Akst: No avoiding vaccination runaround

In September, prompted by one of the Republican presidential debates, I wrote a column about the foolishness of scaring people away from having their teenagers vaccinated against human papillomavirus.

The vaccine has mostly been administered to girls, who are at greatest risk of the various HPV cancers. But it works in boys, too. So my wife and I decided to have our sons vaccinated.

That was the easy part. The hard part was penetrating the maddening opaqueness and expense of the fragmented American health care system, which may be effective at treating dire diseases, but has shortened my life by making my blood boil at every encounter.

All we wanted was to have our boys vaccinated. They're the right age. We have health insurance. We can afford some out-of-pocket expenses. Getting them the shots would even benefit society: First, by protecting others from HPV, and second, by protecting others from the cost of treating my sons someday if they got an HPV-related ailment. Health care in this country, remember, is a heavily shared expense.

Yet trying to do the right thing for our boys and everyone else has involved considerable hair-tearing. First we learned that our outrageously expensive health insurance doesn't cover the Gardasil vaccine for boys. Fine, I thought; we'll pay for it. How much can three shots cost?

Well, $900, or $1,800 for my twins -- which seemed outlandish. Ah, but we could pay with pretax dollars from our "flexible spending account," thereby foisting a bunch of the expense on the taxpayers. What the heck, employer-paid health insurance premiums do the same thing by being tax-deductible. But we didn't have that much money in the account.

Luckily, I discovered the federal Vaccines for Children program, which covers shots for kids lacking insurance or with insurance that doesn't cover a vaccine. (Neither our pediatrician or insurer mentioned it.) VFC, presumably, gets a better deal than $900.

Back to the pediatrician. Are you a VFC provider? Yup. OK, great, let's have the shots.

Not so fast. Gardasil for boys isn't covered by VFC, the doctor's office said, after transferring me around a bit. But the VFC website says it is, and so does the Centers for Disease Control and Prevention, VFC's parent agency. Merck, the maker of Gardasil, agreed.

As it turns out, VFC does cover Gardasil for boys, but won't pay for the shots at a normal VFC provider. No, you have to go to "the department of health," our doctor's office said. Whose department of health? Not clear.

So I tracked down the regional VFC administrator, at the state Department of Health in Albany, who said VFC-paid Gardasil for "underinsured" kids can only be had "at a Federally Qualified Health Center."

I'll spare you a blow-by-blow account of every phone call, web search and email. Suffice to say that the amount of time and energy this has consumed -- without a single shot having been fired, so to speak -- is ridiculous. The whole episode perfectly encapsulates so much of what is wrong with our health-care system, which can thwart even the best-informed, insured and intentioned of individuals.

And my sons still aren't vaccinated -- the Federally Qualified Health Centers are far from our home. (Visit findahealthcenter.hrsa.gov to find ones on Long Island.) But recently the Advisory Committee on Immunization Practices, which advises the CDC, recommended that boys get Gardasil just like girls. So maybe, soon, our health insurance will cover it. Or not.

No wonder so many kids are still unvaccinated. One can only hope their cancer treatment, if they need it later in life, isn't so difficult to obtain.Daniel Akst is a member of the Newsday editorial board.