Who Should Bear the "Costs of the Unvaccinated"

Balancing Rights and Risks

I’ve written extensively on the policy failures that are Covid vaccine mandates, and I’ve tried to push back on some of the more common counter arguments. Such as the argument that mandates are justified due to the externalities of remaining unvaccinated.

Check Your Externalities

Another argument I’ve heard recently centers around the “costs” associated with choosing to remain unvaccinated. As the argument goes, “It may be your right to pass on the vaccine, but why should I have to pay for your medical bills if you then get sick? It was your choice, you should pay the consequences.”

This argument is bolstered by the current popular framing of the Covid situation as a “Pandemic of the Unvaccinated”. Now an examination of the extent to which this framing is true will have to wait for another post. In the meantime I think it’s proper to address the argument directly. Another example of this argument can be seen in this twitter exchange below:

Nicholas Sarwark @nsarwark

Libertarians believe other people shouldn't be taxed to subsidize the personal choices of others. Rights come with responsibilities.

Cato Institute @CatoInstitute

The decision to be inoculated (or not) is a personal one, but society should not subsidize the decision to remain unvaccinated. https://t.co/iCuXR2ERcz #CatoHealth #CatoCOVID

The argument is framed as a statement as to how we should decide who should pay the medical costs for our life decisions, be that smoking cigarettes, or eating and drinking to excess, or deciding to take the Covid vaccine.

I agree with the Cato Institute, in a perfect world the probable medical costs for all of those decisions should be borne by the persons making those decisions. We would be better off as a society treating medical insurance more like life insurance, with actuaries basing the costs of our insurance on the true expected value of our future medical costs. We don't quite live in that world unfortunately, but if we did, what might it look like?

I think what many people might miss is that the probable costs of remaining unvaccinated are not uniform for all members of society.

If you're a healthy 25 year old, of normal BMI, who can still run a mile in 5 minutes flat, I doubt the medical actuaries really care if you are vaccinated or not, you are of such low risk of costing them anything due to Covid. Maybe if they really sharpen their pencils they'll tack on $100 bucks a year or something…

Per CDC Covid-Net Data, the annualized risk of a 20 year old becoming hospitalized “with COVID” is less than 0.2%/year and concentrated mostly in those with co-morbidities. It’s closer to 1/10 that rate for our example above.

On the other hand if you're a 65 year old with obesity, high blood pressure, and diabetes, yeah, those medical actuaries are definitely going to raise your rates if you decide to forgo the vaccine.

The annualized risk is ~1%/year for 65-74 year olds and significantly higher for those with co-morbidities. Notice also how the age 65 line jumps dramatically with the Covid waves while the age 20 line is flat. This is a telltale sign that much more of the age 20’s are in the hospital “with Covid”, not “from Covid”

Obesity, high blood pressure, and metabolic diseases such as diabetes are the three most common underlying conditions among those hospitalized “with COVID”. Eliminate those risks and you dramatically reduce your risk of a Covid hospitalization regardless of your vaccination status.

Yet, the actuaries I know are a lot smarter than your typical government bureaucrat. They're going to look for any edge to keep their rates lower than the competition. They might ask that 65 year old if they have had a documented prior Covid infection, aka “Natural Immunity”. If so, that might actually LOWER their rate, since not only are they not at the same Covid risk of an immune naive individual, but based on the weight of scientific evidence they are at less risk of Covid than your typical vaccinated person! This thread includes a list of some of the many study showing the strength of natural immunity:

Aaron Ginn @aginnt

A credential vs. science “Natural immunity confers longer-lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SCoV2, compared to vaccine-induced immunity.” medrxiv.org/content/10.110… science.org/content/articl…

Tyler Black, MD @tylerblack32

"Natural infection immunity is better than vaccinated immunity" is an anti-vax trope that has existed for *literally* hundreds of years, and has no basis in reality. In fact, Vaccinated immunity is far superior, more reliable, and less dangerous than Infection-based immunity.

This isn't a small point, well over half the "unvaccinated" likely have prior immunity to Covid!

So people might want to be careful what they wish for. Are you comfortable paying MORE for medical insurance as a vaccinated individual with no prior infection than what an unvaccinated individual who has had that prior infection would pay?

I think in reality people pushing for "making the unvaccinated pay" aren't making this case out of concern for correctly allocating medical costs, they're advocating for it as a form of punishment.

“Because we’re Delta Airlines… And life is a f**king nightmare…” - John Mulaney

Take for example Delta Airline’s plan to charge unvaccinated employees an extra $200/month for their medical insurance. The fees they plan to charge are punitive, and would apply to all unvaccinated employees uniformly regardless of their actual individual medical risk.

So until we are actually able to treat these medical risks fairly, alongside all the other life choices that affect our potential medical costs, I say we table this idea.

Anyway 0 and 2...