Let’s start with the “no” part. Universal health insurance coverage as such does not seem to have been decisive in how various countries fared when the pandemic hit. Spain, Italy, France and Belgium all have universal coverage, yet all have recorded higher death rates, adjusted for population, than the United States, while Germany, which also has universal coverage, has recorded a lower rate than this country, according to the Johns Hopkins University and Medicine Coronavirus Resource Center. Timing and compliance with social distancing are likely more important. A respiratory ailment, the covid-19 disease attacks older people, smokers and those with preexisting diabetes, heart conditions and compromised immune systems most lethally. Spain and Italy are both much older and more densely populated than the United States, with more elderly people sharing living spaces with younger family members. Yet Germany and Japan have some of the highest median ages in the world, with — so far — much less harm from covid-19 than peer nations. Clearly, there’s still a lot we don’t know.
Equally clearly, though, the crisis has demonstrated an advantage of universal health coverage: It does not vary depending on whether you are employed. Economic collapse has brought sudden mass unemployment to the industrialized democracies, yet only in the United States, with its employer-based system for the non-elderly, do these job losses also threaten health coverage for millions. Finding ways to pay for all the treatment these newly out-of-work Americans may need, for covid-19 or anything else, is an enormous political, economic and administrative headache — and one that Europe, Japan and others long ago spared themselves. Universal coverage may also enable better management of chronic conditions, thus rendering the general population less vulnerable to certain infectious diseases, even if the data so far is unclear on this point from the coronavirus. In short, universal coverage not only promotes social equity and economic security; it also renders the nation more resilient.
This conclusion does not dictate any particular method of universal coverage: European systems range from Britain’s nationalized health service to the public-private partnerships of the Netherlands and Germany. For all its deficiencies, our system’s emphasis on private initiative has a role to play in stimulating research and development of new treatments and a vaccine. The pharmaceutical industry, demonized by Mr. Sanders as “a bunch of crooks” seeking to “make a fortune” off the pandemic, may prove a major asset.
As first, seemingly self-evident steps, the Trump administration and congressional Republicans should call off their legal battle against Obamacare, and red states should finally let their people have the benefits of the law’s Medicaid coverage extension. In the longer run, and despite inevitable opposition from insurance companies and others who benefit from the status quo, health insurance badly needs reforms that finally separate employment from insurance, while preserving strong incentives for innovation. The pandemic has not so much revealed those conclusions as reinforced them.