The tragedy here goes far beyond the direct damage to the patents who were prescribed this vile stuff off-label. There's also the collateral damage to the medical establishment that supports this -- can anyone argue that the anti-vaxxers don't have a point when they're on about exactly this sort of profit-driven evil from Big Pharma?
I myself am an anti-anti-vaxxer (a pro-vaxxer?) who actually supports state-mandated vaccinations, but this puts me in the very uncomfortable position of having to defend one corner of an industry that does the kinds of things described here and a government that has failed at the most basic oversight.
So the next time you read about a measles outbreak at a theme park or you see a scientifically illiterate ghoul like Jenny McCarthy peddling her child-killing nonsense on TV, spare a thought for Johnson & Johnson, because they're feeding the anti-vaxxer paranoia and kneecapping legitimate public health efforts.
The OP is strongly worded, but I don't think he's starting a flamewar. it's true that this kind of behavior on the part of pharma damages their credibility and feeds some people's paranoia. Just like the mishandling of the Katrina disaster feed a lot of people's paranoia about "big government". It might not make strictly logical sense, but the damage is still done.
> can anyone argue that the anti-vaxxers don't have a point when they're on about exactly this sort of profit-driven evil from Big Pharma
Yes; they do not have a point as regards vaccines.
Because vaccines are so essential to public health, they're very closely regulated and monitored by the FDA. Samples from each and every lot of each and every vaccine are passed to CBER and tested (for efficacy, sterility, etc) at several stages of production, and licenses for distribution are granted per lot, based on passing those tests.
The FDA knows exactly what they want from these drugs, what the active agents are and how they work, and how to test for them. They don't accept cleverness or variations. There's essentially no profit in this process and no room for profit.
The anti-vaxxers would have a point even if J&J wasn't involved in shady activity.
I am not an anti-vaxxer. I was vaccinated. I had my children vaccinated.
I just hold the position that the power of the state shouldn't be used to compel people to inject substances into their bodies, even if we think we have a good reason for doing it.
I'm not looking to delve too deeply into the politics of it but there are good reasons to oppose mandatory vaccinations.
Given that the whole purpose of a state is to compel people to do things, I'm wondering what basis you have for drawing the line there. Or why a simple waiver process wouldn't be sufficient to handle those who object.
In general, I would argue that a state has the authority to compel someone into doing anything that has been sufficiently demonstrated to be a good decision, and so the onus is on the anti-vaxxer to show that receiving a vaccine is in fact not a good decision in their case (because it has been shown to be valuable in general.)
Given that the whole purpose of a state is to compel people to do things
I'd argue that the purpose of the state is to prevent people from doing certain things. To illustrate, most of our laws are "Thou shall not..." versus "Thou must..." to punish "bad" behavior instead of compel "good" behavior.
I'm wondering what basis you have for drawing the line there.
Personal autonomy. Your body, your choice.
Or why a simple waiver process wouldn't be sufficient to handle those who object.
Because a waiver process implies that it's the government's choice and not the individual's.
In general, I would argue that a state has the authority to compel someone into doing anything that has been sufficiently demonstrated to be a good decision
Can the state compel everyone to be a vegan unless they can show proof of a medical condition that would make it unworkable?
Compelling to do good things and compelling to prevent bad things are a duality. They're equivalent in their effects, and you can easily transform one to the other. Punishing people for doing wrong is compelling them to receive a punishment deemed good. "Thou must go to jail."
"Personal autonomy. Your body, your choice."
That's a nice slogan, but it isn't actually realized anywhere. It's always your choice when there's a clear advantage -- that is, when the state doesn't "know best" about your body. And it absolutely reserves the right control your body for the greater good.
"Can the state compel everyone to be a vegan unless they can show proof of a medical condition that would make it unworkable?"
They can if there is good evidence to show a vegan diet is strictly superior to all others.
