A provocative and interesting piece has been doing the rounds wherein a doctor suggests that those parents who decline to have their kids vaccinated against infectious illnesses should be obliged to pay higher insurance premiums as a result [via BoingBoing and many others].
Refusing to vaccinate a child is dangerous not just for that child but for entire communities. It’s precisely this point a colleague of mine was considering when he had the idea that parents who refuse to vaccinate their kids should pay substantially higher health insurance premiums.
It makes sense. Insurance, after all, is just a pool of money into which we all pay. In determining how much we or our employers pay, risk is taken into account.
The perfect analogy is smoking. If you smoke — and want to turn your lungs black and spend a greater portion of that pot of money on your possible chronic lung disease or any cancers you’ll get — then you may have to pay more.
Why shouldn’t we impose the same logic on parents who refuse to vaccinate their children?
It’s definitely logical, and there’s an appeal to market forces in there that I suspect has better odds of turning the tide of anti-vaccination paranoia than attempting to pateinetly explain the science to people who cannot (or simply will not) understand it.
The problem, of course, is what happens when the anti-vaccination faction refuses to pay insurance at all; I’m not sure how the law on these matters works in the US, but I’m pretty sure the consitutional obsession with freedom means that folk can’t be forced to contribute against their will. I’m also guessing that this a fracture that will occur along class and political lines… and those lines are looking pretty fractured already, at least from the outside looking in. So as logical as this idea looks on the surface, it’s probably indicative of greater social schism to come, rather than being a workable solution to a current problem.
But the overarching question here is “can we permit and manage science denialism in large societies using market forces?” Or, to put it another way, “believe what you want, but if you want to live here, there is a premium on dissent against scientific orthodoxy”. Phrased like that, you can see why some people describe science as a form of hegemonic belief system… though those that do tend to be devoted to hegemonic belief systems of their own – ones with much less basis in, y’know, reality, evidence, that kind of stuff. And I can’t see them cheerfully ponying up their antivax premiums any time soon, can you? Geographical separation looks increasingly like the only way this is going to shake down.
The US doesn’t have compulsory state-administered medical insurance like in the UK. In the US, if you don’t pay for health insurance or get it through your employer, you have to pay the market price for your medical treatment.
Now, I think you can get emergency room treatment for free, and the government Medicaid programme will still pay for uninsured children, but if you refused to pay for insurance then you would be left without access to proper healthcare (which is true for plenty of Americans).
I am surprised that US HMOs don’t already charge a premium or try to deny coverage if children haven’t been vaccinated. I wonder if they do actually pay for treatment of children who are deliberately left unvaccinated when they contract preventable diseases.
I’m surprised we’re not seeing more discussions of premiums for high risk behaviors too, particularly in the system here (the U.S.). I know there have been discussions, and I’m of the opinion that, if we’re to keep an insurance-based system, that premiums should be paid for those who practice behaviors that are avoidable and damaging to your health. But it could get sticky depending on the conditions you have. Where do we draw the line between “what I can avoid” and “what I can’t avoid”? Given the kinds of jobs some people work, risk is built in. Maybe we can charge premiums for smokers and anti-vaccination people, but we’d have to clearly define why that is acceptable, whereas other instances are not.
“The problem, of course, is what happens when the anti-vaccination faction refuses to pay insurance at all”
You can choose not to pay for insurance. Just like you can choose not to pay for food. “I refuse to buy this constitutionally overpriced food! it’s a violation of my nutritional rights! (rahts)” And you can starve. Insurance companies would be happy to not have to treat your increased-risk unvaccinated child. Hell, they employ teams of people whose job is JUST to find ways NOT to treat you when you HAVE insurance. It’s not insurance companies who are struggling to maintain their client bases, but people who are quite literally dying to get covered (50 million+). It’s called a non-universal health care system.
And thank empathetic, socialist people for our “compulsory state-administered medical insurance”, eh Ben?
Without it, I would never be able to run again (anterior cruciate ligament reconstruction, surgery performed admirably after a rugby training incident, on the NHS), I wouldn’t be able to get counselling for my OCD (paid for by the local primary care trust, something I could never afford), and (though prescriptions and the prescription charge aren’t strictly a part of the NHS) I wouldn’t be able to afford the antidepressant medication that makes my life bearable.
There is another possible-and more expensive-answer. I believe that the names of parents who refuse to have their children vaccinated are on record. If that is the case, then perhaps all such parents might be required to sign a contract by which they agree to cover the total costs of any people who contract the diseases, other than themselves or their children.
This also covers those who cannot or will not pay for health insurance. For those who cannot, all vaccination should be free.
Failure vaccinate or sign the contract should result in their children being denied entry into school. Private schools already have such a right.
Oh, and for all you libertarians out there: This is a public health issue not a civil liberties one. Just as you’re not allowed to scream fire in a theater when there isn’t one so, you are not entitled to endanger others. Sometimes, even to us First Amendment defenders, there do have to be restraints.
Rick York
You’ve raised my curiosity as to the class lines along which antivaxxers divide – I’d been under the possibly erroneous impression that a lot of the parents refusing to vaccinate were upper-middle-class; but it might be different in N. America. (It’s probably different between the U.S. and Canada, if it comes to that, given our different health-care systems.)
@Sarah
In my experience most of the anti-vaccine people in the U.S. are middle to upper-middle class.