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You are here: Home / Anderson On Health Insurance / Vaccination is not conducive to nudging — may need two handed crosschecks

Vaccination is not conducive to nudging — may need two handed crosschecks

by David Anderson|  August 30, 20217:30 am| 56 Comments

This post is in: Anderson On Health Insurance, COVID-19 Coronavirus

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The United States has made vaccination primarily an individualistic act. Get them if you want them, and if you need a nudge, there will be a nudge or a lottery or a gift card give-out.

2/

What did we find?

Basically: nothing. Null results.

Specifically: The 24 programs were associated with a (non-sig) decline in daily vaccination rates of 8.9 per 100,000 individuals (95% CI [-64.3,46.5]; p=0.75).

— Alison Buttenheim (@abuttenheim) August 28, 2021

That has not worked. Or at least it worked to an extent for individuals who were inclined and able to readily get vaccinated. Before Delta, we had bottomed out at a few hundred thousand newly vaccinated individuals per day. Since Delta started surging, we’re only getting a million new shots into arms per day.

Bigger sticks such as employment and mandates are likely needed.

Duke University tells all employees they must get a COVID-19 vaccine or be fired … If employees don’t comply, they will be terminated and will not be eligible for rehire with Duke in the future, the announcement said. …https://t.co/FgwZgxCTv7 pic.twitter.com/hFZmsxzTur

— George Hess (@george_hess) August 29, 2021

This is a very strong mandate.

It has very real consequences that are large, obvious and immediate.

Duke is also making it ridiculously easy to get vaccinated. There are multiple spots on campus where shots can be given out. This action is one of many that makes me feel fairly confident that I will be learning in-person for the entire semester and able to teach in person for the half of the semester that I’m scheduled for.

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Previous Post: « COVID-19 Coronavirus Updates: Sunday / Monday, Aug. 29-30
Next Post: Monday Morning Open Thread: Face the New Week »

Reader Interactions

56Comments

  1. 1.

    Baud

    August 30, 2021 at 7:43 am

    Time to escalate.  It’s either us or them.

  2. 2.

    Parfigliano

    August 30, 2021 at 7:43 am

    But…but…what about my Freedumb!

  3. 3.

    Butter Emails!

    August 30, 2021 at 7:55 am

    It’s probably not conducive to nudging because at this point many of the resisters are convinced the vaccine is more deadly than the the disease. That’s before you factor in that for many, taking the vaccine is a grievous sin in their new religion and huge betrayal of their social group.

  4. 4.

    JPL

    August 30, 2021 at 7:56 am

    It’s time for insurance companies to charge more for those who refuse the vaccine. ACA has some protection for preexisting conditions, but it’s doubtful that stupidity counts.

  5. 5.

    Argiope

    August 30, 2021 at 7:57 am

    I’ve been waiting for employer mandates for months now, because I’m fairly sure the only way my 79-year-old dad who believes his vitamins will save him is going to say yes to a shot is if his school board mandates it for substitute teachers. I’ve tried bribes, offered hand-delivery to his home, and lots and lots of info. My sister has tried guilt and threats (she’s the bad cop this time around). I’ve even tried tapping into the mistakes he will admit to making in the past when his predictive powers failed. Nope. Can you guess how he votes? At this point I’m resigned to the old saying about how you don’t always have to be smart, sometimes you just need to be lucky. It’s maddening, particularly because I’m a healthcare provider with a doctorate, yet because Tucker is against them…… so the slow, patient, probably unsuccessful campaign is all that remains open other than mandates. I’m going to reverse-haunt his ass if he goes out from this thing.

  6. 6.

    Skepticat

    August 30, 2021 at 8:18 am

    @JPL: 

    It’s time for insurance companies to charge more for those who refuse the vaccine. ACA has some protection for preexisting conditions, but it’s doubtful that stupidity counts.

    This. And unvaccinated people who develop COVID and need treatment should be treated—if at all—in tents set up outside hospitals rather than given a bed in the ICU.

  7. 7.

    satby

    August 30, 2021 at 8:18 am

    Putting a hard mandate with a deadline for termination was the only thing that influenced my last two vax holdouts at work. Sticks worked better than carrots, because trying to bribe them earlier with a bonus didn’t get it done.

  8. 8.

    ciotogist

    August 30, 2021 at 8:22 am

    @Argiope: the most enraging thing is that Tucker himself has been vaccinated!

  9. 9.

    Tazj

    August 30, 2021 at 8:23 am

    I wonder if Biden should require vaccinations for airline, train and cruise travel in the US like they recently did in Canada. I don’t know what’s possible legally for the Federal government to do but mandates are needed now, when there are too many people even in government that are actively working to dissuade people from vaccinations and masking.

