Do hospitals turn away people with the flu away if they are not vaccinated? Or is it only Covid that you would impose this rule for?

Fair question.

It looks like flu (influenza) hospitalizations run at about 0.15% of total population, per year.

SARS-CoV-2, at 1-5%? Although that might be vs confirmed cases (?), which would muddle the numbers.

But suffice to say substantially higher. So I think there's an argument to be made for this being a COVID only measure (and probably measles, etc too).

IMHO, people are entitled to freedom regarding their choice to vaccinate.

But if they choose to exercise their freedom in ways that limit my freedom (via resulting lockdowns, mandatory masking, banned social gatherings, preventing businesses from operating normally, etc.), then that doesn't feel very fair.

They're externalizing the consequences of their decisions onto me, and the rest of society.

So yeah, IMHO, their decisions: their bill to pay. With their life, if necessary.

(But I may be biased, as I have family working ICU, triaging unvaccinated coronavirus deniers who show up at the ER, begging to be saved, who are then sapping care from non-COVID patients...)

I don't think anybody that's unvaccinated wants any restrictions either. So if it was proposed there would be no more restrictions on society would you still turn away unvaccinated people from hospital? Going off your logic they are no longer impacting your freedoms.

> But if they choose to exercise their freedom in ways that limit my freedom (via resulting lockdowns, mandatory masking, banned social gatherings, preventing businesses from operating normally, etc.), then that doesn't feel very fair.

You can easily make that argument for plenty of things though. Didn't care for education and wanted to party instead? No welfare for you! Overweight? Sorry, you're limiting my freedom via increased healthcare costs. Broke your leg while skiing? Sorry, you knew the risk, now live with it, insurance is for real accidents only.

All of those other examples have additional characteristics that cast the argument differently.

Education and obesity both have income and access issues. In that, if you are poor, you don't have access to the same options as those who are wealthy.

Skiing is actually the best example (Alaska aside!), given that it's a purely personal decision to engage in or not.

So hypothetical...

If hospital ICUs were filling with ski accident victims, to the extent they were unable to provide normal care to non-ski patients, and the economy was being impacted (businesses unable to operate, jobs lost, etc.) due to this ski pandemic, then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"?

> Education and obesity both have income and access issues.

Some, but not primarily, so it still stands. I'm sure you can find similar reasons with vaccine-anxiety. People aren't choosing to be afraid of vaccines "just because", there's something going on that terrifies them.

> then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"?

Yes, because that's the principle the system is built on.

I mean, I think lots of people somewhat consciously make lots of terrible decisions all the time, and the consequences of their decisions do cost giant sums of money that I have to pay lots of taxes for and that cannot be used for people who face truly accidental hardship (think extreme skiing vs walking and a suitcase dropping from a plane).

But we've generally decided that that's totally fine, and I've accepted that and I pay taxes to make sure they don't have to face the consequences of their decisions. We cannot say "that's fine for everything, but not here" if we operate on a principle. It's either "you're on your own" or it's not, but it has to be consistent.

> We cannot say "that's fine for everything, but not here" if we operate on a principle

We already say that, for smoking.

And through mandatory school vaccinations (DTaP, varicella, polio, MMR, meningococcal).

Which is a big part of my point. What we claim our system to be (Freedom! With guaranteed care! With equal rights to opt out!) and reality (We won't pay for certain dumb things you do. And we'll give you basic guaranteed care and probably not let you die) are two different things.

Which is the main thing that's shredding our health care efficiency in terms of per capita GDP spending.

> We already say that, for smoking.

"We" don't, but maybe you do. I'm from Germany, the only time smoking/alcoholism/substance abuse comes up in a relevant way is when you need a transplant and there are multiple recipients and too few donors.

And it's not a punishment for what you previously did, it's because of a prediction of what you're going to do, e.g. an alcoholic who has shown no sign of compliance will probably not get the liver if there's a non-alcoholic who also needs it and does what it takes to get/stay healthy.

Deaf people whose condition could be cured/massively improved with implants are free to choose not to, and won't lose their disability status, it doesn't turn into a choice/hobby just because there's a choice in fixing it.

I'm not sure that's what makes healthcare in the US so expensive. Again, we do it and we spend significantly less than the US. The country is much more densely populated though, university is free and physicians' income is much closer to the average than in the US.

We (US) do in that national law allows a surcharge for smokers.

States may (and some do) override and decrease this, but it's allowed as the default. Notably, that and age are some of the few factors allowed to influence insurance pricing.

