In “Coronavirus Proves It: We Need Medicare For All?,” I discussed some general problems with a ubiquitous claim coming from the left that COVID-19 proves America needs Medicare For All. The gist was that for the COVID-19 pandemic to prove that America needs universal healthcare, one must demonstrate that universal healthcare systems handled the pandemic better than America’s system. While I presented some evidence that America was doing better than European healthcare systems, I did not present data on what I believe to be the ultimate test of the healthcare system: Deaths per capita. This post presents data comparing COVID-19 deaths per capita in the US and in the 15 European counties that had the most “Confirmed Cases” of COVID-19 as of April 2, 2020. Data for April 2nd, 9th, and 16th, 2020 is analyzed.[i] A comparison of deaths is used because the number of deaths is less subject to false positives, interpretations, and vagaries, and, as I have discussed before, “Confirmed Cases” is mostly a meaningless number.[ii] Confirmed Cases do, however, sufficiently correlates to the relative intensity of the problem among countries to be a reasonable means to select the sample of countries to be analyzed.
I had expected the numbers to show more convincingly that America’s healthcare system is handling the COVID-19 pandemic better than the universal healthcare systems of Europe. While the analysis shows evidence of that, the deeper one digs into the issues, the more questions arise. A comprehensive and fair comparison is impossible* because of the many variables involved, and the data compiled on most of those variables are not consistently compiled by all countries.[iii] For example:
- The US counts every death, no matter how likely the deceased would have died soon from other causes, as a COVID-19 DEath so long as the deceased infected with COVID-19, or probably was infected. (In fact, a person killed in an auto accident who happened to be infected with COVID-19 is classified as a “COVID-19 Death” according to the CDC guidelines. Other countries do not do that.[iv]
- Population densities and modes of transportation (e.g., compare New York City[v] to Houston[vi]) vary greatly and can have a considerable effect on death rates during a pandemic.
- Nonpharmaceutical interventions (NPIs) and the degree to which populations adhere to NPIs, both of which significantly affect death rates, are unrelated to the effectiveness of a county’s healthcare system.
On the other hand, a completely objective and fair comparison is not required to address the issue at hand, whether the available data, compromised as it is, is sufficient to conclude: “Coronavirus Proves It: We Need Medicare For All.”
The data here presented reveal that such a claim is not supported by the numbers available to those who make that claim. (Ironically, those who are the first to declaim as “science deniers” anyone who does not accept every aspect of every assertion and proposed solution concerning climate change is not basing their conclusions on data or science).
Here is a table that compiles some available relevant data:
The first column lists the US separately, as the control, and the 15 European countries with the most Confirmed Cases of COVID-19 (per the COVID-19 Map) as of April 2, as the comparison countries. The second column shows each country’s population.
The first two columns of each of the three sections of the table (for April 2nd, 9th, and 16th) show the relatively unreliable, and therefore unimportant, “Confirmed Cases” and Confirmed Cases per capita. The important and relatively reliable data, the number of COVID-19 deaths and deaths per capita for each country, are in the right two columns of each of the three color-highlighted sections.
Note that for every date, the deaths per capita in the US are markedly lower than the average deaths per capita in the 15 universal healthcare countries (e.g., On 4/2/2020, America’s deaths per million were 16 and the European average was 79 ). Only three of the fifteen countries in the first section had lower death rates than the US, and the majority of states did worse than the US in every section. Individually, each section would support the proposition that the US healthcare system is better suited to deal with pandemics than are the listed universal healthcare systems. The data offers no support for the opposite proposition.
An objection to the above comparisons might be that the waves of virus infections started earlier in Europe than in the US. Consequently, some might say that using the same starting date for Europe and the US is to compare incomparable numbers. For reasons described below, there are problems with such an objection. For now, however, let’s assume that the objection is fair.
