Privatizing Public Health

The Atlantic has an article by Wendy Parmet titled Employers’ Vaccine Mandates Are Representative of America’s Failed Approach to Public Health. As people discuss mandating covid vaccines, the next question is, who will do the mandating? The government or employers? And right now it looks like we’ll be falling back on employers.

Although important legal questions and limits remain—such as whether vaccines that have received only emergency-use authorization, rather than full FDA approval, can be mandated—the Equal Employment Opportunity Commission’s recent guidance assumes that employers can require, subject to limitations established by the Americans With Disabilities Act and Title VII, that their workers be vaccinated. This comports with the long-standing view that employers, especially in nonunionized workplaces, have broad power to set the terms and conditions of employment, including requirements that their employees be vaccinated. Doing so might be just the trick to overcoming people’s resistance. Although many Americans rebel when the government tells them what to do, they can, for obvious reasons, be quite acquiescent to the dictates of their employers.

Already some employers are offering bonuses to employees to get vaccinated, which I’m fine with. I understand there’s a real problem with nursing home staff refusing to get vaccinated, and IMO state health departments need to mandate vaccines asap.

Keep in mind that a big problem with U.S. nursing homes is that, while there may need to be a Registered Nurse on duty at all times, most of the staff are either Licensed Practical Nurses — high school graduates with one year of nurse’s training — or Certified Nursing Assistants — high school graduates with four months of training. Depending on the state, there may be more CNAs than anything else, and while they may be very good at helping residents with bathing and other functions, they don’t necessarily know science from salsa. So it shouldn’t be a big surprise that staffers are afraid of the vaccine.

Wendy Parmet’s larger point is that the pandemic is showing us how much public health has been privatized in the U.S. And this is not working.

Unquestionably, the private sector has a role to play in public health—just look at the private companies that produced the vaccines and the private hospitals that have cared for the ill. But to rely on it to protect the public’s health is pure folly. As the pandemic has shown only too well, private and public interests do not always align. Before COVID-19, for example, hospitals focused on their bottom line and failed to stock up on personal protective gear or extra ventilators, even though they knew a pandemic could strike. Once one did, competitive pressures also pushed many businesses, such as restaurants and meatpacking plants, to stay open and overlook the health of their employees and communities, even as they became sources of infection. To depend now on the private sector to increase vaccination rates would further underscore America’s tepid commitment to the basic principles of public health.

This goes along with our insane religious faith in “free markets” to provide for everyone’s needs. It doesn’t work, folks. But the other point, IMO, is that people who don’t like being told what to do are just trading one authority for another. If the government doesn’t make them get vaccinated, their employers probably will sooner or later. I believe that eventually covid vaccinations are going to be required before any of us can do much of anything — hold a job, go to school, travel — and if government doesn’t enforce it, the private sector will step in. And the private sector is much less democratic than government.

What else can I say but … go Chiefs.

12 thoughts on “Privatizing Public Health

  1. I'm very leery of vaccine mandates, especially now. My feeling is like this: certain employers should be able to pay bonuses, and change jobs for employees who won't get vaccinated, or lay them off if there are no other jobs. This should be for people with contact with potentially otherwise-unwell people. (Nursing homes, but maybe drug stores; maybe even grocery stores, for, say, checkout clerks.)

    And I feel like that should be *it*, for a while. Not forever, but for a while. 3-6 months, maybe, while we can verify that there are no long term side effects from the vaccines. Let people see a clean safety record; let vaccinated people talk about how it's just a bit unpleasant; find out if we're seeing 80% of people wanting the vaccine.

    Then, that's when I'd say we should discuss mandates. That, coincidentally, will also be close to the time that we *can* vaccinate everyone who wants to be vaccinated, and should also be close to the time when we find out how well herd immunity is going. If there are only tiny numbers of sick people, with R0<1, maybe we don't need them.

    The one thing that does bother me about this is how boneheaded stupid the Supreme Court is. They struck down Cuomo's restrictions on church services, even though they were moot, because they didn't want him to be able to reimpose them… presumably, *regardless* of how bad an outbreak might be occurring. (I mean, come on – that's really *not* a hard thing to consider. There are 5 SCOTUS idiots who are either Covid-19 denialists, or too stupid to think of the obvious implications of their ruling.) I wouldn't put it past them to rule against mandates, even for people who will be providing medical services to vulnerable populations.

    • I did say "eventually." Obviously there will be no mandates in the near future, because supply of vaccines is way short of demand. Once supply catches up to demand, we'll see where we are.

    • The Supreme Court is going to seem "Stupid" probably for the next generation, at least. It will be amazing if the republic endures.

      Thanks to the Federalist Society, we have a bunch of hot-house flowers who would be excellent at counting the number of angels that could fit on a pin, but who have no clue about how ordinary people experience the world.

  2. When did we become such a STUPID country?

    I mean, people have killed other people over masks.  MASKS!

    And now, at a time vaccines that were created in double-quick-time finally start to become readily available, a lot of people in this country are deciding to pull a Bartleby the Scrivener, and saying, "I'd rather not…"


    • Answer: The stupid was always there. What changed is how the right strong-armed the left (the not-stupid) into accepting their rule. It all started with cries of "liberal media!!!"  Which was nothing more than working the refs. Downhill from there.

  3. I'm not thrilled with a mandate. For one thing, it's not enforceable.  Really, are you going to arrest someone, strap them down and inject a foreign substance into their body against their will? Even if they are scientifically wrong, it's their body.

    Flipside is also true. If airlines think you are a threat to other fliers, they don't have to sell you a ticket. Get it? You have rights as an individual, but business has rights. And employers – unless you are granted work-from-home 100% of the time – can require proof you have gotten the vax to protect customers and employees 

    I absolutely agree that if your work will bring you into contact with high-risk people, the health department can mandate that the employer obtain proof of vaccination.

    Maha – hope you didn't put money on the game.


  4. The health dept website never has appointment s available. So i had to set up an account with walgreens to get on a list which means they will send me their crap emails and advertising into eternity. All i want is a damn shot and you wont believe the hassle. Hell my employer doesn't care if we die.

    • My employer is Republican, and are still not sure that COVID is real. They cannot think for themselves, and so the place "collaboration" – physical togetherness – above everything. It took me 4 stressful months, and 2 coworkers to flee for their lives, in order for me to get an exemption to WFH till it ends. Moral: Never work for nit-wits if at all possible. And, as Frank Zappa said: You have to learn to make Stupid work for you.

Comments are closed.