Regarding transplant, my understanding is people are transplanted on (1) current health state (worse = higher priority) & (2) ability to comply with post-transplant protocols.

So someone who burned their liver out with alcolism and is very sick, but makes a good case that they'll be able to stay sober post-transplant, gets an organ over a less-ill, sober victim of circumstance (e.g. dehydration/heat injury or something).

One of the key features I've heard that allow other countries to drive down health care costs is a regulatory requirement that approved treatments (pharmaceutical, surgical, etc) demonstrate greater efficacy and/or lower cost. In the US, the FDA approves on efficacy only.

End result being that in the US you can reformulate a medicine, try your best to sell it for $1,000 a pill, even when a cheaper alternative that produces the same results is available.

Health systems operate by prioritizing, via an imperfect system, patients based on need. If you run a red light and slam into another car, but you're more injured than the other person, you will be prioritized even though you were culpable. I think that is the appropriate, ethical, and practical approach.

However, the calculus changes when the health system is at or over capacity. Now, if two people come in and both are critically ill, but you only have room for one, I'm ok with choosing the one that was vaccinated. Likewise with many other situations and illnesses. If you cause a car accident, and both you and the person you hit require the ICU, but there is only one spot open, I'm ok with the person that got hit getting the spot.

Now, I'm assuming you are jaded like me and know that actual answer is probably the person with the most money tends to get the treatment, but that's another bitter, cynical discussion.

Here's my current level of jade -- listening to repeated stories about hospital staff having to argue with a patient's family (all unvaccinated) about why they can't visit the patient (also unvaccinated) in the COVID ward, when care is being withdrawn due to organ failure.

At some point, it's like, "Jesus. Just stop talking, and please let me help you not kill yourself."

Has there been a flu season in recent history that caused the hospital system to collapse?

Hospitals in some areas were overwhelmed with influenza cases as recently as 2018.

https://time.com/5107984/hospitals-handling-burden-flu-patie...

For reference, when I looked up the numbers, influenza hospitalizations (estimated, total annual US) vary from around 150,000 to 550,000, depending on the year and strain.

So yes, year to year has a lot of variance.

No. Everyone deserves medical care, even if you and I consider the decisions that led to that care to be illogical. You are proposing a slippery slope. Currently you could say that we should turn the unvaccinated away but why not the obese? If someone is obese, generally it is a personal choice much like the unvaccinated. What about homosexuals that contract AIDS. I am all for vaccines and I even support businesses requiring their employees be vaccinated. But I am very much not for beginning to play the game where your lifestyle choices determine if we provide treatment. Everyone deserves to be treated to the best of the hospitals ability.

Yes. Everything about health insurance (which is what we're basically talking about) is a slippery slope.

Our health care system is unsustainable. And it's unsustainable because of one very simple reason: we want people to have absolute freedom and an absolute right to emergency care.

I don't think those two are compatible. I don't think they've ever been, but historically that contradiction has been papered over with others' money (either in the form of your insurance premiums or your tax dollars).

Cue present situation.

We have a scenario where there is a (1) free, (2) available, (3) well-tolerated, (4) effective preventative option in vaccines.

If someone chooses to remain unvaccinated, without medical reason, that is a pure personal choice.

And moreover, unlike in normal scenarios, their making that choice directly burdens everyone else.

Economically, through damage to normal economic functioning. And medically, through consuming limited hospital capacity.

These arguments could be made for other conditions (e.g. obesity), but in a much murkier and more tortured manner. COVID is crystal clear: if you can be vaccinated, and you choose not to be, you are imposing a greater burden on society.

Last I heard, the anti-vax crowd was big on personal responsibility. So why shouldn't individuals pay that debt of their own making?

I hear what you are saying but I can see this spiraling out of control. What happens when global warming and over population is considered to be a dire threat to the continued existence of human life? Do we allow hospitals to refuse services to women on their third child or men / women that refuse to be sterilized after the government approved x children. Seems far fetched but our definition of clear and present dangers can shift over time to fit the scenario something similar has already happened in China. I am very much not for allowing institutions to make those sort of decisions regarding the care provided to people as entities don't usually relinquish power once granted.

Edit: I am ok with triaging the vaccinated over the unvaccinated in a scenario with limited space as mentioned by another poster below.

What's the alternative?

You can't solve a resource limitation problem by mandating access.

And pretending to have free access, while in reality prioritizing the wealthy, is just a free market with ethical window dressing.

By this logic, we should also turn away the morbidly obese, all smokers, anyone who injured themselves while participating in risky activities (e.g, skiing), and so on and so forth.