REALITY IS A PRE-EXISTING CONDITION.

The formulaic introduction to economics might go something like "the study of how people allocate scarce resources among competing uses."  A person considers a resource scarce if he'd like to have more of it than he currently has.  The competing use takes the form of another person also considering it scarce.

We could allocate the resources by force, the winner of the conflict establishing ownership.

We could allocate by force at one remove, with rulers determining who gets what, and enforcing the outcomes by having a monopoly on violence.

We could allocate by force at a second remove, by establishing and enforcing institutions within which people trade for mutual gain.

The problem of allocating scarce resources among conflicting uses does not go away.  Somebody, perhaps everybody, makes do with less, or perhaps does without.

When it comes to allocating health resources, Our Political Masters have trouble determining whether the second remove is even possible, or if the first remove is still the way to go.

But they can't even do that consistently.  Consider the so-called Patient Protection and Affordable Care Act.  I lose track of the changes, but I suspect the outlines are still in place.  Insurance companies can only offer coverage in the states they are chartered in.  Insurance companies must issue coverage even to people with preexisting conditions.  And there are limits on experience rating: women must buy policies that cover prostate problems in order that men must buy policies that cover pregnancy, and all in the interest of broadening the risk pool, or something.

But then comes the Wuhan coronavirus, and now denial of care on the basis of a preexisting condition becomes virtuous. “It’s time that we say ‘You choose not to get vaccinated, then you’re also going to assume the risk that if you do catch COVID, and you get sick, the responsibility is on you.’” 

Yes, I went there last August, but that was in jest.

I resist the temptation to be provocative and suggest that clinics and hospitals start billing corona patients for their resource usage. Vaccinated people qualify for a break on their insurance! I do not resist the temptation to suggest that the Technocratic Overreach be cut off!

That argument is corollary to a normative public health position of long standing, the imposition of motorcycle helmet laws because people who splatter their brains make more work for ambulances and emergency rooms.  Never mind what Obamacare provides for.

And under federal law, insurance plans, such as those offered through the Affordable Care Act’s “Marketplace,” cover treatment for preexisting medical conditions and aren’t allowed to terminate coverage for changes in a person’s health status. That includes the diagnosis or treatment of COVID-19, according to healthcare.gov.

The legislator who introduced that proposal in Springfield got a nasty reaction, something that's common in politics these days, and withdrew the proposal.

Experience rating, though, does not go away.  I wonder if making premiums depend on vaccination status in Quebec will persist, whilst Canadian truckers still have the Ambassador Bridge blocked and the prairie provinces are quickly lifting their corona tyranny.

The Quebec government wants to impose a “significant” financial penalty on the “small minority” of Quebecers who refuse to get vaccinated against COVID-19.

Premier François Legault made the announcement — which would be a first in Canada — during a press conference on Tuesday. He said he was working on the tax with Finance Minister Eric Girard while also reviewing the measure’s legality.

“Unfortunately, there is still a small minority, about 10 per cent of the population, that refuses to get vaccinated,” Legault said. “I sense the frustration from Quebecers towards that minority that … is clogging our hospitals.”

“That is why I am announcing that we are currently working on a health contribution that will be charged to all Quebec adults who refuse to get vaccinated,” he continued, adding that people with medical exemptions would be excluded from the new tax.

The basis for the premier's hope is, you guessed it, that normative public health claim. “People who refuse to get vaccinated impose a burden on (health care) personnel and an important financial burden on the majority of Quebecers.”  No different in principle from tracking who has a motorcycle endorsement to a driving license, or basing insurance premiums on smoking behavior or weight, is it?

In addition, I have trouble understanding why vaccinated people are losing patience with people who haven't received a corona shot yet.  If the vaccine works, the protected people are protected, and the unprotected people are doing so at their own risk.  Oh, wait.  But the premier is responding to those constituents who have the protection, such as it is.  "Recent polls have shown the majority of vaccinated Canadians are increasingly frustrated by the unvaccinated few."  Perhaps because they see the force at one remove as a manifestation of that normative public health claim.

That’s one of the reasons vaccinated people get annoyed with the anti-vaxers. Those who reject vaccines claim it’s nobody’s business but their own, but whenever there’s a COVID-related surge hospitals seem to run out of beds, and the anti-vaxxers are taking up a lot of them.

