AMY GOODMAN: This is Democracy Now!, democracynow.org, The Quarantine Report. I’m Amy Goodman.

As the U.S. death toll from COVID-19 approaches half a million, a new report says nearly 40% of those deaths were avoidable. The medical journal The Lancet came to this conclusion by comparing the pandemic in the United States with other high-income G7 nations, like Britain, France and Canada. The findings are included in a report by the Lancet Commission on Public Policy and Health in the Trump Era that faults Trump’s, quote, “inept and insufficient” response to COVID-19, as well as decades of destructive public policy decisions.

One of the report’s recommendations is a single-payer reform, like Medicare for All, that would, quote, “cover all residents under a single, federally financed plan providing comprehensive coverage,” unquote. President Biden has so far rejected Medicare for All, saying instead he wants to bolster the Affordable Care Act with more subsidies. House Democrats proposed a bill last week that would boost subsidies for people who buy plans through the marketplace, and Biden has already signed an executive order to reopen enrollment on HealthCare.gov starting today, February 15th, through May 15th.

For more, we’re joined by one of the lead authors of this new report on “Public policy and health in the Trump era.” Dr. Mary Bassett is the director of the FXB Center for Health and Human Rights at Harvard University. She’s also the former New York City health commissioner, where she served from 2014 to ’18. Before that, she lived in Zimbabwe for nearly two decades, was on the medical faculty of the University of Zimbabwe.

Dr. Bassett, welcome to Democracy Now! It’s great to have you with us. Can you start off by talking about the findings of your Lancet study?

DR. MARY BASSETT: Thanks very much for having me.

We’re really pleased to release this report, which began with work as the assembly commission began in 2017. We looked at the four years of Trump’s policies, which were destructive in many ways that affected health, that have been displayed by the U.S. response to COVID-19. But, as you say, we went back further, 40 years of bad policies that embrace the marketplace as the way to determine how we organize ourselves as a society. And then we went back 400 years, to the foundational impact of enslaved labor and the embrace of white supremacy.

So, we do in fact recommend single-payer health insurance as the best way to assure healthcare coverage is available for all. Of course, Mr. Trump tried to reverse the Affordable Care Act and failed at doing that. But the Affordable Care Act still left millions of people — 28, 29 million people — without healthcare insurance coverage. And single payer would address that.

Of course, there are interim steps that will be helpful, not only reopening the marketplace as President Biden has done, but trying to encourage the states that declined Medicaid expansion, the principal way in which healthcare coverage was extended under the Affordable Care Act. The states that declined Medicaid expansion should accept it. It’s of no cost to them, and it would greatly increase both the number of people who are covered and address racial disparities, because it’s mainly Southern states that have declined Medicaid expansion.

AMY GOODMAN: I wanted to ask you about the comparisons of the United States to other countries, like Britain. Now, the U.K. has done very poorly, overall, with COVID. And, you know, they’ve got the variant. It’s ripping through the population. But when it comes to vaccines, they have vaccinated — at least the first shot — 15 million people, which is astounding. It’s far more than many countries of Europe combined. Now, one of the things they attribute their success to in this vaccination program is their National Health Service. They have soldiers, they have volunteers, various people, firefighters, who are injecting the vaccines. And they are using the entire country. They’re using stadiums and cathedrals, racetracks, mosques, fire stations, because they have a national, coordinated approach, which is possible because they have a national healthcare system. If you can talk about how what has happened in the United States has exposed the catastrophic problems with having such a patchwork system that for so long in this country has clearly just benefited wealthier Americans?

DR. MARY BASSETT: You’re right. The ability to dispense and administer the vaccine is greatly enhanced by a centralized system such as the U.K. has. And the U.S. has a privatized, fragmented system. We have had, until the Biden administration, no national policy guidance, so that you have different jurisdictions that are doing different things. And the result has been really chaotic. It’s getting better, but it explains why the U.S. has been unable to deliver a highly effective vaccine that it has developed, mostly with public funding, to the population. A fragmented system can’t identify the people who need to be vaccinated, has to rely on people finding their way. All of this is something that a central, nationally supported healthcare system doesn’t have to deal with.

So, this is where the healthcare system really comes out as a problem. But our vulnerability to this novel virus really was related to broader societal failures, not only to our health system, but also to the fact that too many people work low-wage jobs where they lack labor protections, too many people can’t get affordable housing and live in crowded circumstances. That’s what allowed the virus to spread so exponentially. But now we have an effective vaccine, and our system is really challenged in delivering it, because it’s private, driven by profit and totally fragmented.

AMY GOODMAN: So, let me remind people what Joe Biden said when he was running for president. He was asked by MSNBC’s Lawrence O’Donnell what he would do if he was elected president and Congress sent a Medicare for All legislation to his desk.

JOE BIDEN: I would veto anything that delays providing the security and the certainty of healthcare being available now. If they got that through, and by some miracle, and there was an epiphany that occurred, and some miracle occurred that said, “OK, it’s passed,” then you’ve got to look at the cost. I want to know: How did they find the $35 trillion? What is that doing? Is it going to significantly raise taxes on the middle class? Which it will. What’s going to happen? Look, my opposition isn’t to the principle that there should be — you should have Medicare. I mean, if everybody — healthcare should be a right in America. My opposition relates to whether or not, A, it’s doable, two, what the cost is, and what the consequences for the rest of the budget are.

