How To Save $1 Trillion!

Ralph welcomes Dr. Alison Galvani, the founding director of the Yale Center for Infectious Disease Modeling and Analysis, and co-author of the forthcoming article, “Projected Economic Gains and Lives Saved Under Universal Health Care in the United States.” Then our constitutional law expert, Bruce Fein, stops by to tell us about a letter he and Ralph sent to states Attorneys General urging them to prosecute Donald Trump for exhorting his followers to commit voter fraud in the forthcoming midterm congressional elections. Finally, we respond to your feedback on how to be a smart voter.
Alison Galvani is the founding director of the Yale Center for Infectious Disease Modeling and Analysis and the Burnett and Stender Families Professor of Epidemiology at the Yale School of Public Health, Yale School of Medicine. She has applied her modelling and health economics skills to address public health challenges including HIV/AIDS, Zika, Ebola, influenza, and COVID-19. And she is co-author of the forthcoming article “Projected economic gains and lives saved under universal healthcare in the United States.”
We analyze the American healthcare system as a national balance sheet. And on one side of the ledger, we have: covering the uninsured and expanding care for the uninsured (that costs money). And we took into account that utilization will increase for people that currently have inadequate health care… And when we initially started looking at this in 2019…I anticipated a hefty price tag as well. Our work has focused on the effectiveness and cost-efficiency of public health policy in the US and around the world, and usually we’re asking: How much will it cost to save lives? And we rarely get a no-brainer where you save money and you’re saving lives.
Alison Galvani
Currently, no country spends more on health care than America (even though millions of Americans are completely uninsured and many more have inadequate insurance). And despite spending so much, we trail dozens of nations in life expectancy, infant survival, maternal mortality, and deaths that timely medical care should prevent. The prevailing issue is that even though we’re spending so much, a lot of the money we’re spending isn’t going to health care delivery itself. So much of it is extracted by for-profit insurance companies and directed away from care towards shareholders. There’s a misalignment of incentives—insurers make more profit when health care is denied. So, Americans are literally forfeiting their health so that corporate shareholders can make more money. And that’s just the architecture of our current health care system by having for-profit companies at so many junctures, even beyond the health care insurers.
Alison Galvani
People are dying not because their conditions couldn’t be prevented or treated, but because they couldn’t afford to see a doctor or fill their prescriptions. People without health insurance are more likely to die than insured people of the same age—that’s been empirically shown. So we took those empirical parameters and we applied that increased risk to the uninsured population in each age group, and then the difference between the deaths we have and the deaths we would be able to avert under universal health care coverage is more than 114,000 lives a year, we estimated. And last year’s Big Beautiful Bill, with its health care retractions, will only exacerbate the toll.
Alison Galvani
Bruce Fein is a Constitutional scholar and an expert on international law. Mr. Fein was Associate Deputy Attorney General under Ronald Reagan and he is the author of Constitutional Peril: The Life and Death Struggle for Our Constitution and Democracy, and American Empire: Before the Fall.
[The US Supreme Court] issued this very broad immunity theory that Presidents have immunity from criminal prosecution for discharging Constitutional responsibilities entrusted to the President. And this was way outside that scope because it relates to Mr. Trump’s activity as the...