Much of the argument about lockdowns and mask mandates boils down to disagreements about the level of risk that’s appropriate to impose on others and how much should be left to individuals to decide.
But now that vaccines are easy to obtain (and have always been free to the recipients), the calculations have shifted. Those who choose to remain unvaccinated no longer pose a serious threat to the vaccinated – but they’re still imposing a cost. Hospitalizations for COVID are almost entirely confined to those who are not vaccinated, often at the cost of tens or hundreds of thousands of dollars.
Who should bear those costs? Under our system of risk-sharing, it’s all of us, whether through government programs like Medicare and Medicaid or through private insurers. When someone who refuses to get the vaccine gets seriously ill, their bills currently are paid by taxpayers or others in their insurance group.
But why should the vaccinated bear those financial costs? Insurers, led by government programs, should declare that medically-able, eligible people who choose not to be vaccinated are responsible for the full financial cost of COVID-related hospitalizations, effective in six weeks.
That gives time for the unvaccinated to make a choice, based on their personal preferences and a truer sense of responsibility. Those who continue to believe that COVID is no more than a cold, or that the pandemic is a sophisticated fraud, or that sheep parasite medicine is more effective than vaccines with shockingly good efficacy, can put their money where their mouths (and keyboards) are.
One of the fundamental lessons of economics is that people respond to incentives – just witness the success of vaccine lotteries at encouraging vaccinations. But a policy of letting the unvaccinated foot the bill for their COVID-related hospitalizations is only partly about wielding a financial stick to push reluctant people into vaccination. It’s also about not expecting others to pay for your decisions. Standing up for your beliefs means being willing to bear the consequences. Otherwise, it’s just cheap talk.
The most common objection to this policy is a slippery slope argument: what if the insurers stop covering the health outcomes of other lifestyle-driven diseases, like cirrhosis or Type 2 diabetes? Or not covering health costs for those who are unbelted in auto accidents?
Health insurers already do charge more to people who smoke and are permitted in many states to exclude coverage when injuries arise from illegal acts or under the influence of drugs – including alcohol. And a full debate about whether people should be charged more when engaging in certain activities is not unreasonable if the costs of these kinds of choices are going to be spread to everyone.
But more importantly, there is a direct and clear connection between vaccination and the likelihood of serious complications from COVID, unlike the decades-long development, mediated by genetics, between many health behaviors and serious illness. A more apt comparison would be if a safe single-shot cure for Type 2 diabetes was developed. The rest of us would be justified in refusing to cover the costs of complications for diabetes for anyone who refused to take the cure.
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