The U.S. Supreme Court ruled Jan. 13 that the federal government cannot constitutionally impose vaccine mandates on large employers through the Occupational Health and Safety Administration.

That means Uncle Sam, even for the sake of workplace safety, can’t require private sector employees (other than health care workers) to accept the most effective available measure for controlling the spread and severity of the pandemic.

As if that weren’t bad enough, the feds are simultaneously subsidizing irresponsible pandemic behavior by paying funeral and health care expenses for anti-vaxxers who’ve been hospitalized for, or died from, COVID-19.

Subsidizing bad behavior encourages bad behavior — or so Republicans have been claiming for decades with regard to welfare programs without work search requirements. And the Supreme Court has long upheld the validity of attaching strings to federal subsidies: if you want to receive Washington’s money, you have to follow its rules to qualify. So why not attach those strings to COVID-19 vaccination status? Yet just the opposite is occurring.

On March 24, 2021, the Federal Emergency Management Agency announced it would be covering funeral expenses for COVID-related deaths that occurred after Jan. 20, 2020, to “to help ease some of the financial stress and burden caused by the pandemic.” Under the rubric of disaster relief, FEMA defrays the cost of “funeral services and interment or cremation” up to a maximum of $9,000 per funeral. The money is available to unvaccinated, as well as vaccinated, COVID-19 victims.

Recent CDC data shows that the risk of dying is about 11 times higher in unvaccinated than fully vaccinated adults, so the former disproportionately benefit from FEMA handouts. Granted, it’s a stretch to suggest that funeral subsidies incentivize risky behavior, but subsidizing healthcare for anti-vaxxers may be a different story.


Americans spend about $3.6 trillion on health care each year. According to the Urban Institute & Brookings Institution Tax Policy Center, about one third of that amount, or $1.2 trillion, was paid by the federal government in 2019 through Medicare, Medicaid, Children’s Health Insurance and veterans’ care. An additional $234 billion was federally subsidized through tax deductions for employer contributions to employee health plans.

Moreover, federal law gives at least a partial free ride to the uninsured. Under a 1986 statute, known as EMTALA, a Medicare participating hospital has an obligation to provide a screening medical examination and stabilizing care to any patient who seeks assistance regardless of ability to pay.

The hospital cost of caring for COVID patients is staggering. According to a study by Fair Health, an independent nonprofit that tracks national healthcare costs, the average tab for noncomplex COVID-19 cases ranges from $98,336 to $111,213 in the five most expensive states while the average for complex COVID cases in the top five runs from $377,198 to $472,213.

These figures don’t even take into account the hidden cost of delaying treatment to non-COVID-19 patients suffering severe acute and chronic illnesses who can’t get through the door because hospitals are clogged with COVID patients.

The cost of COVID hospital care that could be avoided through vaccination is also monumental. One recent study found that nearly 98% of patients hospitalized with a primary diagnosis of COVID-19 between August and December 2021 were entirely unvaccinated compared with only about 2% who were fully vaccinated.

The statistical message is clear: get fully vaccinated and the odds of staying out of the hospital with COVID-19 are almost 50 to 1. I’d take those odds at the roulette table any day. Yet 25% of Americans still remain unvaccinated and 40% less than fully vaccinated one year after the first vaccine became available.


So should the government incentivize vaccinations by denying federally subsidized hospital care to those who decline them? Or should it at least allow hospitals to prioritize the patients they accept based on whether they’ve been vaccinated — a triage protocol that would kick in when there’s a shortage of beds, personnel or equipment?

These questions raise difficult issues of medical ethics, and they would almost certainly involve changes to existing federal statutes and regulations.

It may sound like a harsh judgment, but I, for one, am tired of taxpayers having to foot the bill for those who continue to engage in wishful thinking or reckless denial about the dangers posed by this contagion. Even more to the point, I want to make sure the unvaccinated have the strongest incentive to get vaccinated.

Perhaps the grim prospect of being denied hospital care in a life-or-death crisis would, at long last, provide that incentive.

Elliott Epstein is a trial lawyer with Andrucki & King in Lewiston. His Rearview Mirror column, which has appeared in the Sun Journal for 16 years, analyzes current events in an historical context. He is also the author of “Lucifer’s Child,” a book about the notorious 1984 child murder of Angela Palmer. He may be contacted at [email protected]

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