So for a more appropriate example, it can compel you to use a seatbelt in an automobile, because there are real social costs to not doing so. It doesn't matter if you want to take a risk, once you go to the hospital, you are utilizing a public resource. And the state has a responsibility to ensure those resources are available and used efficiently, which means preventing unnecessary emergencies. (Like what would occur if you contracted something like polio.)
> That's a nice slogan, but it isn't actually realized anywhere. It's always your choice when there's a clear advantage -- that is, when the state doesn't "know best" about your body. And it absolutely reserves the right control your body for the greater good.
That's true legally, and in theory, but if someone tries to medicate me without my permission I'll leave the country. I can't trust the government with my health given its track record on drugs, the tuskegee experiment, the whole nasty eugenics business, the miserable mess that is psychiatric drugs, and doctor assisted suicide laws, and visitation/commitment rights. It's extremely clear the government does not have my health in its sights but is rather driven by a paternalistic morality supporting existing social and industrial entities. Even paternalistic forces must earn respect before the subordinate cooperates.
NOTE: I was on Risperdal (risperidone) for two years. It made me lactate painfully (I'm male) and I couldn't work well. My thoughts were scattered. I never should have been prescribed it; the positive effects of the drugs I was taking was mostly from the SSRI stabilizing my emotions. Even that is hard to justify given the subtle nature of the perceptual change, its low effect on my actual depression, and the large physical side effects.
Well, one might agree with you were they able to distinguish between paranoia and an actual problem. I highly suspect that your experiences with that drug weren't a result of a government mandate that you could not exclude yourself from. An adverse reaction to medication is exactly the kind of information that is needed to circumvent its use. Nobody is arguing against that.
No, but it's a sign that we need drug reform that it was on the market at all. If they can't even validate the psychiatric drugs we're giving to people, how can we expect them to make sweeping decisions for an entire population? It's not paranoia at that scale, it's just kicking the tires to see if our government actually has the wherewithal to make these kinds of decisions. It seems extremely obvious to me they don't, and we've only seen positive change on this front in the last ~seven years at the NIH, FDA, and DEA in terms of recognizing and resolving these past issues.
And it's not so much that there was a mandate to prescribe risperidone, more that they prescribed me a very, very shitty medication when I was a ward of the state. It's their responsibility to ensure the doctors and RNs have accurate, up to date knowledge of the medication they're educated to prescribe by the FDA. IMHO they failed with risperidone.
The reason we have states is to manage public resources, including the people who make up the state.
But really, you might sue them, but that's not the only way to fix that kind of problem. You could also elect a new government, or create laws or regulations to prevent mismanagement, or usurp the government. Suing is only one way to interact with a government that makes mistakes, and it's certainly not a necessary mechanism for doing so.
How about "Thou shalt not spread deadly diseases by leaving yourself unvaccinated", by analogy to "Thou shalt not spread deadly diseases by selling tained food" or "Thou shalt not spread deadly diseases by leaving your hair out when you're working in a restaurant's kitchen"?
By leaving yourself unvaccinated, you are bearing the risks of contamination. The risks that someone else takes leaving themselves unvaccinated is up to them.
There are people who can't be vaccinated, and instead depend on everybody near them being vaccinated so the disease can't spread to them, so leaving yourself unvaccinated is not a risk only to yourself. I, for example, have a family history that means I can't take the usual meningitis vaccine. I am depending on the people around me getting vaccinated, and if they don't, they push to me a risk of becoming infected, exactly like someone who doesn't wash their hands after using the restroom won't make themselves any sicker but can infect me. http://www.slate.com/articles/news_and_politics/jurisprudenc...
Now, imagine if due to the incompetence or corruption of government and pharmaceutical companies, you were forced to be vaccinated with a meningitis vaccine anyway (or risk punishment), even though you and your doctor protests there will be dangerous side effects. That's a situation that will happen to some if people are forced to vaccinate. They may or may not be right about the side effects, but to them, it will feel exactly like as if you yourself was forced to take the meningitis vaccine even though you feel very sure it will not be in your best interests. It's probably worth forcing that situation on everyone around you for your own family's wellbeing - but I think it's still worth pointing out the suffering this will cause others.
