Working as a lawyer in the Trump administration, I was part of the team that faced a seemingly insurmountable challenge: how do you stop an uncontrollable virus? As with any new threat, the initial tools were limited, but we knew American ingenuity was not. We focused on a few possible solutions. One was contact tracing. Before a vaccine or a cure, identifying cases was arguably the best way to control outbreaks. But Americans are too freedom-loving (and rightly so) to allow their locations and COVID status to be constantly tracked. Government monitoring was never the solution.
Second, the Trump administration poured billions of dollars into vaccine development, which allowed for nationwide vaccine distribution the moment FDA authorized its use.
I truly thought vaccines would end the pandemic — not end the virus (the flu still exists, despite available vaccines), but end the mask mandates, loose voting rules, travel restrictions, and so on. No doubt, the pandemic should be considered over, as everyone has had ample opportunity to protect themselves, if they so choose.
But I also thought everyone would be willing to get the vaccine. After all, it was pretty cool — a modern miracle, in such a short time! The media widely derided President Trump’s claim that a vaccine would be ready in 2020, but astonishingly we did it. And shouldn’t we all want the shot — new and a little scary, perhaps, but bearable — that could let us go back to living our lives? If normalcy isn’t reason enough, isn’t peer pressure a convincing motivator? Having to call your attractive recent date, or the fellow moms in your kids’ class, and say, “I came down with COVID, you may want to get checked,” is vastly more awkward than people realize.
I was naive. Too many Americans today remain unvaccinated. But when I think about it, it’s actually not surprising. Many Americans continue to smoke cigarettes and drink to the point of illness. Almost 70 percent of U.S. adults are obese or overweight. We do all of this even though the CDC tells us not to. Why? It’s fun, chips are tasty and the primary victim is ourselves.
So how does a society prevent bad personal decisions? Either criminalize them (remember, willfully violating Biden’s OSHA vaccine mandate would carry criminal consequences), or allow the private sector to reconnect personal choices with personal consequences. Option one is unbearable, so let me explain a possible option two.
In a sane world, a person can assess the costs of her own decisions. She decides, for example, whether she wants health insurance or not. Let’s say an insurer provides three options: (1) $1,000 a year, to vaccinated, healthy-weight individuals; (2) $10,000 a year to unvaccinated, healthy-weight individuals; and (3) $30,000 a year to unvaccinated, obese individuals. That’s a huge incentive to get vaccinated, if you want health insurance. An individual’s rates would go from $83/month to $833/month based solely on vaccination status. Such a deal makes sense for the insurer, who would want a low-rate option, because insurance would be optional.
Let’s add price transparency to this scenario, such that individuals could know COVID-19 hospital prices in advance, and can choose to go uninsured with full information. Currently, the average cost of a COVID-19 hospitalization is $42,200, so high-COVID-risk people would hesitate to go uninsured. (This cost would certainly be lower in a world with price transparency, a topic on which Marty Makary has written plenty.)
We’re far away from that world. For one thing, health insurers have become so entangled with the federal government that we cannot trust an insurer’s rates would be science-based, and not just a favor to the administration. The government pays almost $1 trillion a year for health insurance for Americans under age 65. The reasoning underlying Obamacare — that we must all pay for the health and choices of others — has become irrefutable dogma in Washington, limiting even the discussion that individual choice should yield individual effect. One New Republic article argued “we must reject the idea of ‘individual responsibility’ for health altogether.”
It seems that hardly a day goes by without the Biden administration proposing a new unconstitutional policy, because outlawing bad personal decisions (as opposed to decisions that affect others) is an endless path. To improve personal health choices, why not focus on digging ourselves out of the American health care disaster by promoting price transparency, freeing insurers from federal dependence, and abandoning the socialist canard that everyone is responsible for my health but me?