Wrong way to convince the unvaccinated

Opinion: Harsher and harsher punishments are not the way to convince the unvaccinated

By Megan McArdle Columnist December 15, 2021 at 4:58 p.m. EST

Recent months have seen a rising number of ideas for making life unpleasant for the unvaccinated. Vaccine mandates, of course, but why not also jack up their premiums for health or life insurance? Hell, charge them for the cost of treatment if they catch covid-19. And while you’re at it, maybe push them to the back of the triage line.Opinions to start the day, in your inbox. Sign up.

I won’t try to argue that this is cruel or medically unethical; the authors of these proposals will simply retort that spreading covid-19 is also cruel and medically unethical. So instead, let’s ask whether such policies are justifiable and, if so, whether they actually work.

In some cases, yes, there are clearly valid reasons to treat the unvaccinated differently from the vaccinated, and possibly effective ways to do so. When unvaccinated people impose substantial, direct and unnecessary costs on others, it’s fair to impose rules that limit the damage or recoup those costs.

If a nursing home decides it’s better off running short-staffed than coping with a covid-19 outbreak, it’s reasonable to impose a vaccine mandate. Companies that want to minimize the liability and disruption of outbreaks also have a right to pursue that goal by demanding that customers be vaccinated before they step on the premises.

Nor is it outrageous for employers such as Kroger supermarkets to say that unvaccinated employees should bear avoidable costs of the disease they impose on others rather than the company having to cover them. If a company wants to curtail paid sick leave when unvaccinated employees are out with a predictable case of covid-19, it has that right. If unvaccinated employees with severe infections are consuming lots of costly treatment, jacking up premiums for the whole company, it is justifiable for the company to charge them extra for health insurance.

It’s also reasonable for doctors to take vaccination status into account when forced to calculate who is most likely to survive — for example when allocating limited ICU beds, or organs for transplant. Transplant patients, especially, face a lifetime of immune-suppressing drugs, leaving them particularly vulnerable to covid-19 if they haven’t been vaccinated. Giving an unvaccinated person a transplant in the middle of a pandemic potentially wastes a scarce organ that could have given someone else a long life.

But such policies have to be proportionate to actual risk, not merely punitive. And let’s be honest: Many vaccinated folks are feeling pretty punitive. They’d like to change minds, or failing that, at least change behavior. But they’ll settle for making anti-vaxxers pay for their pigheaded refusal to protect others or themselves. Hence the popularity of anecdotes in which anti-vaxxers catch covid-19 and then die in the horrified realization that they did this to themselves. Blue America loves to share these morality tales with sanctimonious sorrow — so sad! (So satisfying!)

The best defense of the punitive instinct is that more people might get jabbed if we make it sufficiently costly not to resist. But at this point we’ve reached a hard core of refusers who are not merely a little hesitant, but apparently happy to risk their lives rather than take a shot. If the possibility of dying doesn’t faze them, how likely are they to respond to lesser threats? And if the answer is “not very,” can we really justify punishing them anyway?https://aec4e53060e351c2c3e4729df087a179.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

It might be tempting to say “yes,” since we punish people who violate the social contract in other ways, and what else can you call recklessly endangering others and clogging up our health-care system with avoidable infections? But of course we, too, have obligations under the social contract. The health-care system exists to provide treatment for the sick, not judgments about how they got that way. And if you aren’t moved by appeals to the Hippocratic oath, consider the ways that punitive instinct might backfire.

Mandate a vaccine and your nursing home might struggle to find sufficient staff. Deny paid sick leave to the unvaccinated, and people might come to work with covid-19. Force anti-vaxxers to pay the costs of covid-19 treatment, and they might not seek care until they are really sick, costing the system even more and straining its capacity. Send unvaccinated people to the back of the triage line and you establish a precedent. How many of us would always fare well in a health-care system based not just on prognosis but perceived virtue?

Of course, it’s frustrating when people refuse a lifesaving vaccine. But we can’t solve that problem by building a world that none of us, vaccinated or not, would much want to live in.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.