That's not how vaccination works. Even if I get all my vaccines, there is a chance one of them didn't work for me. Then when people start getting sick and spreading it because not enough of us are vaccinated, so do I.
They work by having the vast majority of people not carriers so that the few that don't end up protected directly are still protected.
This is sorta like having shitty brakes and tires. Sure you're the person most likely affected but there's a good chance your accident is going to mean harming someone that does have good brakes and tires.
I'd argue that the whole purpose of a state is to shift game theoretic weights of decisions of individuals in a way that benefits the overall population. So we don't fall into certain instances of the "tragedy of the commons" [1].
Vaccination is a good example. As an individual there is a really small risk in not vaccination if everybody else do otherwise (the disease can't spread). If there is no regulation then the Nash equilibrium will be at a not desirable point, where a certain percentage of people still don't vaccinate and the disease never dies out. If there is a regulation it can increase the cost of not vaccinating (most easily you pay a high amount of fine and you still have to vaccinate) and shifts the Nash equilibrium to a more effective point.
tl;dr: you don't vaccinate only for yourself and your kids, you vaccinate for everybody stopping the spreading of the disease.
edit: Note that making vaccination mandatory is not the only (but IMHO an effective) way to motivate vaccination. The state can reward people who take vaccination.
I can't/shouldn't take the flu vaccine... it will drastically the risk (around 5% without flu shot) that I'll have Guillain-Barre again. I'm almost done paying the hospital bills from 5 years ago, when it happened... insanely expensive treatment, even if you have insurance that caps at half a million.
Oh, I see, you were making a smaller point than I thought originally, my misunderstanding. Since I hunt and own livestock, I regularly consume meat that didn't go through FDA inspection. My impression is that is a fairly rare thing.
How many people would fly on a regular basis if the state outlawed commercial manufacture of airplanes?
If you don't get vaccinated, and you get sick, then you infect everyone else. You don't have the right to choose to infect other people.
Vaccination needs to be mandatory, and if the state has to send agents to burst into people's homes, tie people down, and forcibly administer the vaccinations, then I'm all for it.
I generally agree with LordKano, and in the same positions of having been vaccinated myself and my kids. At the same time I really don't like state-mandated vaccines. For philosophical reasons first of all ("Your body, your choice"). But also for practical, as it presents a great possibility of abuse; as an example impagine corrupt officials mandating unnecessary vaccination of BigPharma's profit.
> If you don't get vaccinated, and you get sick, then you infect everyone else. You don't have the right to choose to infect other people.
I would NOT be against public schools mandating vaccines in order for children to attend school. Same for places of employment.
I appreciate your concern, but this is a slippery slope fallacy. It's highly unlikely it would be abused without knowledge, because we currently have a net-good policy that is being "debated" at all levels today. I can't imagine a net-neutral or net-evil policy would slip by undetected.
Slippery slope is not automatically a fallacy. In fact, since this is a political (and more importantly, rhetorical) debate, slippery slope isn't a fallacy at all. It is an argument, carrying some weight or none at all, depending on how it is presented. In light of an article that is precisely about how "Big Pharma" overprescribed drugs to people who didn't need them, suggesting that allowing the government to enforce prescriptions will lead to more corruption and overprescription, this argument should hold a lot of weight.
More generally: Slippery Slope is a logical fallacy. It, along with many of it's brothers [1], do nothing to prove a point in a logical debate. They do no represent MUSTs, they represent SHOULD, MAY, and OPTIONAL [2]. These are rhetorical devices that you should use when you are feeling out the scope of the problem and advocating for policy in a political debate. And it can be relevant to call them by name, but dismissing an argument because you can name it is actually illogical.
Of course it is. Do you feel the pain when I get stuck by a needle?
If you don't get vaccinated, and you get sick, then you infect everyone else.
This is a possibility. Life is risk.
You don't have the right to choose to infect other people.