Let's leave for another day whether the hospitals have "run out of beds" because certificate of need laws limit the construction of intensive care units, or because the vaccination mandates have pushed health care workers out of jobs.

That sentiment is not limited to Canadians, and we'll see, it extends beyond Canadian-adjacent people.  "MSNBC's Joy Reid proposes that unvaccinated Americans be paid less in the workplace (regardless of what their job is), face higher insurance premiums alongside groups like smokers, and pay higher medical costs if they ever get sick."  A perceptive observer asks the right question.  "Did she sleep through the whole rationale for Obamacare?"  I call the Patient Protection and Affordable Care Act two lies for the price of one, dear reader.

In addition, it's apparently easier to slag on the people who haven't been vaccinated, rather than to concede the limited protection the protected have.

I’m beginning to lose patience. I’ve pretty much had it with mask mandates and social distancing. The scientific community has had a strong consensus from near the beginning of the pandemic that the purpose of wearing a mask and social distancing is less to protect the wearer and distancer than it is to protect the people around if that person has an asymptomatic infection. But then I have to wonder who I am actually protecting.

One of these days, somebody will come up with an estimate for how many "asymptomatic infections" are actually false positives. But scolding the unprotected for putting protected people at risk seems to be the thing to do.

At every level of society we should be free to discriminate against the unvaccinated.

Airlines should be able to deny tickets to the unvaccinated. Insurers should be able to deny coverage to the unvaccinated or charge a premium. Hospitals should put the unvaccinated at the end of the line when there aren’t enough beds. Businesses of all kinds should be able to deny entry to the unvaccinated. Schools should not admit unvaccinated students, just as they already do for other diseases.

There's more than one way to protect the unprotected, though.

Justice Sotomayor is a 67 year old overweight diabetic who participated in oral argument on Friday by phone because she was too afraid to come to court to hear the arguments in person. And her response to this is that every American–including our kids–should be compelled to get vaccinated to protect people like her. Well as far as I’m concerned, she can go… jump in a lake if she thinks that’s the way to deal with this pandemic. After all, she is at not only greater risk of contracting Covid than my healthy 16 year old daughter, once infected an overweight older person exhales virus at a rate that is equivalent to many health children (I can’t find the reference now, but I saw one study that said that one obese person exhales as much virus as 3 dozen healthy kids when they are sick).

Yes, that comment is being outrageous to make a point.

I’m getting more than a little frustrated with this idea that people who are unwilling to control their own health, even to the extent of endangering the rest of us, are now claiming its my daughter’s responsibility to risk her health for them. She has to stay out of school for a year because of people like Sonia Sotomayor? She is now in therapy and on anti-anxiety medication that makes her ill because school closures, masks, and paranoia spread by fat people like Sonia Sotomayor imply its my daughter’s job to risk her mental and physical health because some 67 year old Supreme Court Justice can’t put down her Krispy Kremes. And Sotomayor and people like her instead imply it is healthy, young unvaccinated people who are supposedly the reason why Covid has been so bad.

Reality, though, dear reader, is both a pre-existing condition and messy.

I ran [triaging the unvaccinated] past several ethicists, clinicians, and public-health practitioners. Many of them sympathized with the exasperation and fear behind the sentiment. But all of them said that it was an awful idea—unethical, impractical, and founded on a shallow understanding of why some people remain unvaccinated.

In addition to denying reality.

But if the hospital crisis gets worse, the urge to conserve resources may force health-care workers to make tough choices. Vaccinated patients are more likely to survive a coronavirus infection than unvaccinated ones, and health-care workers might give them more attention as a medical judgment rather than a moral one. (But such calculus is tricky: “You should preferentially give monoclonal antibodies to unvaccinated people,” [Colorado medical ethicist Matt] Wynia told me, because each dose will be more likely to keep someone out of the hospital.)

As health-care workers become more exhausted, demoralized, and furious, they might also unconsciously put less effort into treating unvaccinated patients. After all, implicit biases mean that many groups of people already receive poorer care despite the ethical principles that medicine is meant to uphold.

You can allocate the resources by force, by politics, or by trade. But allocate you must, and somebody doing without might follow.