If one were to try to line up the dates to correspond to comparable points in the waves of various countries, how many days to shift the numbers is the critical question. In March, the US Surgeon General said that the US’s wave was two weeks behind Italy.[vii] However, note the following:
- Italy’s deaths per capita on April 2 were 219, and the US’s corresponding number two weeks later (April 16) was 95, i.e., the US deaths per capita were less than half of Italy’s when the waves were supposedly synchronized. Making matters more stark, Italy’s wave started when there was far less demand for PPE and ventolators
- According to The Guardian, Britain’s wave was approximately two weeks behind Italy,[viii] i.e., the same as the US’s wave. Note, however, on April 2, 9, and 16, the UK had 2.2, 2.3, and 1.1 times, respectively, as many deaths per capita as the US.
- According to Wikipedia,[ix] on average, the first confirmation of COVID cases in Europe occurred 23 days after the first confirmation in the US. If anything, the US’s wave should have been sooner than the average of the European countries’ waves. Excluding Italy, if wave-timing adjustments are to be made, the US system’s numbers would be even more complimentary to the US healthcare system.
If, despite reality, one were to go with the idea that Europe’s average wave was two weeks ahead of the US, note that on April 2, Europe’s average COVID death rate per capita was 79, and that the US COVID death rate was 95, i.e., 20% higher. However, consider the following:
- “Obesity increases risk for coronavirus complications: report.” Obesity is in the US is 163%[x] higher than the average obesity in the 15 European countries in the analysis. A country’s healthcare system is not responsible for America’s extraordinary prevalence of obesity. Consequently, in comparing healthcare systems, America’s healthcare system should get credit for the ability to handle a more vulnerable population during a pandemic. America’s 163% obesity rate could alone account for at least 20% of the higher death rates between April 2 and April 16.
- There is no universally accepted international standard for what deaths are counted as “COVID-19 deaths.” For some reason (US epidemiologists are especially embarrassed by their wildly high death rate projections produced by their models? They desire the appearance that the problem they are handling is bigger than it is?), the CDC and other are dreaming up every imaginable way to define “COVID Deaths” in ways that inflate America’s death rates.[xi] [They are doing this despite the fact that muddying the data complicates, if not stymies, the identification of the best way to phase in the reopening of economies,[xii] and painting a much scarier picture of how dangerous COVID-19 is—thereby reducing the chances of convincing people that it is time to go back to work and play—regardless of when that time is.]
Even if one were to suppose the CDC definition of “COVID Deaths” is proper or that the number of “COVID Deaths” in the US are even higher than deaths counted by the CDC method,[xiii] claims that the pandemic proves that America needs a universal system would still be unfounded. To make that claim based on the reported number of COVID deaths, one must also prove that the listed European countries are not reporting more accurate death numbers. In light of this, one should acknowledge that the CDC deemed “COVID Deaths” are likely to overstate deaths caused by COCID compared to methods used by more reasonable countries (as Dr. Birx confirmed. See endnote iv). More to the point, one cannot validly assume that the US COVID death rates are not overstated compared to the 15 European countries—thereby reducing the nominal 20% difference in death rates to a lower, possibly negative percentage.
Contra facts exist, e.g., the median age of Europeans is higher. Pointing out the contra facts in the absence of accurate identification and quantification of all relevant data would not alter the facts that (1) America’s healthcare system is not demonstrative worse than Europe’s universal systems,** and (2) the jury will remain out for a long time while the final tallies of the relative merits and demerits of the two kinds of systems concerning dealing with pandemics. Until then, no proof will exist concerning the pandemic that a universal healthcare system would be better for America.
There is a high correlation between (1) the people who claim that America’s handling of the COVID-19 pandemics is proof that America’s healthcare system is inferior to universal healthcare systems, and (2) the people who claim that the reason America is handling the pandemic so relatively poorly is because of the incompetence of President Trump and his administration. If Trump is doing as poorly as they claim and America’s COVID Death rate per capita is not substantially higher than the rates of countries with universal healthcare systems (something not supported by the data), then the healthcare system must be outperforming the other countries sufficiently to overcome the calamities they say Trump is inflicting. In other words, the more say the country’s COVID-19 problems are attributable to Trump, the more they are making a case that America’s healthcare system is superior to European universal healthcare systems—the exact opposite of what they claim when talking about America’s allegedly bad healthcare system.