That is true. They also have the right to decide for themselves if they want to be vaccinated. As I said, I was vaccinated and I had my children vaccinated. I hope that everyone does. I am opposed to using the coercive force of government to make them do it.
Vaccination needs to be mandatory, and if the state has to send agents to burst into people's homes, tie people down, and forcibly administer the vaccinations, then I'm all for it.
Should the state be willing to kill people in order to administer vaccines to keep them from getting sick and dying?
> Can the state compel everyone to be a vegan unless they can show proof of a medical condition that would make it unworkable?
Consider that the state does compel you not to kill humans. If non-humans were accorded similar rights (which is a separate discussion) then yes, they most certainly could.
The state regulates the killing of humans. If you forcibly enter my home with a perceived intent to harm me or my family and without any right to do so, I will kill you and never run afoul of my state's laws.
If you attack me and I find myself in fear of death or grave injury, I will kill you and never run afoul of my state's laws.
>a state has the authority to compel someone into doing anything that has been sufficiently demonstrated to be a good decision
These are dangerous words. "Sufficiently demonstrated to be a good decision"? What does that even mean? My take on trying to derive the meaning of that sentence is that it doesn't actually mean anything.
What is a "good decision" and what does it mean to be "sufficiently demonstrated"? I posit that no one could sufficiently define those words as to make an actionable decision criteria that satisfies those (highly abstract) requirements.
Many states have felt that it was a good decision to force people into labor or death and the consequences have been severe. Are you really trying to reuse their (poor) reasoning?
Having a new generation, i.e. babies, is good for the state -- it's actually essential for Social Security style systems to work. It's also considered desirable by many, many people.
Taking your argument to the logical extreme, your argument implies that the state has the authority to impregnate women.
Not arguing against vaccines, (I'm pro vaccines), but I'm against giving this much power to the government. Government abuse of power is always a question of "when and how", never a question of "if".
>In general, I would argue that a state has the authority to compel someone into doing anything that has been sufficiently demonstrated to be a good decision
Okay, the state now orders all the people to stop eating red meat and show up for 45 minutes of mandatory PE at 6 am monday, wednesday and friday.
After all the list of benefits of exercise is tremendous.
Vaccination is not an onerous requirement and there is very good reason to believe it is beneficial to public health when widely administered. If you want to reject it on principle alone, you'll have to address why your liberty in principle is more important than my health concern in practice.
The problem I have with thee sorts of debates is that fundamentals are very hard to argue against in principle. But in effect, practical "compromises" can often serve both goals better than a single purists solution.
I happen to believe in both liberty and public health.
In practice, vaccinations against infectious diseases need to hit certain percentages, not 100% of the population. With free vaccination, post natal health care, school programs and public education campaigns we can hit those numbers, and we do so regularly.
There's no need for the gross violation of freedom some people fear, locking up parents or declaring them unfit, tying people to a chair and needling them. Doing this voluntarily puts more onus on the system to be smart and high functioning, invest in education and making people comfortable with the whole thing. It increases the pressure to reduce side effects, inconvenience, cost, fear and any other barrier to getting kids vaccinated. Generally, the whole thing works better.
The fundamentalist is not serving principles more faithfully than the centrist or pragmatist. She's often just being argumentative and trying to be right to the detriment of her principles.
Declaring all state involvement or authority to be (equally?) coercive and violent is silly, thinking in discreet categories when the world of human beings is fuzzy. Ignoring people's agency in the decision to vaccinate them or their children is an obvious violation is a basic morally deafness.
I see comments like these from smart people who think more deeply about such things than the average person. It's baffling. Almost makes me think that the whole enterprise of moral philosophy and political philosophy is counter-productive. People fall into traps of vainly searching for consistency and leave their moral sense behind, with common sense far behind.
TLDR: There is no reason to forgo obesity for vaccination or vaccination for freedom. People are motivated into these arguments by a desire to be right, not to help people be free or healthy.
As you suggest, one can be strongly pro-vaccination and just as strongly against the ability of the government to send a SWAT team to the door to vaccinate you forcibly.