  10. 10.

    mrmoshpotato

    August 30, 2021 at 8:27 am

    @Argiope: I hope your dad comes to his senses (or is forced to by the school board.)

    I’m going to reverse-haunt his ass if he goes out from this thing.

    How exactly would that work?

  11. 11.

    HinTN

    August 30, 2021 at 8:28 am

    @Parfigliano: “Somebody else can pay you to exercise your freedumb!” Good on Duke!

  12. 12.

    mrmoshpotato

    August 30, 2021 at 8:29 am

    @ciotogist:

    the most enraging thing is that Tucker himself has been vaccinated! 

    And sadly not via a punt into the Sun.

  13. 13.

    Victor Matheson

    August 30, 2021 at 8:32 am

    My institution (College of the Holy Cross in MA) instituted a student mandate in May and a faculty/staff mandate in July. With students returning over the weekend, we are at 99% vaccination for faculty (which means roughly 3 unvaxxed profs on the whole campus), 96% for students with 3% claiming a religious exemption and 1% being dismissed from campus, and 92% vaccination rate for staff, with many of the unvaccinated in off campus work from home and still until October to get the shot.

    So, I am feeling fairly confident about my return to in person teaching on Wednesday. (And we are testing and masked for at least a month.)

  14. 14.

    Soprano2

    August 30, 2021 at 8:39 am

    I wish my employer would mandate it, but I doubt they will because City Council already has problems with the howling monkeys coming to council meetings.  I will say that at my workplace the re-imposition of the mask mandate on unvaccinated employees has caused three people that I can see to get vaccinated, because suddenly they aren’t wearing masks in the office anymore, and my boss is a hard ass about the vaccine like I am. I asked him if he needed to see my card, and he said “No, in your case I don’t think I need to see it, I know you’re vaccinated” because I’ve been so adamant about it. LOL Reminds me, I’ve got more cartoons to put on my door….

  15. 15.

    Anonymous At Work

    August 30, 2021 at 8:55 am

    @JPL: Went down that road with David Anderson already and it was a null verdict and use of smoking as a pre-existing condition subject to price differential has had no significant impact. Longer-term, you run into problems with people who got Long COVID prior to vaccines versus those who got Long COVID afterwards.
    I feel you on this, making people literally pay more for their refusal seems like a winner but our fragmented health insurance system makes that logistically impossible.

  16. 16.

    debbie

    August 30, 2021 at 8:57 am

    @JPL:

    Seconded. I had hoped they would speak up as soon as the FDA approved Pfizer. My company’s started in on enrollment for next year’s health plans and not a peep about COVID at all.

  17. 17.

    debbie

    August 30, 2021 at 9:01 am

    @Anonymous At Work:

    Whether it changes minds or not, they have to pay for their decision. Let’s see how much their belief is really worth to them.

  18. 18.

    rikyrah

    August 30, 2021 at 9:18 am

    @Baud:

     

    Time to escalate.  It’s either us or them.

     

    You are not lying. I have come to this decision  too.

  19. 19.

    rikyrah

    August 30, 2021 at 9:19 am

    I can’t wait for my employer to lower the boom. Expecting it any day now. And, have no sympathy at all for those not vaccinated. Get the shot or get another job. It really IS that simple.

  20. 20.

    Percysowner

    August 30, 2021 at 9:20 am

    Ohio judge orders hospital to treat COVID-19 patient with ivermectin, despite CDC warnings

    I lived in Butler County for a few years. It’s an interesting place. I’ve lived in the Akron/Cleveland area and now I’m in Columbus. In all that time I have never seen a strip club. When I was down in Butler County I drove past at least 3, one of which was catty corner to a HUGE evangelical church, which had a 60′ statue of Jesus. It was the most surreal thing in the world.

    The Jesus statue had his hands raised and was in a pond. It was a dark and stormy night when the congregation discovered that a steel frame 60′ in the sky is a great lightening rod and the statue was burned to the ground, or rather the pond. Like I said interesting place.

  21. 21.

    H.E.Wolf

    August 30, 2021 at 9:29 am

    @JPL:

    It’s time for insurance companies to charge more for those who refuse the vaccine. ACA has some protection for preexisting conditions, but it’s doubtful that stupidity counts.

    @Skepticat:

    This. And unvaccinated people who develop COVID and need treatment should be treated—if at all—in tents set up outside hospitals rather than given a bed in the ICU.

    Beware of the Law of Unintended Consequences… which is (in non-legal terms) that the consequences always hit the innocent much harder than they do the guilty.

