Yes, non-vaxxers should pay more for their care

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Many of my neighbors ask why we don’t increase the burden on those who get sick with COVID-19 if they don’t get vaccinated. If they ignore proper precautions and end up in a hospital, why should those of us doing the right thing pay?

Whether the non-vaxxers improve or not, they certainly have a pretty good bill for the cost of their hospitalization. What if you had to postpone your colonoscopy or hip replacement or missed an IVF cycle because hospitals are overwhelmed with COVID patients, how fair is that?

Some countries are preparing to penalize the non-vaccinated. Greece says people over 60 who don’t go will pay a monthly fine €100 ($114) per month. Austria will be OK unvaccinated people at least €600 ($681) every three months. In Singapore, those who choose not to be vaccinated must pay for their own medical bills if they contract COVID.

Some American employers insist that those who are not vaccinated pay a higher copayment for their insurance if it is determined that they have not received the full set of vaccines – in the case of mRNA vaccines, three injections. (“The average hospital stay for COVID-19 cost Delta $50,000 per person,” said the CEO of the airline, Ed Bastian, last summer. He noted that “not all Delta employees who were hospitalized with COVID were fully immunized.”)

What is fair? What is fair? I disagree with those who say, “Well, if you’re not vaccinated, you can’t get into the hospital – or you’ll get a lower priority if you do.” I think health care providers cannot ethically discriminate on the basis of vaccination status as to who can enter the emergency room or intensive care – even if the unvaccinated make choices with which I strongly disagree. .

I believe we need to insist on vaccination for all and deny services to the unvaccinated in certain settings – for example, eligibility for transplants. Some 1,200 people are waiting for a transplant in Connecticut. The chances of you succeeding in keeping your transplant are very low if you are not vaccinated, because you will be immunocompromised and the virus, if you catch it, would likely kill you and your new organ. In this context, a transplant for an unvaccinated person is probably futile, so it makes sense to say that as a condition of being transplanted, you must get all your vaccines, including for COVID.

But these circumstances are rare. How about charging more?


As state residents know, health and disability and life insurers say every day, “You’re overweight, you engage in risky behaviors, you have a history of drug abuse, so you’re going to pay more for your insurance. Underwriting, as it is called, is an accepted practice in many insurance markets.

There’s nothing illegal about saying, “In order to determine how much you’ll pay for private insurance, we’re going to look at your risk profile. If you are diabetic or have another underlying condition, we will charge you more.

When it comes to money, private insurance charges people more when they are at greater risk. Not being vaccinated means you are at a higher risk of hospitalization. I think a case can be made for charging larger co-payments or higher premiums to unvaccinated people.

If you choose to behave in a risky way that increases costs for everyone, you have to pay more.

Neighbors should try to provide health care for all, but those who drive up health care costs should shoulder more of the burden.

Arthur Caplan lives in Ridgefield. He is the Mitty Professor of Bioethics at New York University Langone Medical Center.

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