No coverage for ‘COVID Carl’

Typhoid Mary was nothing compared to “COVID Carl.” Mary could not know that she was placing others at risk of infection. Carl, deliberately refusing free vaccination against a lethal disease, cannot plead ignorance. 

With COVID-19 infections surging, hospitals and medical staffs in many locations are again overwhelmed. Insurance companies are also facing financial strains with a massive number of cases, stemming predominantly from unvaccinated patients.  

Those companies could help themselves – and more importantly help curb the spread of COVID – by adopting a straightforward policy: Individuals who refuse vaccinations against COVID will be refused medical coverage for COVID if they develop the disease. By linking the financial risks of catching COVID with the health risks of refusing vaccination, insurers would create a valuable incentive favoring vaccinations. 

Companies regularly adjust their coverage as they recalculate costs of particular provisions. Individuals who reject the vaccinations that are known to diminish the spread of COVID and the intensity of the disease would still be free not to protect themselves with vaccinations. They would, however, have to consider whether they wish to assume the risk of self-insurance if their choice proves unwise. That prospect should encourage a significant number of people to protect their health insurance by protecting themselves against COVID.  

This policy would mesh well with the new practice of some firms and organizations to place relevant costs on people who reject safe, well-proven vaccines. 

And the current experiment in Houston suggests that financial incentives (in that case paying people directly to be vaccinated) can help overcome anti-vaccine reticence.

A thoughtful person might ask, “Why should people who enjoy natural immunity against COVID be obligated to receive the injections?” To begin with, those who believe they have natural immunity can prove it through appropriate blood tests. If in fact they have a natural immunity, they could argue that injections are unnecessary for themselves. Furthermore, they would have no need for personal COVID insurance if they are protected against that disease.

But what is reported about transmission of the disease by asymptomatic individuals to vulnerable persons would indicate that those with natural immunity can still spread the disease to others. Compared to the few people infected by Typhoid Mary as the first known example of an asymptomatic transmitter, the rampant spread of COVID makes clear the enormous dangers such individuals pose to the community. Mary was an innocent agent. The COVID Carls among us have no such excuse. 

Even vaccinated people appear to harbor large doses of the COVID virus in their nasal and respiratory passages. To approach so called herd immunity, the rational requirement is for people to defend themselves by being vaccinated.

Such a policy by insurance companies may strike some as unfair. And it is indeed an uncomfortable proposal to advance. Yet it does not involve a denial of care. It simply shifts the cost of such care to the individuals who refuse vaccination for themselves.  

Some people may still prefer to take a chance on bankruptcy or other financial calamities. They should not, however, be allowed to impose additional costs on responsible citizens whose insurance premiums will likely increase when unvaccinated individuals add heavy burdens to medical budgets.

Beyond the issue of who pays for COVID treatment, there are critical questions of who receives care. Given the overload in many medical facilities, including a shortage of intensive care unit (ICU) beds and ventilators, doctors often face anguishing decisions about triage. The U.S. health care system has been confronted with more than 37 million cases.

In many situations, physicians are forced to ration care, directing limited resources to those most likely to survive. That is a separate issue from the cost considerations outlined here. 

Tying vaccination to health insurance coverage could create incentives working to reduce the total number of cases arising in the population. Doing so could reduce the need for the dreadful choices compelled when too many patients flood too few hospitals and medical personnel are confronted with no alternative to triage.

Beyond the economic and medical aspects of this discussion, there are profound moral questions for all involved. Freedom to choose one’s health care and economic preferences is certainly precious. It deserves respect. Does it not also impose a responsibility to exercise that freedom with due regard for the impact of such choices on one’s fellow citizens? More than 600,000 Americans have died from COVID-19, and the number increases daily. How many of those cases were triggered by the willful refusal of some to accept vaccination?

Alton Frye is the Presidential Senior Fellow Emeritus at the Council on Foreign Relations and a fellow of the National Academy of Public Administration.