Re: [asa] Re: [ASA] Mandatory HPV vaccination

From: David Opderbeck <>
Date: Wed Feb 07 2007 - 12:02:37 EST

*Is there a cost that would be prohibitive or would it be something like a
nominal filing fee.*

"Cost" in this sense doesn't necessarily mean a monetary fee. It means the
time and effort required to find the information necessary to opt out
properly. It also means the possible costs of potential challenges to an
exercised opt-out.

For example, I tried Googling for the information about what forms would be
needed in Texas and how to find them, and ten minutes later, I still haven't
found them; apparently they don't yet exist. I see in the Governor's Order
( ) that the
relevant agency is supposed to make the opt out forms available online, but
apparently that hasn't happened yet, and who knows whether or when it will
happen. Even then, it's unclear whether online opt-out forms will help poor
families that lack reliable internet access.

It's also not entirely clear what the "conscientious objection" affidavit
will entail. It's not a simple opt-out for any reason; it requires a
statement under oath that the objector has a specific religious or moral
reason for opting out. A person who wishes to opt-out might be concerned
that his or her reason for opting out could be challenged in a judicial or
administrative proceeding.

Of course, a determined person with enough resources likely will figure out
how to opt out of this particular program. The broader question for soft
paternalism generally is the aggregation of opt-out costs if such programs
are adopted for a wider range of health and welfare questions. As Cass
Sunstein noted on the blog post I linked, *"it might be worth thinking about
how the basic approach* [of soft paternalism]* can be applied to such
diverse problems as savings, prescription drug plans, social security
reform, obesity, school choice, preparation for natural disasters, and
safety on the highways."*

Imagine if there were twenty or thirty different paternalistic regulations
to track and possibly opt out of. It seems to me that most people likely
would just give up and accept the regulation. That may be ok from a policy
perspective (or it may not), but I think the implications need to be
considered and that it isn't enough just to cite the opt-out right for a
given regulation.

On 2/7/07, SKrogh <> wrote:
> That's fine. Is that the case in this instance? No labor or costs of
opting out were discussed. Is there a cost that would be prohibitive or
would it be something like a nominal filing fee. The entire interview with
Perry is now on the web.
> -----Original Message-----
> From: []On
Behalf Of David Opderbeck
> Sent: Wednesday, February 07, 2007 9:39 AM
> To: SKrogh
> Cc:
> Subject: Re: [asa] Re: [ASA] Mandatory HPV vaccination
> Right, but the presence of an opt-out right can be a little misleading, in
that it involves some effort and cost to opt out, such that many will not do
so. This kind of regulation has been called "libertarian paternalism," and
it has generated an interesting debate the the behavioral law and economics
literature. See, e.g., here: (for a negative
view) and here: for a
positive one.
> On 2/7/07, SKrogh <> wrote:
> >
> >
> > It's not mandatory since you can opt out. Gov Perry explained while
being interviewed at this time on WBAP in Dallas. So it is not really
> > =========================================
> >
> >
> > -----Original Message-----
> > From: []On
Behalf Of Jack
> > Sent: Wednesday, February 07, 2007 6:07 AM
> > To:;
> > Subject: Re: [asa] Re: [ASA] Mandatory HPV vaccination
> >
> >
> > The vaccine costs $120 each for three injections over 6 months. Merck
is in the position to make millions of dollars a year if all states mandate
vaccinations. Various medical societies are recommending the vaccine, but
not mandating it.
> >
> > So then Perry, a conservative Christian, who would seem to be someone
opposed to mandating it, passes an excutive order to make it mandatory. It
just so happens that his former chief of staff is now the lobbyist for
Merck. Make of that whatever you will.
> >
> > ----- Original Message -----
> > From:
> > To:
> > Sent: Tuesday, February 06, 2007 10:44 PM
> > Subject: [asa] Re: [ASA] Mandatory HPV vaccination
> >
> >
> > David Opderbeck wrote:
> > > I think the problem is the mandatory nature of this executive order.
> > > Mandatory vaccinations for schoolchildren are appropriate for
> > > diseases that are transmitted by ordinary social contact. It seems
> > > different to me to require that kids be vaccinated against an STD. It
> > > seem like the kind of thing families should decide for themselves. I
> > > see maybe making state funding available for any family that chooses
> > > vaccine.
> >
> > Except it isn't mandatory. In Texas (and I think in all the other
states where this is coming up), families can "opt out" if they want.
> >
> > A legitimate question that some have raised is the cost-benefit
analysis. The vaccine is pretty expensive (a few hundred dollars as I
recall). The cancer prevented, while certainly tragic, is not extremely
common. So society is spending hundreds of thousands, or maybe millions, of
dollars for each cancer prevented. What are the opportunity costs for that
expense? If insurance is required to cover it, how much will premiums go up
and how many people will go uninsured as a result?
> > I'm not advocating any specific answer to these questions, but I think
they need to be asked in such a situation.
> > And one could point out that they are already making such a calculation
to some extent by not requiring the vaccination for boys, although that
would also prevent some cancers (albeit a much smaller number).
> >
> > The other legitimate question that people have raised is the active role
of the company that owns the vaccine in lobbying for states to pass such
> >
> > ---------------------------------------------------------------------
> > Dr. Allan H. Harvey, Boulder, Colorado |
> > "Any opinions expressed here are mine, and should not be
> > attributed to my employer, my wife, or my cat"
> --
> David W. Opderbeck
> Web:
> Blog:
> MySpace (Music):

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Received on Wed Feb 7 12:03:29 2007

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