Aside from the data and the fact that most research, innovation, and development of medical devices, drugs, and techniques, upon which all healthcare systems rely, have been and are funded by Americans paying higher prices for those things than foreigners do,[xiv] if it were shown that America’s healthcare system was inferior to universal healthcare systems when it comes to pandemics, that would not prove that universal healthcare would necessarily be better. With a government competing to be the wokest government in the world and a citizenry that supposedly loves its universal healthcare system, Canada’s healthcare system was not as prepared and is not outperforming America’s.
“Even in normal times, the average wait in Canada from referral to treatment by a specialist is 20 weeks, compared to less than four weeks in the U.S. Long before COVID-19, an estimated 1 million Canadians languished on waiting lists, waiting in pain or flying abroad for faster treatment… Per capita, Canada has one-third as many ICU beds as the US and about the same number as ravaged Italy. In some provinces, including Alberta and British Columbia, ICU beds number fewer per capita than Iran.”[xv]
Sadly, we are still nowhere near the end of the COVID-19 saga. It is possible that things could turn much worse for America and much better for the European countries in ways that show America’s healthcare system is relatively inferior. (I doubt it, but who knows at this juncture?) However things turn out, based on the data so far, no one can reasonably say that “Coronavirus Proves It: We Need Medicare For All.”
UPDATE: The table below adds data as of 4/27/2020.
* This is not to say that much scientism will not be devoted to the attempt.
** NOTE: When people talk about America’s healthcare system, all too often they confuse the healthcare system (which has to do with the quality and availability of medical care) with accessibility which primarily has to do with the ability to pay for healthcare. That some people do not have sufficient wealth to buy the healthcare they want is a welfare system problem. It is not a healthcare system problem. Measures to improve the quality and delivery of healthcare have no necessary connection to improving the economic conditions of poor people can, and often are, in conflict, i.e., trying to address both issues in a single package can making solving problems in either system more complicated, if not impossible.
[i] As reported by the Johns Hopkins COVID-19 Map reports for April 2 [LINK], 9 [LINK], and 16 [LINK]. [A note about the April 2 data: It did not occur to me to take screenshots of the COVID-19 Map data to document the April 2 numbers in the table. Fortunately, I happened to take a screenshot of the map on April 4, which shows that the April 2 numbers are, at least, in the ballpark. (Not only are they in the ballpark, I attest that the numbers were taken directly from the COVID-19 Map website.)]
[iv] Id. and “New ICD code introduced for COVID-19 deaths,” “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.”
|First Case||Days Behind|
|AVERAGE DAYS BEHIND THE U.S.||23.2|
[x] Obesity by Country
US/Eur Avg. 163%
[xiii] “Why the true COVID-19 death toll in NYC could be much higher: Only those tested BEFORE they die are counted as virus victims, says Big Apple councilman, as the city records 3,400 fatalities.” NOTE: NYC is addressing this “problem.” “N.Y.C. Death Toll Soars Past 10,000 in Revised Virus Count.”
[xiv] “High Drug Prices Are Bad. Cutting Them Could Be Worse,“”Despite these glaring problems, current policy choices must confront the real world we are living in. In the current situation, drug pricing and research funding are intertwined;” and
“The Link Between Drug Prices and Research on the Next Generation of Cures,” “Market conditions not only affected the size of research spending, it also affected its location. Looking at other sets of data, they found biopharmaceutical research in the EU countries exceeded research conducted in the United States by 24 percent in 1986. But by 2004, U.S. levels were 15 percent greater than EU levels.82 This is mostly due to EU spending stalling between 1997 and 2001, roughly the same time the two price indexes diverged. Total U.S. biopharma research by foreign firms has been growing at a faster rate than foreign research by U.S. firms, largely because U.S. prices for on-patent drugs are higher than those in Europe. Higher prices have therefore caused foreign companies to divert their attention to the U.S. market, thereby strengthening the U.S. domestic industry.”