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The Unvaccinated Should Pay More For Health Insurance

A sign promotes COVID-19 vaccines at Lake Charles Memorial Hospital on August 10, 2021 in Lake Charles, Louisiana. (Mario Tama/Getty Images)
A sign promotes COVID-19 vaccines at Lake Charles Memorial Hospital on August 10, 2021 in Lake Charles, Louisiana. (Mario Tama/Getty Images)

The Supreme Court upheld states’ right to mandate vaccination in 1905. One hundred sixteen years later, that memo hasn’t reached some governors. They don’t just abstain from ordering COVID-19 shots themselves. They’re ordering schools, businesses, and municipalities not to order them.

Florida, the third most populous state, and Arizona, the 14th, are among five prohibiting private employers from requiring workers to get shots. They and Texas, second in population, are among 21 states outlawing vaccine passports. Florida and Texas have led the charge for banning school mask requirements.

Their obstructionism has helped prolong a pandemic that was poised to become history just heartbreaking months ago. The Lone Star and Sunshine States recently logged 40 percent of the nation’s COVID hospitalizations between them. That’s unsurprising, given their middling vaccination rates. Pending their leaders’ enlightenment (right), what’s to be done?

One smart suggestion would leverage the capitalist muscle of health insurers. They should charge the unvaccinated higher premiums for coverage, exempting those who can’t take the vaccine for medical or impeded-access reasons.

For those whose anti-vax stance is the child of a demented ideology, force them to choose between a shot in the arm or the wallet.

For those whose anti-vax stance is the child of a demented ideology, force them to choose between a shot in the arm or the wallet.

The heads of hysterics who’ve compared vaccine mandates to Nazi medicine are combusting over that last sentence: Unconstitutional! Unprecedented! Unpatriotic! Their blather is Unhinged. Just as mandatory vaccination does not violate the Nuremberg Code (are cranks clueless that they received state-ordered shots as kids?), there’s ample precedent for making the reckless fork over more for insurance.

Insurers don’t always use that stick. They cover care for smokers’ and drinkers’ self-inflicted damage. Still, Obamacare, while reining in premium discrimination — against pre-existing conditions, for example — permits insurers to charge smokers up to 50% more than nonsmokers. A few states prohibit “tobacco rating,” but four-fifths of them allow the full penalty. Insurers rely on smokers self-reporting when they apply for coverage, but lying about your habit can be prosecuted as insurance fraud. And medical exams’ blood and urine testing can detect nicotine.

Premium-punishing the irresponsible isn’t just the prerogative of health insurers. High-risk drivers pay more for auto coverage.

Anti-vaxxers surely don’t know this. They obviously don’t grasp the ethics undergirding these laws: As Paul Krugman writes, “When you reject your shots or refuse to mask up, you’re increasing my risk of catching a potentially deadly or disabling disease, and also helping to perpetuate the social and economic costs of the pandemic.” Which, the longer it drags on, might evolve new variants that the vaccines won’t protect against.

A man wears an 'UNVACCINATED' t-shirt ahead of U.S. President Donald Trump's "Save America" rally at York Family Farms on August 21, 2021 in Cullman, Alabama. With the number of coronavirus cases rising rapidly and no more ICU beds available in Alabama, the host city of Cullman declared a COVID-19-related state of emergency two days before the Trump rally. According to the Alabama Department of Public Health, 67.5% of the state's population has not been fully vaccinated. (Chip Somodevilla/Getty Images)
A man wears an 'UNVACCINATED' t-shirt ahead of U.S. President Donald Trump's "Save America" rally at York Family Farms on August 21, 2021 in Cullman, Alabama. With the number of coronavirus cases rising rapidly and no more ICU beds available in Alabama, the host city of Cullman declared a COVID-19-related state of emergency two days before the Trump rally. According to the Alabama Department of Public Health, 67.5% of the state's population has not been fully vaccinated. (Chip Somodevilla/Getty Images)

I listen to a talk radio station for mental candy, so I’m familiar with the risible retorts of the cranks to Krugman’s point. No, the vaccines aren’t experimental, and they haven’t killed thousands. No, masks, while uncomfortable, don’t smother kids and, in tandem with other precautions, they do offer real protection. One host on that station said that if his employer mandated vaccination, he’d broadcast from home to avoid the needle. What if his flippancy cost a bigger bite of his paycheck towards the company health plan?

Anti-health jihadists in governors’ offices might try to checkmate insurers. But those executives have their hands full with school districts defying their no-masks mania, with court support. Having already usurped businesses’ ability to regulate safety on their premises, they might not want to pick a new fight with the insurance industry.

We speak of COVID becoming another front in the culture war. The martial metaphor is apt. Anti-vaxxers wage war on science and the lives sacrificed in the pandemic on behalf of an ideology camouflaging selfishness as personal liberty. Denouncing vaccines and the discomfort of cloth across their faces as infringements of “freedom,” they trivialize that word, as if public health measures were the gulag.

In reality, it’s anti-vaxxers who have a jones for authoritarianism. A school board member in New Jersey, Jackie Tobacco (there must be a God to have concocted such a preternaturally ironic name), proposes abridging teachers’ First Amendment right to even discuss vaccination status. This bent is hardly shocking, as lack of vaccination corresponds to support for Donald Trump, inciter of anti-democratic insurrection.

The government’s full approval of the Pfizer vaccine may coax some to take their shots. Others among the unvaccinated seem tireless in their birther-style substitution of emotional bleating for thinking. The birthers vomited one racist conspiracy theory after another to insist Barack Obama was illegitimate. As each fallacy was debunked, they’d drop it like roadkill and flit to a new one, never acknowledging that they’d been wrong.

Anti-vaxxers’ copy-catting this approach makes mandatory vaccination the preferred public health strategy. But money talks, and charging them for their heedlessness is a worthy Plan B.

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Rich Barlow Cognoscenti contributor
Rich Barlow writes for BU Today, Boston University's news website.

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