My neighbor is a libertarian — she believes in a minimal role for the state. That includes not requiring her children to be vaccinated. She gaily gamed the system by “mistranslating” Czech medical records for her children so they could attend public school. My neighbor has also been contemplating not being vaccinated against COVID-19. Here there is no deception involved, just selfishness. She figures she will benefit from herd immunity while others assume what she considers the risk of being vaccinated.
She is unmoved by a moral argument that if everyone did as she is doing there would be no herd immunity. Instead, operating as a classic free rider, she is assuming that most people will in fact get their shots.
She is probably right when you take the country as a whole. According to a recent poll 69% of respondents indicated that they had or intended to get vaccinated. But she is likely wrong when we look at the state and local level, especially among concentrations of Trump supporters. According to a report of Federal study of vaccine hesitancy, “Mr. Trump won nine of the 10 states where the most residents said they would probably or definitely not get the vaccine.”
Well, you might say, so be it. If a community decides not to be vaccinated, let them live with the consequences. Those of us who have become vaccinated will be protected. But that is wrong. First, vaccination only offers 95% immunity. And second, where the virus has a foothold, it can mutate and, as we saw in a recent outbreak in Texas, those mutations can produce strains that are anti-body resistant. That is to say, those strains can infect those who have been vaccinated.
My neighbor, being a libertarian, is unmoved by these considerations. “If you are worried, stay home!” she says. I’d prefer to make her stay home — or mandate her to be vaccinated. But we live in a country that has always romanticized libertarianism as a doctrine, and done so by never holding supporters of that doctrine to account. As such, we make it very easy for libertarians to have their cake and eat it too. We allow them to advocate for no state interference in their lives, but then allow them to draw on the state when they need it. This is a case of moral hazard writ large. And nowhere is this truer than when it comes to COVID-19.
In a rational world, we ought to at least hold libertarians to their word. If you get sick with COVID we will give you a bed in an ICU, but you will be last in line for it and you better be able to pay for your own care.
Instead, under the 2021 CARES Act, the Federal government is providing free care to any and all who get COVID and even granting a $9,000 toward funeral expenses to those who succumb to it, and that includes those who refuse vaccination.
There is, however, a way to reorient policy to create incentive to become vaccinated, even if it is out of self-interest. A recent Virginia law provides funds for healthcare workers to cover lost wages and medical expenses and is retroactive to March of 2020, but it excludes those who are offered vaccination and refuse it (unless their refusal is medically indicated).
One way to extend this idea to the general public is to follow the precedent set by companies that make employees who smoke, and refuse to participate in a smoking cessation program, pay more for their health insurance.
Insurance rates march to two drummers. One assumes we are all at risk and so shares the cost caring for those of us who suffer misfortune equally. The other assumes we are at differing degrees of risk and therefore varies insurance premiums taking that into account. Which of these approaches wins out is a delicate matter. But one thing is clear — where risk is differentiated but is not a matter of choice, we all pitch in equally. On the other hand, where you choose risk, you and your fellow risk lovers, are on your own.
The average cost of treatment if you get COVID-19 is $35,000 to $46,000 varying by age. The insurance pool for those playing Russian Roulette should not have to include the rest of us. And so too, the insurance pool to cover COVID care and burial expenses for those who decline vaccination without a medical justification. Let the libertarians among us fend for themselves.