    Here’s one recent example:

    https://twitter.com/jelenawoehr/status/1426286913162412035

    [ETA: Apologies. Quoting and links do not work for me with Balloon Juice’s current comment software.]

  22. 22.

    mrmoshpotato

    August 30, 2021 at 9:34 am

    @Percysowner:

    The Jesus statue had his hands raised and was in a pond. It was a dark and stormy night when the congregation discovered that a steel frame 60′ in the sky is a great lightening rod and the statue was burned to the ground, or rather the pond. Like I said interesting place. 

    LOL!

  23. 23.

    A Ghost to Most

    August 30, 2021 at 9:48 am

    Bullies don’t back up until you punch them in the mouth.

  24. 24.

    Fake Irishman

    August 30, 2021 at 9:51 am

    @Victor Matheson:

    and I’ll bet that of those three unvaxxed profs , only one is a true believer and the other two either forgot to report or can’t figure out how to use the Web site to report their vaccination.

  25. 25.

    bbleh

    August 30, 2021 at 9:51 am

    @Butter Emails!: You know, I don’t believe either of those is a genuine issue for more than a handful of truly gullible / deluded / stupid people.  I think they’re just excuses, and if one is disproven they’ll switch to the next with equal (fake) fervor.

    They’re children throwing a temper tantrum.  This is modern Republicanism: one tantrum after another, about whatever they’re told on Fox to be outraged about.  They’re a pathological soup of anger junkies and ODD-type behavior.

    They want to behave like a screaming 3-year-old, treat them that way.  Fire them, shun them, put them in a chair in the corner.  Coddling them only encourages the behavior.

  26. 26.

    bbleh

    August 30, 2021 at 9:52 am

    @JPL: While I’m all for sticks, I reeeely don’t think we want to crack open that door again, because the inscos will barrel through it, and we’ll be back to the bad old days.

  27. 27.

    Ken

    August 30, 2021 at 9:53 am

    @Percysowner: Ohio judge orders hospital to treat COVID-19 patient with ivermectin, despite CDC warnings

    “A critically ill patient was left on an Ohio judge’s porch.  When the hospital was contacted, a spokesperson said ‘He thinks he knows medicine better than the doctors and nurses, so we thought we’d give it a try.'”

  28. 28.

    Another Scott

    August 30, 2021 at 9:56 am

    Nudging does work, but it has to be done by people that the nudgee trusts.

    Belt and suspenders.

    https://www.statnews.com/2021/08/29/former-anti-vaxxer-now-nudge-people-to-get-covid-19-vaccine/

    Thanks.

    Good luck!

    Cheers,

    Scott.

  29. 29.

    Fake Irishman

    August 30, 2021 at 9:58 am

    Dave, it’s interesting to note the parallels between carrots not working all that well to help individual vaccination and gobs of money not helping all that well to encourage holdout states from taking the ACA Medicaid expansion.

  30. 30.

    smith

    August 30, 2021 at 10:00 am

    @Percysowner: This is an unspeakably bad precedent. I hope the hospital defies him, or at least appeals.

  31. 31.

    Barbara

    August 30, 2021 at 10:02 am

    @smith: ​The hospital is in a no-win position here. If the guy dies without it, his wife will be able to claim that he “would have” lived with the treatment. Yes, they should appeal.

  32. 32.

    burnspbesq

    August 30, 2021 at 10:02 am

    I wonder if Duke would fire Coach K, or the CEO of Duke Health, if they were among the vax holdouts.

  33. 33.

    Ramalama

    August 30, 2021 at 10:02 am

    @Another Scott: Thanks for the link. That’s a pretty good read.

  34. 34.

    Fake Irishman

    August 30, 2021 at 10:04 am

    @bbleh:

    agreed. We can’t start to engage in the deserving/undeserving of health care line, or we just open the door to (more) fat shaming/racism/classism etc. But I’m totally OK with other consequences for unvaccinated (can’t go to school, lose your job, no admission to that amusement park or sports arena)

  35. 35.

    New Deal democrat

    August 30, 2021 at 10:04 am

    @Tazj: I wonder if Biden should require vaccinations for airline, train and cruise travel in the US like they recently did in Canada. I don’t know what’s possible legally for the Federal government to do

    The Federal government has the Constitutional right to regulate interstate commerce, so yes they ought to be able to do it*, but it will work a lot better if it is in partnership with like-minded States, which have the Constitutional right to erect cordon sanitaires.*

    *Unless the 6 right-wingers on the Supreme Court are willing to throw out 100+ years of precedent that this is lawful – so, yeah, a crapshoot.

  36. 36.

