If opting-out becomes a reality in the healthcare reform bill, it is almost certain to be a political wedge and a litmus test of Conservative Values for Republicans. No GOP incumbent will stave off primary challenges without walking the coals and rejecting ‘socialized medicine’.
As a anecdote, consider this Wired magazine article about parents who opt-out of vaccination for their children (via kottke):
Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines. If your newborn gets pertussis, for example, there is a 1 percent chance that the baby will die of pulmonary hypertension or other complications. The risk of dying from the pertussis vaccine, by contrast, is practically nonexistent ” in fact, no study has linked DTaP (the three-in-one immunization that protects against diphtheria, tetanus, and pertussis) to death in children. Nobody in the pro-vaccine camp asserts that vaccines are risk-free, but the risks are minute in comparison to the alternative.
Still, despite peer-reviewed evidence, many parents ignore the math and agonize about whether to vaccinate. Why? For starters, the human brain has a natural tendency to pattern-match ” to ignore the old dictum “correlation does not imply causation and stubbornly persist in associating proximate phenomena. If two things coexist, the brain often tells us, they must be related. Some parents of autistic children noticed that their child’s condition began to appear shortly after a vaccination. The conclusion: “The vaccine must have caused the autism. Sounds reasonable, even though, as many scientists have noted, it has long been known that autism and other neurological impairments often become evident at or around the age of 18 to 24 months, which just happens to be the same time children receive multiple vaccinations. Correlation, perhaps. But not causation, as studies have shown.
And if you need a new factoid to support your belief system, it has never been easier to find one. The Internet offers a treasure trove of undifferentiated information, data, research, speculation, half-truths, anecdotes, and conjecture about health and medicine. It is also a democratizing force that tends to undermine authority, cut out the middleman, and empower individuals. In a world where anyone can attend what McCarthy calls the “University of Google, boning up on immunology before getting your child vaccinated seems like good, responsible parenting. Thanks to the Internet, everyone can be their own medical investigator.
The stubborn irrationality of the opt-outters endangers us all:
Consider: In certain parts of the US, vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).
That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California’s kindergartners are unvaccinated (10,000 kids, or about twice the number as in 1997), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough). The clustering means almost 10 percent of elementary schools statewide may already be at risk.
If individual states are allowed to opt-out, it will most certainly be the red states – those with the lowest access to healthcare, most dissatisfaction, and most unhealthy lifestyles. It is likewise reasonable to assume that rates in those states will rise faster still.
The parallels of healthcare reform and vaccination coincide here:
Ah, risk. It is the idea that fuels the anti-vaccine movement ” that parents should be allowed to opt out, because it is their right to evaluate risk for their own children. It is also the idea that underlies the CDC’s vaccination schedule ” that the risk to public health is too great to allow individuals, one by one, to make decisions that will impact their communities. (The concept of herd immunity is key here: It holds that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune.)
Yet again, in yet another domain (just like the world of finance), irrationality and a failure to gauge risk may put us all in peril.