The British medical journal the Lancet, on Wednesday, published a damning assessment of Donald Trump’s presidency and its impact on Americans’ health, concluding that 40 percent of the nearly 500,000 COVID-19 deaths in the U.S. over the past year were avoidable. The journal came to the conclusion by comparing the U.S. health outcomes on the coronavirus—the country leads the world in COVID deaths and confirmed cases with more than 27 million—with the weighted average of other G-7 nations. So it’s not a wildly abstract conclusion to draw: the U.S. could have saved hundreds of thousands of lives if it had just performed similarly to its economic peers.

The report assailed Trump for his response to the pandemic, but emphasized that the disastrous response to the virus’s spread was the result of years of destructive public policy decisions on health that extended well beyond the Trump years. From the Lancet:

Many of the cases and deaths were avoidable. Instead of galvanizing the U.S. populace to fight the pandemic, President Trump publicly dismissed its threat (despite privately acknowledging it), discouraged action as infection spread, and eschewed […]