Delta, the law and medical debt.

1.?????Is it legal to mandate vaccination? Our country is known for the struggle between individual rights and government authority. You may not want to pay your taxes, but you must pay your taxes. You may not want to obey the speed limit, but you have to. If you want to attend school, you must get the requisite vaccines. A few states have religious and/or philosophical exemptions around requiring vaccines. Now comes the Coronavirus – the most infectious and deadly virus that we have seen in over 100 years. Indiana University in Bloomington, Indiana is, like many colleges around the country, requiring students to get a Covid vaccine before returning to campus in the Fall. And here come the court cases. According to the New York Times, “in his opinion, released on Monday, Judge Damon R. Leichty of the U.S. District Court for the Northern District of Indiana said he weighed individual freedom against public health concerns in his ruling that the state’s flagship university could require vaccines. Judge Leichty’s ruling appeared to be the first case in which a university’s coronavirus vaccine requirement has been upheld, yet in delivering the ruling he expressed his personal misgivings, citing individual freedom and self-determination.” James Bopp Jr., a lawyer representing the eight students at Indiana University who are the plaintiffs, said the case turned on the right to “bodily integrity and autonomy.” He went on to say that, ““What we have here is the government forcing you to do something that you strenuously object to, and have your body invaded in the process.” Of course that rhetoric has been dismissed for decades by all states that have required school and college students to obtain vaccines before attending. In addition, hospitals can require healthcare workers to be vaccinated and the military can require soldiers to be vaccinated. The only twist on the current situation is that the law has always been applied to FDA approved vaccines. Because our current vaccines – Pfizer, Moderna and Johnson & Johnson – are under an emergency use authorization, the plaintiffs in the Indiana case may have a bit more of an argument. That part of the argument will go away once the vaccines obtain FDA approval which they surely will. Of note, some states have passed legislation banning colleges from mandating the Covid vaccine. The Indiana case will be appealed, and we may see the first pivotal vaccine case to reach the Supreme Court since 1905 -- which would be very interesting! Jacobson v. Massachusetts was a?U.S. Supreme court case in 1905 in which the Court upheld the authority of states to enforce?compulsory vaccination?laws regarding smallpox. The Court's decision articulated the view that individual liberty is not absolute and is subject to the?police power?of the state.

?2.?????The J&J vaccine is not adequate against Delta. Not so fast with that headline. A?new study?posted online on Tuesday only looked at antibody results in vitro – meaning in the test tube – and did not correlate those preliminary lab findings in clinical trials to see if it is really true that those who received the J&J vaccine were either more likely to contract Delta or get more sick once infected with Delta. This study has also not been peer reviewed or published so it should be taken with a grain of salt. It is likely that because the J&J only offers one shot, people will generally have lower antibody levels than those who receive the two shot regimens with Pfizer or Moderna. Many believe that over time the J&J vaccine will modulate into a 2-shot regimen or be combined with the Pfizer or Moderna vaccines in a combination regimen.

?3.?????Medical debt is worse than we thought. For a long time, we have known that medical debt is the leading cause of bankruptcy in the United States. We just didn’t know how bad it really was until a study?published Tuesday in JAMA?by Stanford economist Neale Mahoney. He updated the previous estimation of aggregate medical debt from $81 billion to over $140 billion. One of his findings which is not really surprising, but needed to be validated, is that medical debt has increased more in the 12 non-Medicaid expansion states. In the South, 24% of people carry medical debt. The article states that, “Medical debt is now the No. 1 source of debt collections, surpassing debt from credit cards, utilities, auto loans and other sources combined.” The average medical debt amount was $2,424 last year.