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

From: David Opderbeck <>
Date: Thu Feb 08 2007 - 11:58:01 EST

*What did you think of the interview?*

He started off by saying: *"The parents are the decision-makers."* Well --
not really. The state is the default decision maker. Families must accept
the default decision unless they opt out. The entire regulatory theory
behind soft paternalism is that people tend to accept default decisions and
don't opt out even if they don't really agree with the default decision.
So, I think the Governor's statement in this interview that the parents are
the decision makers is spin.

Now, it might be good in this instance for the state to be the default
decision maker. It *is* good, I think, that the state is the default
decision maker for many other mandatory vaccines kids need before entering
public school, particularly for diseases that are transmitted through
ordinary social contact. But let's be honest about what the state is doing.

Re: Jack's comments about the public health issue: I think everyone should
agree that it would be good to eradicate this cancer. But concern about the
state's intrusion into the sphere of the family concerning a sensitive issue
relating to sexuality has to be included in the mix as well. There are many
public health issues that theoretically could be solved if the state were to
take over the care of children born to parents who don't have special
expertise in health, psychology, etc. Heck, I'm sure there are experts who
would disagree with some things I do in raising my own kids. Heaven forbid
that I'd ever have to go on that Supernanny TV show! There's a need for
balance between the wild west and the brave new world.

On 2/7/07, SKrogh <> wrote:
> I gathered from the interview that it would be very simple to opt out. I
guess we can speculate about such things but even poor people can get Tax
forms without having to have a computer. And as much scrutiny that would be
on this, I doubt that it would be hidden. I am not surprised you could not
find information readily available on opt out forms, it is pretty new, but I
am sure they will be eventually, if that is indeed what would be needed.
Just as I am sure that hard copies will be available at various sources,
accessible to poor people. What did you think of the interview?
> =========================================
> -----Original Message-----
> From: []On
Behalf Of David Opderbeck
> Sent: Wednesday, February 07, 2007 11:03 AM
> To: SKrogh
> Cc:
> Subject: Re: [asa] Re: [ASA] Mandatory HPV vaccination
> 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 does
> > > > 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
> > >
> > > 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 laws.
> > >
> > > ---------------------------------------------------------------------
> > > 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):
> --
> David W. Opderbeck
> Web:
> Blog:
> MySpace (Music):

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Received on Thu Feb 8 11:58:53 2007

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