A healthcare system deteriorating for decades, compounded by policies created by former president Donald Trump, led to unnecessary deaths early in Mr Trump's presidency and during the Covid-19 pandemic, a recent study said.
The peer-reviewed study by medical journal The Lancet reported that when comparing the situation in the US with other G7 countries such as the UK, Germany and Japan, at least 40 per cent of the Covid-19 death toll – expected to reach half a million in February – is attributable to Mr Trump's actions.
"About 40 per cent of [the deaths] could have been averted had the US death rate mirrored the weighted average of the other G7 nations," the report read. "Many of the cases and deaths were avoidable."
The US faces the world's largest coronavirus outbreak. As of February 10, more than 27 million infections had been recorded by Johns Hopkins University, and more than 470,000 people had died as a result of the disease.
Researchers pointed to an array of actions taken by Mr Trump that caused the further spread of the coronavirus and a high death toll.
"Instead of galvanising the US populace to fight the pandemic, President Trump publicly dismissed its threat (despite privately acknowledging it), discouraged action as infection spread and eschewed international co-operation," the report read.
"His refusal to develop a national strategy worsened shortages of personal protective equipment and diagnostic tests. President Trump politicised mask-wearing and school reopenings and convened indoor events attended by thousands, where masks were discouraged and physical distancing was impossible."
The nation's top infectious diseases expert, Dr Anthony Fauci, shared similar thoughts about Mr Trump's role in the pandemic in an appearance at the World Economic Forum in January.
“There were a few things that were complicating and overlapping, and explain almost the unimaginable, about how a very, very rich country got hit the worst,” the director of the National Institute of Allergy and Infectious Diseases said.
“We had a situation where, instead of concentrating from the top down on the data and science and realising that we must make decisions based on evidence, there was a considerable amount of mixed messaging from the top down," said Dr Fauci, now chief medical adviser to President Joe Biden. "That cost us dearly.”
The Lancet report further declared that 461,000 lives were unnecessarily lost in the year 2018.
The researchers examined 40 years of the US healthcare system, starting after Ronald Reagan's presidency, when life expectancy in the country was shown to decline when compared with countries such as Italy, France and Canada.
The study found that deaths in the US began to increase when Mr Reagan left office and peaked during the early years of Mr Trump's presidency.
His attempts to scrap the Affordable Care Act, or Obamacare, and his changes to US health policy led to 2.3 million more people becoming uninsured, the report said.
A large chunk of the report emphasised the crisis of health care for racial minorities, during the pandemic and beyond. Researchers said there was concern over a weakened safety net for black, Latino and indigenous people in the US.
"Trump's disastrous actions compounded long-standing failures in health policy in the US," said Dr Kevin Grumbach, a Lancet Commission member from the University of California, San Francisco.
"We know what it will take to create a healthy society. We just need the political will to do it."
Mr Biden and Vice President Kamala Harris have promised to address the pandemic and the nation's racial disparities.
After rejoining the World Health Organisation, Mr Biden began a 100-day plan to push the countrywide adoption of wearing face masks, increase vaccinations and ensure safe school reopenings. He has already mandated masks in federal spaces and tried to address the country's rocky vaccination distribution programme.
He also presented an ambitious $1.9 trillion proposal that will send direct payments to Americans, help support small businesses hit by the pandemic's economic fallout and improve the country's Covid-19 testing systems.
The plan is moving through Congress. Democrats hope to pass it before mid-March, when many enhanced unemployment benefits and eviction moratorium protections expire.
Mr Biden indicated that there will be a secondary bill acting as a recovery plan after his first rescue bill passes.
The White House suggested the bill may be presented later in the year and that it will directly address racial equity in the country as well as job creation, infrastructure and climate change.
The recovery plan may be more aligned with the Lancet Commission's recommendations to tackle healthcare issues in the US.
"The disastrous, bungled response to the pandemic made clear how existing, long-standing racial inequities simply have not been addressed. It's time to stop saying these preventable gaps cannot be eliminated," said Dr Mary Bassett, a Lancet Commission member and director of the FXB Centre for Health and Human Rights at Harvard University.
Additionally, researchers declared that the former president's reductions in environmental and workplace protections led to increased pollution and harmful occupational situations for many in the US, leading to more than 22,000 deaths between 2016 and 2019.
The study said that these decisions "reversed 15 years of steady progress".