer system in the 1990s, achieved Covid-19 zero without a lockdown.

There were other factors which should have made Covid-19 uniquely suited to deliver us major health care reform. Unlike a number of other public health crises (the opioid epidemic, homelessness), Covid-19 received near-constant media coverage. It was front-and-center in everybody’s mind for three years. It also came on the heels of two back-to-back election cycles in which Medicare For All was a key issue in both debates and public policy discussions.

Public support for Medicare For All was at an all-time high in 2020. And in 2021, when Rep. Pramila Jayapal introduced the legislation, it was co-sponsored by a majority of Democrats in the House. Nothing like that had ever happened before. Even according to right-wing outlets like the Pacific Research Institute (PRI), Covid-19 led to a significant spike in support for single-payer.

Why, then, did nothing happen? One major problem was that the pandemic kept people inactive. The public was too atomized and immobile for any effective, coordinated response to cohere. The pandemic created a lot of pent-up anger, much of which got unleashed in the summer of 2020 via the Black Lives Matter protests, coming at a time when many people had been stuck in lockdown for months, many without jobs. When the spark was lit, it quickly became a lightning rod for solidarity and popular discontent.

The biggest problem is that single-payer health care is opposed by some of the most powerful special-interest groups in the country; the private insurance industry, pharmaceutical companies, and the for-profit hospitals. Health care is a massive sector of our market economy, a multi-trillion-dollar a year industry, so despite widespread popular support for the program, there is currently no mechanism strong enough to bring this public pressure to bear on politicians.

If we are to rise to the level of the rest of the developed world and guarantee health care to all citizens, we need to constitute an organized popular opposition which can participate in shaping public policy. Ideally, this will mean grass-roots initiatives backed by a strong labor sector—unions in the nursing, trades, and service sectors working in conjunction with local advocacy groups. We must capitalize on the momentum built up in 2020 and continue to push single-payer forward. If we organize and act to exercise our power, this is hardly a utopian goal.