Millions of Americans are angered by the sight of intentionally unvaccinated COVID-19 patients who now crowd hospital ERs and intensive care units. Many people — even before the omicron surge — have expressed arguments that unvaccinated patients should be placed at the end of the line for scarce resources such as ventilators. "As controversial as it may be, we should deprioritize the eligible unvaccinated patients during medical triage," wrote Trish Zornio, a lecturer at the University of Colorado, Boulder, and a columnist for Colorado Newsline: "Choices have consequences . . ."
To be clear, proposals to triage intentionally unvaccinated ER patients are non-starters, violating basic canons of medical ethics. We can't discriminate against patients because we are angry with them or because we believe their irresponsibility deepened their medical plight. There's even less reason to wonder whether "choices have consequences" when an intentionally unvaccinated patient lies on a gurney in the ER. He's sick and scared. He's likely to get a whopping hospital bill. Life has punished him plenty for his choices.
But this punitive impulse among many liberals — Blue America has embraced vaccines more emphatically and effectively than Red America has — and the resentment conservatives feel in response, could prove unexpectedly instructive. We all might take a moment to appreciate the perspective of our counterparts across the ideological line — and examine whether our attitudes in addressing this brutal public health challenge match our instincts and our approach when America faces other social challenges. Through such self-examination we might at least salvage some cross-partisan empathy out of this ugly conflict.
Many liberals — me, for example — believe it's mean-spirited and wrong to distribute public benefits on the basis of distinctions between the worthy and unworthy poor. Our beliefs and our training — I teach social work and public health at the University of Chicago — instruct that people are poor for myriad reasons beyond their control or proper moral accountability. Some are indigent because of disabilities or educational barriers, or because of a long-ago criminal record that blocks employment in a tough economy. Still others are poor because they got fired from their last job for stealing.
Whatever the reason, we believe, everyone has the right to a roof over their head and to decent health care. People don't have to do everything right in their lives to deserve these basic things. They just need to be human.
We liberals can't spurn this empathetic perspective when we ponder our unvaccinated neighbors seriously ill in the ER. We might remind ourselves why we bristle when conservatives embrace personal-responsibility rhetoric in other contexts, such as debates over public aid. We bristle because such rhetoric easily provides cover for social contempt, a contempt often tinged with cultural and class stereotypes. Those further left than the typical liberal may view personal-responsibility rhetoric as a mechanism to impose discipline on the working class within a capitalist economy — concerns close to the surface in the vaccine-mandate debate.
Of course, we are sometimes right to be angry with people who behave irresponsibly and harm others. Conservatives insist that when someone steals and gets herself arrested, she should pay the price — as should someone who screws up on the job or misuses public benefits. At least sometimes, perhaps, liberals should listen to those complaints with a more open mind.
Considering their anger toward the intentional-unvaccinated, honest liberals might view more generously conservatives' anger toward people who undermine the social fabric in other ways. Consider our reactions to widespread disorder after the murder of George Floyd. Some liberals were a bit too quick to dismiss anger about looting as efforts to deflect attention from police violence and structural racism. Here in Chicago, stores were destroyed and may never return. A Ronald McDonald House was vandalized. One can be angry about that, without in any way minimizing or condoning Floyd's murder. Honest conservatives, meanwhile, might take greater responsibility for unworthy behaviors within their own flock — certainly including widespread belligerent irresponsibility regarding vaccination.
Rather than denying care when the unvaccinated fall sick, it might make more sense to hold accountable the vast majority of intentionally unvaccinated people, who took the identical risk and did not land in the ER. Maybe we should charge them more for health insurance, given the costs they impose on society. Maybe we should require vaccination in key job roles (as many companies have done already, as has the Biden administration). It's right, in the proper domain, to enforce important social norms — including through financial pressures. We liberals aren't always comfortable saying so. Yet as the late public policy scholar Mark Kleiman famously emphasized, swift, certain and fair sanctions are key arrows in the quiver to deter anti-social behaviors ranging from gun violence to white-collar crime.
Liberals' anger toward the intentionally-unvaccinated — and conservatives' corresponding discomfort — should also remind us of the dangers of stereotypical and coarse imagery that denies our common humanity. My Facebook and Twitter feeds now fill with images and videos of MAGA-hatted unvaccinated patients who deny the reality of COVID, who scream at nurses, or otherwise misbehave. Viewing such viral content, we liberals might ponder the role of earlier coarse imagery to divide our society.
Consider the racially tinged rhetoric of 1976 candidate and eventual president Ronald Reagan, who lambasted an imagined "strapping young buck" who bought steaks with food stamps. Consider media imagery of drug-using Black single mothers that circulated prominently during the debate over welfare reform. The unflattering stories conservatives peddled about welfare recipients weren't always or entirely false. Rather, they were cardboard and incomplete, disparaging depictions designed to harden social contempt while denying their subject's individual humanity.
As we remember that history, we should remember that our unvaccinated neighbors have many human reasons — many rooted in family, community, and social context — to be hesitant. Not all of these reasons are on display in the viral videos we're tempted to retweet. We in public health and in medical care must reach out to every community with honesty, humility and cultural competence to address these reasons and concerns.
Videos of those horrible patients should also chasten conservatives, because they don't come from nowhere; they aren't made-up. For decades, conservatives argued that cultural factors perpetuate social dysfunction within what is euphemistically termed "the inner city." The moral crisis and cultural dysfunction present in Red America, on display in these videos, is real and destructive.
One symptom of this dysfunction is widespread acceptance of false narratives, propagated by conservative media, about vaccines and the 2020 election. Others include disdain for expertise, celebration of bullying incivility exemplified by President Donald Trump and his administration.
Bristling at liberals' disdain for the unvaccinated — and at the supposed intrusion of vaccine mandates — conservatives might begin to understand why liberals resist Medicaid work requirements and other measures designed to punish or stigmatize the supposedly unworthy poor. After all, conservatives would not want anyone to say: "A safety net, not a hammock: Back of the line for unvaccinated patients in the ER."
And we liberals might ponder why many Americans chafe at the genuine unfairness that generous social policies sometimes occasion. It's hard to watch an intentionally unvaccinated hospital patient get first-dibs, ahead of the vaccinated cancer patient. It's hard for many Americans to watch a drunk driver on Medicaid receive free care at the ER, when the typical victim of a DUI faces a steep insurance co-pay. There's nothing stupid or bigoted about that very human reaction, even if that reaction shouldn't determine public policy.
Liberals and conservatives are both angry. If we each take seriously why our counterparts are so incensed, we might at least use this pandemic to embrace our common humanity. We have the chance to recognize defects in our own world views. We can embrace the need for personal responsibility, even as we honor the need for restraint and forbearance when our fragile fellow citizens fall short of our own exacting standards.
Harold Pollack is the Helen Ross professor at the Crown Family School of Social Work, Policy, and Practice, University of Chicago.