AMY GOODMAN: So, to be fair here, this is before the pandemic. It’s in the middle of March, almost a year ago. Now, Kamala Harris has endorsed Medicare for All. And this goes to the issue, Dr. Bassett, of movements. You’ve participated in panels, for example, with Reverend William Barber where you talk about the importance of movements, that scientists are not outside of society. I mean, there’s a reaction right now, the way Trump was so anti-science, that we just need the facts. But can you talk about what it would mean, a year later, with this massive catastrophe that is the pandemic, for the movement for Medicare for All? Do you think this is the moment? After all, Biden did leave an opening. He said, “Is it doable? And now much does it cost?” Well, how much has the pandemic cost us?

DR. MARY BASSETT: Right. The pandemic is measured, clearly, in trillions of dollars in terms of economic costs and the many preventable lives lost. We estimated 160,000 people wouldn’t have died if we simply did as well as the median of the other wealthy nations in the Group of Seven.

So, this is something which I hope will help spur movement. And we’ve seen a massive outpouring of anger and rejection of the racial hierarchy in the United States. And this is part of that movement, is to ensure health for all. People of color, Blacks, Latinx, people of Indigenous descent, are much less likely to have adequate access to healthcare. So, this movement for healthcare for all, which I can’t imagine anyone would disagree with, is something that should be embraced by the broader social movements. I see it as a really promising time. We’ve paid much too high a price not to try and — not just do what we used to do, but have a better society which guarantees more access to all the things that we need for a healthy life.

AMY GOODMAN: Can I ask you about your experience, 20 years almost, in Zimbabwe, the growing concerns over the global inequity in vaccine distribution? Duke University health researcher Andrea Taylor told The Washington Post, “It remains to a large degree a zero-sum game, which means that every dose that goes to the U.S. or the U.K. or an EU country is a dose that’s off the shelves. And the shelves aren’t going to be restocked for a while.”

DR. MARY BASSETT: Yeah.

AMY GOODMAN: Let’s talk about who gets vaccines, who doesn’t, and what it means. What we’ve learned from the pandemic: If one person is sick anywhere, we are all threatened.

DR. MARY BASSETT: You’ve said it. That’s exactly right, Amy. We have a highly contagious virus that spreads through the air, that has affected every country in just one year with massive mortality impact. So, the fact that the wealthy nations have not attended to the need for vaccination coverage in the developing world, particularly in Africa, is a risk to all of us. The head of WHO said just a couple of weeks ago that only 24 vaccinations had been administered by government sector in Africa. Two-four. So this obviously is a risk to all of us.

Thankfully, the Biden administration has rejoined COVAX, the vaccination facility of the World Health Organization. But this is a chance for the United States to regain global leadership by making a commitment to vaccine access everywhere, not just for our citizens, because that won’t protect us. If all of us are vaccinated and the virus continues to mutate and spread in other sec, we’ll have new strains. We will have challenges to our vaccine. We need the whole world to be vaccinated.

AMY GOODMAN: And the Ebola outbreak we’re beginning to see in, for example, Guinea? It was believed it was eradicated in the world. What this means in Congo and Guinea?

DR. MARY BASSETT: Well, Ebola has been coming back year after year for decades now. We had the terribly lethal outbreak about five years ago because it reached the cities. But Ebola will keep coming. I hope we can go forward with a vaccination for that, as well. They’re pressing.

AMY GOODMAN: And finally, I wanted to get your comment on this controversy in New York around the deaths in nursing homes. You were New York City’s commissioner of health, and I want to ask you about these allegations that New York Governor Andrew Cuomo covered up the true death toll of the pandemic on nursing home residents, underreporting the statewide number of COVID deaths among long-term care residents for months — now stands at nearly 15,000, up from the 8,500 they previously reported, the higher death toll only revealed after a report by the Democratic state Attorney General Letitia James on the administration’s failure to include nursing home residents in the reports of people who died at hospitals. Can you respond to this?

DR. MARY BASSETT: Well, I haven’t kept up with the details of it, but, clearly, nursing homes were a place of initial spread. And it matters where people got infected, not only where they died. So, the fact that the data weren’t available in a transparent fashion is a problem. We need to know how important being a resident in a nursing home was to the risk of getting COVID. And we know that elders are at very high risk of dying of COVID. So, those data should be available. We need data transparency. And that is something that should be embraced by every jurisdiction. It’s something that the Biden administration has talked about. And it doesn’t seem to have been the case in New York. It matters not only where people died, but where they got infected.

AMY GOODMAN: Dr. Mary Bassett, we want to thank you for being with us, former New York City commissioner of health, now the director of the FXB Center for Health and Human Rights at Harvard University, one of the lead authors of The Lancet report we’ll link to, “Public policy and health in the Trump era.”

Remember, wearing a mask is an act of love. Wear two. Democracy Now! is produced by an amazing group of people. I want to thank Renée Feltz and Mike Burke. Special birthday greetings to Brendan Allen! I’m Amy Goodman. Thanks for joining us.