Paying for ignorance of other Americans
If I decided to sell my SUV and buy a red, late-model twodoor convertible sports car that has a top speed of 200 mph, my auto insurance company would certainly give me a call to inform me my rates would be higher. It’s not like those conservative curmudgeons don’t like red sports cars. It is simply that based on their experience, men going through their third midlife crisis who drive red sports cars are at greater risk of accidents.
The same principles hold when you evaluate the cost of health insurance. There is something called an actuarially fair premium that estimates the cost of spreading the total community cost of some activity evenly over the insured population. This concept is particularly important now as we enter the third year of the COVID crisis.
Up to this point, all Americans have been paying the health care system for the cost of COVID. I am going to make the case that this is not fair, it is not economically efficient, and most importantly it does not lead to the best public health behaviors and outcomes.
If there were no vaccine that lower the probability of hospitalization and death, this would not be the case. If the disease hit all Americans randomly, you can make the case that all Americans should pay. But this is not the case with an effective vaccine.
With an effective vaccine we now know several observable facts. One: Over 400,000 Americans will have died from COVID-19 each of the past two years. Two: Since the vaccine, over 95 percent of Americans in ICUs are unvaccinated Americans. Three: There are approximately 100 million unvaccinated Americans. Four: Vaccines are administered at no cost to those who want them. Five: The average cost of one day in an ICU is over $10,000. Six: Forty percent of COVID patients who go into
ICUs do not come out alive. Seven: The average stay in an ICU for a COVID patient is seven days.
With this information we can estimate that the total annual cost of ICU care for the unvaccinated is over $70 billion. Therefore, if we were to ask all unvaccinated people to be covered for COVID ICU treatment that policy would cost about $1,000 per person. For a family of four unvaccinated Americans, their total COVID insurance premium would be an additional $4,000 on top of their current insurance.
Right now, no such policy is available, but I do not put it past the very aggressive health insurance industry to be working on just such a product. We know that many unvaccinated Americans would probably not be interested in buying such a policy because they are not only unvaccinated, they do believe they are going to get the virus. Insurance works best for rational actors.
In the absence of COVID insurance for the unvaccinated, the vaccinated and the unvaccinated are left holding the bill. This is grossly unfair given what we know. It would be like asking all drivers to pay the higher premium on my red sports car (which I do not have at this time).
An alternative to COVID insurance would be to directly address who has access to the nation’s critical care hospital units. There are images from the 1918 pandemic of patients being lined up on cots in large public buildings. Hospital care was at a very different place in 1918 than it is today, but a lesson from the last pandemic is that we might want to build out alternative lower cost facilities for the unvaccinated. We could use closed school buildings, unused warehouses or other spaces. These spaces would include just palliative care and a limited number of ventilators. The case I am making is that the scarce physician and other critical health care human resources should be reserved for those who are behaving in a way that promotes public health. And those who do not behave in that way should bear the consequences of their actions.
These alternative treatment facilities for the unvaccinated should be humane and caring. These facilities can also be open to the misguided pseudo medical treatment wishes of the unvaccinated, who for some reason believe the medicines of quacks are better than the medicines of scientists. Give them all the Ivermectin, hydroxychloroquine, boiled betal leaves UV light they want. Let their unvaccinated family visit them as much as they want. Let them enter these facilities without masks. Let the unvaccinated nurses and unvaccinated doctors treat them based on their own and similar ignorance. In effect, give them what they want. But keep them out of our hospitals and ICUs. These are not the places for them.
Of course, they could all buy COVID insurance. Or they could all simply get vaccinated.