The Cost of Ignorance: Why Anti-Vaxxers Belong in the High-Risk Pool

By u/Wormtalk94

Freedom of choice has never meant freedom of consequences. People choosing to drink and drive can see insurance rates jump from 28%-371% after a DUI(1) reflecting the higher statistical likelihood of accidents and harm. Similarly, anti-vaccine choice creates predictable, and preventable costs for the healthcare system. Consequently, there is a moral and pragmatic imperative to assign the financial burden of this choice to those who voluntarily incurred it rather than transfer this cost to the rest of society.

Insurance exists as a shared pool of risk. We all pay into it hoping that we never need it with most favoring preventive care, safe driving, and early medical planning to avoid unnecessary insurance interactions. Each step is taken to prevent the possibility of premium hikes or overt coverage denial. As such we opt in to taking these bare minimum actions acknowledging the inability of insurance to make everyone whole following catastrophe.

Anti-vaccine advocates have chosen to opt out this social contract, asserting that their personal convictions outweigh medical consensus. They are shielded from the consequences of their actions, benefiting from a system that they burden without personal accountability.

Robert F Kennedy Jr is broadcast on a large screen as he speaks during an anti-vaccine rally in front of the Lincoln Memorial in Washington DC

As of December 9th, 2025, 1,912 confirmed cases of measles were reported in the United States this year. The CDC estimates that 1 in 5 measles cases will require hospitalization at an average cost of $43,000 per patient (2,5). 92% of these cases were from unvaccinated individuals (3), with this outbreak representing the highest measles case load in over 30 years (4). The result: an estimated $16 million in preventable medical expenses. This likely represents the lowest number we will see in the coming years as national vaccine rates have plummeted since COVID (6), eroding herd immunity and amplifying future costs.

Insurance isn’t a bottomless pool. Certain treatments and procedures go uncovered, with reports suggesting that 15% of all claims submitted are denied (7). This includes people undergoing cancer treatment, accidents, autoimmune disorders and mental health crises. The pool is limited, and every unnecessary expense removes resources that could go to someone else’s coverage. Thus, it is fair to question why avoidable illnesses resulting from voluntary vaccine refusal should compete with unavoidable medical needs.

Anti-vaccine advocates have always been present, though till recent their rarity has made their impact minimal and mostly unnoticed. These people have been shielded by their contemporaries, as herd immunity has prevented widespread disease outbreaks protecting the vulnerable. This is no longer the case. MMR vaccine rates have fallen below the 95% threshold to prevent outbreaks, with other disease like pertussis (whooping cough) bordering essential thresholds (6). As such, they are no longer protected, nor are the people who have actual medical exemptions or medical conditions that lessen the efficacy of the vaccines.

The current system subsidizes the anti-vaccine movement, and in a coldly rational world preventable diseases resulting from the refusal of preventative care might be denied coverage. However, such a stance could be deemed cruel and counterproductive as completely denying coverage to people could cause life threatening harm and impose cost for the system. Whereas I believe risk-adjusted premium increases are virtuous from both a moral and pragmatic standpoint. People who willing opt-out of the public health social contract will require some proportion of funds, which if preemptively accounted for will prevent their choices from disenfranchising others.

This is not a vindictive stance, its holding people accountable for their choices. Numerous other lifestyle choices are met with increased insurance premiums, such as speeding in a car or smoking. Yet getting vaccinated is a minor effort, typically just two or three brief visits to a doctor, unlike lifestyle changes like quitting smoking, which require months or years of sustained effort. No one should be forced to take a medical treatment against their will. Opting out of proven medical treatments should, however, be viewed in the same light as other behaviors that increase risk. If one truly believes that vaccines ‘cause more harm than good’, then this proposition should not be controversial.

Vaccine-preventable illnesses are reemerging, and based on current trajectories are likely to become a larger burden in the coming years. If the system doesn’t start to preemptively account for this, foreseeable cost will occur adding undue stress on a system that is already understood to have coverage issues. Freedoms are self-evident but not free, and thus far the responsibility of these choices has been shifted from the beholder to the rest of society. Risk-adjusted premiums aren’t punishment, they’re fairness, and the only way to ensure that one’s freedom to choose does not infringe on someone else’s.