    Victor Matheson

    August 30, 2021 at 10:13 am

    @Fake Irishman: I have considered starting a pool to bet on who those three people are, but yeah, those are good bets.

  37. 37.

    Suzanne

    August 30, 2021 at 10:20 am

    @Percysowner: Was it the Touchdown Jesus statue with the Hustler Club across the street?

    That Hustler Club was untouched by the lightning, as I recall.

  38. 38.

    D Gardner

    August 30, 2021 at 10:32 am

    @Anonymous At Work: One significant difference between smoking cessation and getting a vaccination is that the former is hard, since it is essentially an addiction. I say this as a recovering alcoholic who fervently hopes everyone struggling with any addictive behavior gets the help they need, assuming they want it.

  39. 39.

    Argiope

    August 30, 2021 at 10:35 am

    @mrmoshpotato: I plan to consult Tony Jay on woad, being skyclad, etc.

  40. 40.

    matt

    August 30, 2021 at 10:45 am

    This is good. I wonder if Nate Silver will stop fucking the chicken.

  41. 41.

    MontyTheClipArtMongoose

    August 30, 2021 at 10:47 am

    @Percysowner: if you build it, he will come

  42. 42.

    matt

    August 30, 2021 at 10:48 am

    @Baud: you are right. They’re killing the economy too. The whole ‘ignore it’ approach they say is the best for the economy is of course super counterproductive, like all their childish and stupid ideas. The luxury of having dumb fucks running around doing anything they want is more than we can afford right now.

  43. 43.

    matt

    August 30, 2021 at 10:49 am

    @burnspbesq: coach k got vaccinated in January! https://www.si.com/college/duke/basketball/coach-k-david-cutcliffe-get-covid-vaccine

  44. 44.

    MontyTheClipArtMongoose

    August 30, 2021 at 10:50 am

    @burnspbesq: krzyzewski is definitely vaxxx’d… but encouraging vaxxx denial in others.

    dude is almost as great a disgrace to west point as pompeo.

  45. 45.

    sab

    August 30, 2021 at 10:59 am

    @Percysowner: I reamember that. I think it was reported all over the state.

  46. 46.

    sab

    August 30, 2021 at 11:05 am

    Just got back from the grocery. In line were three of us old folks, all masked, all six feet apart. Unmasked mom with two unmasked preschool kids comes up, all cheerful, and starts crowding us in line because she doesn’t believe in social distancing either. Grr. Virus vectors.

  47. 47.

    Percysowner

    August 30, 2021 at 11:36 am

    @Suzanne: Yep. The Hustler Club was catty corner from the church and it wasn’t touched. I lived in the area at the time and that was the exit to go home from visiting my daughter. So, so funny. I was amused every time I passed the statue and then The Hustler Club. I had moved by the time of the fire.

  48. 48.

    rikyrah

    August 30, 2021 at 11:40 am

    @New Deal democrat:

     

    I wonder if Biden should require vaccinations for airline, train and cruise travel in the US like they recently did in Canada. I don’t know what’s possible legally for the Federal government to do

     

    clap clap clap

    Airlines

    Amtrak

    Greyhound

     

    The Feds should do it like YESTERDAY.

  49. 49.

    trollhattan

    August 30, 2021 at 11:52 am

    Good for Duke. There, I said it! Do not expect gloves come basketball season. :-)

  50. 50.

    David Anderson

    August 30, 2021 at 12:13 pm

    @Fake Irishman: that JGIM piece is on the agenda for later this week…

  51. 51.

    Gunga Dean

    August 30, 2021 at 12:21 pm

    Maybe a place of learning is not a great fit for employment of a demonstrably stupid individual.

  52. 52.

    debbie

    August 30, 2021 at 12:42 pm

    @Percysowner:

    You haven’t seen the very large shadow of Jesus cast on the wall of the Livingston Avenue Methodist church on Livingston Avenue near the Third Street entrance to I-70?

  53. 53.

    angie

    August 30, 2021 at 1:18 pm

    @Percysowner:  RIP, Big Butter Jesus

  54. 54.

    Percysowner

    August 30, 2021 at 3:17 pm

    @debbie: I don’t go downtown very often. I will have to look for it the next time I’m in the area.

  55. 55.

    debbie

    August 30, 2021 at 4:53 pm

    @Percysowner:

    It is turned into a manger scene during the holidays, fyi.

  56. 56.

    Fake Irishman

    August 30, 2021 at 6:53 pm

    @David Anderson: 

    Scooped again!

    (my JGIM piece from last week was only about the why throwing money at states was unlikely to work.)

    I’ll definitely keep an eye out for yours and probably cite it in a piece that’s nearing submission

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