A patient is seen in the intensive care unit for the coronavirus disease (COVID-19) in Thoracic Diseases Hospital of Athens in Greece on November 8, 2020.

Financial Burden of COVID-19 Shifts from Insurance to Patients

By Bailey Kennedy

It’s no secret that health care in America sometimes leaves those without means struggling to pay for their care. However, for the last year and a half, COVID has been an exception to the rule: many insurance companies have stepped up to foot the bills for hospitalized COVID patients. Now insurance companies seem to be returning to the status quo ante COVID by expecting patients to cover a portion of their COVID-19 care.

These attempts to penalize those who become sick with COVID-19 — a disproportionate number of whom are unvaccinated — are not necessarily out of line with other attempts to punish Americans for their perceived poor health.

For example, some companies expect obese people to pay more in insurance premiums than those who have a normal BMI. In other instances, smokers pay more than non-smokers, if the smokers are insured at all. Asking those who are unvaccinated for COVID-19 to pay more than those who are vaccinated seems to serve the same purpose. Those who, by choice, place a higher burden on the health care system are expected to pay more.

Why do we require markets to offer comparably priced coverage to women and individuals suffering from pre-existing conditions, while allowing penalties against smokers, people with obesity, and, now, people who are unvaccinated? Presumably because the latter three categories of people are all assumed to have choice in the matters that lead to higher health care costs, and this choice has no obvious positive benefit for society. A smoker can stop smoking; someone who is obese can lose weight; someone who is unvaccinated can choose to become vaccinated. People born with certain pre-existing conditions cannot simply make the choice to no longer have them. Women, on the other hand usually can choose whether or not to become pregnant, but pregnancy (unlike smoking, obesity, or non-vaccination) is generally considered socially desirable.

However, it’s not obvious that non-vaccination is a choice that is morally blameworthy.

It’s very easy to blame people who have false beliefs about the COVID vaccine for developing and acting on these beliefs. But false beliefs — for example, a belief that COVID vaccinations lead to infertility — are in some sense not a choice at all.

Opinions and beliefs are formed through complex interactions with an individual’s environment. And beliefs are extremely resistant to change; people who are presented with information that should correct a false belief sometimes double down on their misconceptions.

Rather than seeing a “choice” not to be vaccinated as a blameworthy behavior originating from within an individual, it’s more accurate to see it as the health result of external environmental factors. Our minds are susceptible to environmental pollutants in the same way that our bodies are. We are no more blameworthy for taking in false beliefs than we are for inhaling polluted air.

Now that Pres. Biden has instituted a rule that employees at large companies either be vaccinated or submit to regular testing, it’s not quite as clear that requiring employees to pay extra fees for non-vaccination has anything to do with moral blame — non-vaccination will be expensive in a very direct way, as either non-vaccinated employees or their employers will likely have to bear the cost of regular testing. But why should employees have to bear these costs? Like false information in the public sphere, the OSHA regulations are not the “fault” of unvaccinated employees.

Some will try to claim that financially penalizing the unvaccinated is not a moral judgment, but a case of consequences following actions. But it’s clear that we are living in an atmosphere of moral judgment; this is tough to separate from the penalties that are arising in various contexts.

Seen in this light, it doesn’t make moral sense for companies to expect workers to pay a surcharge for refusing to get vaccinated, or for insurance companies to place more of the financial burden of COVID-19 on those who become ill. People are not responsible for their polluted informational environments, just as they are not responsible for their polluted physical environments. While encouraging vaccines is a worthy goal, it should be done in a way that does not place blame — or punishment — on those who might hold false beliefs about the vaccine.

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