Yes, the unvaccinated should pay more for their health care

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

Whether the unvaxxed get better or don’t, they certainly run up a pretty good bill for the cost of their hospitalization. And if you’ve had to put off your colonoscopy or hip replacement or missed an IVF cycle because hospitals are overwhelmed with COVID patients, how is that fair?

Some countries are moving to penalize the unvaccinated. Greece says that people over 60 who don’t vax will pay a monthly fine of €100 ($114) a month. Austria will fine unvaccinated people at least €600 ($681) every three months. In Singapore, those who choose not to get their shots have to pay for their own medical bills if they get COVID.

Some American employers insist that those who aren’t vaccinated pay a higher co-pay for their insurance if it’s determined that they have not gotten the complete set of vaccinations — in the case of the mRNA vaccines, three shots. (“The average hospital stay for COVID-19 has cost Delta $50,000 per person,” said the airline’s

CEO, Ed Bastian, last summer. He noted that “all Delta employees who have been hospitalized with COVID were not fully vaccinated.”)

What’s fair? What’s equitable? I don’t agree with those who say, “Well, if you’re not vaccinated, you can’t come into the hospital — or you’re going to get lower priority if you do.” I think that health care providers cannot ethically discriminate on the basis of vaccination status as to who can come into the emergency department or intensive care — even if the unvaccinated make choices with which I strongly disagree.

I do believe that we need to insist on vaccination for all and deny services to the unvaccinated in some contexts — say, eligibility for transplants. Some 1,200 people are awaiting a transplant in Connecticut. The odds of you successfully keeping your transplant are very low if you are not vaccinated, because you’re going to be immunosuppressed and the virus, if you got it, would likely kill your new organ and you. In that context, a transplant for an unvaccinated person is probably futile, so it makes sense to say that as a condition of getting transplanted, you’ve got to get all your vaccinations, including for COVID.

But those circumstances are rare. What about charging more?

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

There’s nothing illegal about saying, “In order to decide how much you’re going to pay for private insurance, we’re going to take a look at your risk profile. If you’re diabetic or have some other underlying condition, we’re going to charge you more.”

When it comes to money, private insurance does charge people more when they’re at greater risk. Not being vaccinated means you are at higher risk of hospitalization. I think the case can be made for charging bigger co-pays or higher premiums to the unvaccinated.

If you choose to behave in a risky way that raises everyone’s costs, then you ought to pay more.

Neighbors should try to ensure health care for all, but those who raise the costs of health care ought to shoulder more of the load.