Making the Unvaccinated Pay Can Save Many Lives; As With Smokers, Having Them Bear Their Own Costs Can Be Effective
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Making The Unvaccinated Pay
WASHINGTON, D.C. (August 23, 2021) - Requiring those who refuse to be vaccinated (especially without medical or religious justification) to pay at least some of the huge costs of their refusal is only fair, and will save many lives - as such a policy did when some of the costs of smoking were imposed on smokers - says public interest law professor John Banzhaf, who started and then lead the nonsmokers' rights movement, and helped make smokers bear more of the costs they imposed on others.
This can and should occur in many ways, he suggests, and cites a number of examples where it is already happening.
FIRST, those who simply without justification refuse to be vaccinated should be required to pay more for their life and health insurance, just as smokers have for many years.
Indeed, second only to restrictions on smoking in workplaces and other public places, requiring smokers to pay more of the costs they impose on others has been the most effective way to persuade them to change their behavior - more so than all the warnings, guidelines, etc.
The disinformation campaign by the tobacco industry, which helped to initially persuade millions of smokers not to quit, was much larger, much better financed, and better coordinated than today's COVID disinformation. So this one step should be even more effective in persuading people to take the simple step of getting vaccinated.
Banzhaf points specifically to Obamacare under which he helped persuade Congress to include a 50% surcharge on smokers - which, by some estimates, can get up to half of affected smokers to quit.
Last year, most major private insurers agreed to waive patient payments - from coinsurance to deductibles - for COVID treatment. But many, if not most, have allowed that policy to lapse since there are now readily available vaccines.
The professor argues that it is fairer to require the unvaccinated to pay the costs of their refusal than to try to reward them with financial incentives to get vaccinated.
Small financial incentives - for both getting vaccinated and quitting smoking - aren't very effective, and are unfair to the majority who have already been vaccinated (or quit smoking), he argues.
Some have gone even further, arguing that health insurance should not cover treatment for COVID patients who brought the disease on themselves. “Don’t want the COVID-19 vaccine? Then pay full cost if you land in the hospital,” says MarketWatch.
But charging the unvaccinated more - under a policy known as differential health insurance premiums which was adopted and recommended by the National Association of Insurance Commissions [NAIC], and which has been applied in some situations to smokers and/or the obese - is seen as fairer and more humane, says Banzhaf, especially since it would immediately spread the costs of refusing vaccinations among all those who refuse, and help persuade many of them to take this simple step.
After all, notes Banzhaf, it's much easier to take a free and readily-available shot than to overcome a powerful addiction to nicotine.
SECOND, in situations where employees and other groups are required to be vaccinated or face periodic testing for COVID, it seems only reasonable and fair that those who need the test - only because of their refusal to be vaccinated - should pay the costs of their own periodic testing. Otherwise these few holdouts are forcing others not only to bear the risks of becoming infected with COVID, but also to pay these costs of testing - which can add up for both small and large businesses.
Tests can each cost $100 or more, so the costs of periodic testing over time can be considerable. While federal law requires insurers to cover the testing costs when ordered by a health care provider, routine workplace tests are exempt from that provision, so employers can let their workers pay for the costs of their own testing.
Requiring Students To Be Vaccinated
THIRD, at the growing number of schools, colleges, and universities where students must be vaccinated or have periodic testing for COVID, those who stubbornly decline to be vaccinated should pay at least the huge costs of the tests their refusal imposes on others. if not also some of the additional costs.
For example, it has been estimated that at one large university, the difference between a student vaccination rate of 60% and 80% would cost the school - in addition to the additional costs of periodic testing for unvaccinated students - about $4 million to prevent the spread of COVID-19 and treat additional students projected to get infected.
As the Wall Street Journal has reported, "some schools are passing the approximately $50 cost of a surveillance test onto unvaccinated students. Federal aid that colleges and universities received to cover the cost of preventive measures earlier this year isn’t recurring, and insurers generally don’t cover surveillance testing."
As just one example, West Virginia Wesleyan College announced that students who do not submit proof of vaccination, or are not vaccinated, will be charged a nonrefundable $750 fee for the fall-2021 semester. Rhodes College will require unvaccinated students without a medical or religious exemption to pay a fee of $1500 each semester to cover the costs of a weekly COVID testing program.
Banzhaf notes that while some states have prohibited colleges from requiring students to be vaccinated, it's not clear that such restrictions would legally prevent a college from simply having two different tuition or health insurance rates: one for those who have been vaccinated, and a different higher rate for students who simply refuse to be vaccinated.
FOURTH, hotels, motels, cruise ships, and those which rent houses can and probably should charge higher rates for those who cannot prove that they have been vaccinated to cover the much higher costs of cleaning and disinfecting their rooms once they leave, says Banzhaf, noting that most hotels and motels now impose a surcharge on visitors who smoke in their rooms - likewise because of the added costs of cleaning and disinfecting the rooms.
FIFTH, until only those who have been vaccinated are permitted to fly on commercial aircraft, airlines should charge those who do not provide proof of being vaccinated a higher fare, and also concentrate them in a small section so as to reduce the risk that they will infect others -just as some venues for sporting events and other gatherings are restricting the unvaccinated to small designated areas.
The presence of unvaccinated passengers on flights requires far more extensive and expensive cleaning of the planes, imposes an unfair burden of having to wear masks on the majority who are vaccinated, and has greatly exacerbated flights in other ways (e.g., limiting the sale of alcoholic beverages and even snacks, creating major enforcement problems and even physical fights, etc.)
Checking vaccination status should not impose an unreasonable burden on carriers which are already required to check drivers' licenses (and soon to require REAL-ID licenses) on all flights, and both passports and recent COVID test certifications on international flights.
Limiting Entry To Those Who Have Been Vaccinated
SIXTH, many venues such a movie houses, stadiums and arenas, theaters, night clubs, and even some bars and restaurants are now limiting entry to those who have been vaccinated. Some, however, permit unvaccinated customers to enter, but restrict them to certain designated areas to reduce the risk of infection.
When unvaccinated people are permitted to enter, the risk of infection remains high, and the costs associated with separating the two groups, of insuring compliance with masking requirements (especially for the unvaccinated), and of doing the extra and more extensive cleaning and disinfecting required because of the unvaccinated can be considerable.
In such situations, it is fairer to require those whose behavior necessitates the higher costs to pay them, rather than raising the price for all attendees. Charging the unvaccinated more to attend also provides additional encouragement for them to become vaccinated, just as charging smokers more helped persuade many tens of millions to finally quit.
Banzhaf notes that one way most states forced smokers to bear more of the costs of their behavior was to impose very high taxes on tobacco products, but this option isn't available regarding COVID and vaccinations. But, he says, the basic principle - that those whose behavior imposes large costs on others must pay them - should apply to choices to remain unvaccinated as it does to choices to remain a smoker.
Noted medical ethicist Arthur Caplan agrees. In an article entitled People Who Refuse COVID-19 Vaccination Should Be Held Financially Liable, he writes: "the unvaccinated in the United States are imposing costs and harms on the rest of us. They are, as they incessantly point out, free to choose not to vaccinate. But they should pay for their poor choices that hurt others."
Banzhaf adds that while they may be free to refuse to be vaccinated, we the vaccinated are then both free and justified in asking them to pay the costs their freedom to choose is imposing on people who did not freely choose to assume or pay for the greatly increased risks and costs.