As the U.S. death toll from COVID-19 approaches half a million, a new report says nearly 40% of the deaths were avoidable. By comparing the pandemic in the U.S. to other high-income nations, the medical journal The Lancet found significant gaps in former President Donald Trump’s “inept and insufficient” response to COVID-19, as well as decades of destructive public policy decisions. One of the report’s recommendations is reforming the system to a single-payer model like Medicare for All, which President Joe Biden has so far rejected in favor of bolstering the Affordable Care Act. “The Affordable Care Act still left millions of people — 29 million people — without healthcare insurance coverage,” says Dr. Mary Bassett, one of the authors of The Lancet report. “Single payer would address that.”