Charging the unvaccinated more for health care is a slippery slope

Charging the unvaccinated more for health care is a slippery slope

This month, Delta Airlines began levying a $200 monthly surcharge on unvaccinated employees enrolled in the company’s health plan for the financial “risk” they are supposedly imposing on the company.

The airliner is not alone. A major health-care system in Louisiana plans to do the same for unvaccinated spouses on its health plan next year. And a retailer in Utah announced last month that unvaccinated employees would have to pay extra for insurance.

In other words, medical underwriting — the practice of setting insurance premiums in line with actuarial risk — is making a bit of a comeback. This time, it has the staunch support of many Democratic partisans.

Seven years ago, Democrats effectively banned medical underwriting in the individual market as part of the Affordable Care Act. Insurers could not deny people coverage based on their health status or history, and they could only vary premiums by age and tobacco usage.

The intent was to protect those with pre-existing conditions, and to reassure those who got sick that they wouldn’t be penalized with higher premiums down the road.

So how can Democrats stand by idly as corporate America openly discriminates against people who have a higher risk of getting sick — the unvaccinated? Could it be that this group is a convenient political target for Democrats?

Supporters of surcharges for the unvaccinated tend to say that individuals should bear responsibility for their actions. They’re at greater risk of being hospitalized, and research shows that a COVID-19 hospitalization can cost tens of thousands of dollars.

“Why should patients be kept financially unharmed from what is now a preventable hospitalization?” asked Elisabeth Rosenthal, editor-in-chief of Kaiser Health News, and Glenn Kramon, a lecturer at the Stanford Graduate School of Business, in a New York Times opinion piece this summer.

Scott Ratzan, a distinguished lecturer at the City University of New York School of Public Health, told Time magazine, “I think it’s a good thing that we start to remind people there’s a consequence for, frankly, bad decisions when it comes to not getting vaccinated. And these don’t only have consequences on themselves, they have consequences on all of society.”

That line of thinking opens up some interesting possibilities.

If higher premiums are justified for the unvaccinated, why not people with obesity? Obesity raises the cardiovascular mortality rate by four times — and doubles the cancer mortality rate.

Obesity also exacerbates COVID-19. People with the condition have a 113% greater risk of hospitalization and 48% higher risk of death.

Obesity is even contagious! Studies have shown that those who live near people with obesity are more likely to have the condition themselves.

Obesity is serious, expensive to treat, and often preventable. So why should this group of patients be “financially unharmed?”

Or consider those who consume alcohol in excess. There are a lot — one in eight Americans has alcohol use disorder, according to a 2017 study published by JAMA Psychiatry. People who drink too much are at greater risk of heart disease, stroke, liver disease, multiple forms of cancer, dementia and mental health problems.

A decade ago, the annual costs alcohol imposed on society were around $250 billion. And alcohol kills 95,000 Americans every year. That makes it the third-leading preventable cause of death in this country, according to the National Institute of Alcohol Abuse and Alcoholism at the National Institutes of Health.

Another expensive, preventable health problem. Should alcoholics have to pay more for health insurance?

What about people who neglect to get flu shots, or don’t sit for mammograms every year? How about those who eat poorly or don’t exercise regularly?

All these unhealthy behaviors are generally within a person’s control. If it makes sense to charge the unvaccinated more for insurance, it certainly makes sense to charge the obese, or those who consume too much alcohol, higher premiums.

Personal responsibility is not just for one’s political enemies — it’s for all of us.

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