Personally, the law California passed seems a reasonable compromise to me. Once it's phased in, it makes it possible for parents to still opt-out their children but it 1.) makes it very much a non-casual decision, given that they'll probably have to home-school as a result, and 2.) keeps the children away from at least one of the locations (school) where they would interact with the largest population of other children.
> As you suggest, one can be strongly pro-vaccination and just as strongly against the ability of the government to send a SWAT team to the door to vaccinate you forcibly.
Yeah, but no significant group is arguing for that; its a strawman.
> Personally, the law California passed seems a reasonable compromise to me.
Its not really much of a compromise -- its pretty much the far extreme of what mandatory vaccination proponents actually seek.
> the far extreme of what mandatory vaccination proponents actually seek
Vaccination proponents seek vaccine-preventable diseases to be largely prevented.
What do you mean by "mandatory vaccination proponents" if not the previous sentence you just dismissed as a straw man. Why are you trying so hard to be combative?
> What do you mean by "mandatory vaccination proponents"
People actually supporting the idea that government should mandate vaccination of children in some circumstances; the real people on the other side of the actual government policy debate from anti-vaxxers.
>People actually supporting the idea that government should mandate vaccination of children in some circumstances
Which, in fact, proposed laws--including the one passed in California--do not do. Yes. There are significant consequences to not vaccinating children (where there is no medical necessity) but it's not mandatory under any circumstances.
By and large, vaccination proponents recognize that the key is to hit certain vaccination percentages for herd immunity reasons. At least in some areas of the country (e.g. Marin County), allowing personal belief opt-outs without consequence do not achieve those percentages. The assumption is that requiring vaccination to attend public schools (absent medical reasons to opt-out) will reduce the number of children who do not get vaccinated.
> There's no need for the gross violation of freedom some people fear, locking up parents or declaring them unfit, tying people to a chair and needling them.
Not yet. If you don't think propaganda will align "drug-de-jour" with vaccination, you can go back half a century in the history books and find some surprising artwork. The point is that it's a bad precedent to coerce. The whole idea of the federal hammer (all-or-nothing) has betrayed the notions of community and local governance. I see the discussions on Nextdoor.com for my neighborhood, but it's ultimately left up to the Feds to mandate. Why aren't the states doing this? Because they are too afraid of the backlash, while the aloof congresspeople are obviously detached.
I would like to point out that, in practice, we have eradicated Polio, and Smallpox, both of which are terrifying diseases. Also, thanks to vaccination of the adult populace you never hear about babies dying from Pertussis. There are other diseases that are similarly rare now but that used to kill or deform people before vaccinations became a part of public health policy.
So there are some good reasons why I think you're right.
> If you want to reject it on principle alone, you'll have to address why your liberty in principle is more important than my health concern in practice.
Nope, they really don't.
The default should not be for the state to force someone to inject a substance into their body, and if they refuse or raise concern, that it is then on them to explain/justify why NOT. The state should justify why they're doing it, and make a good case to each individual so they make the right choice.
If you think the first amendment is an important right in the US, then the right to not have complex chemicals and or living organisms injected into your body should be an even higher right (since you're entrusting your very health on the state).
I fully support vaccines and we are CHOOSING to vaccinate our kid. I understand herd immunity, but your fear doesn't trump other people's individual rights.
I dislike both anti-vaxxers AND forced-vaxxers. One is scientifically ignorant and the other is morally bankrupt. Pick your poison I guess.
> The default should not be for the state to force someone to...
I agree.
> The state should justify why they're doing it
And they do: herd immunity, which is supported by convincing scientific evidence.
I didn't say liberty should be violated by default. We are no longer in a default position -- the argument has already been made and it is apparent that vaccination is justified as a social good. As a member of a society, sometimes social good takes priority over individual liberty. My argument is that if people still want to reject it, they need to explain why their liberty should come before others' health. (This is a rhetorical request I don't expect someone will be able to convince me of, though some may hold this view.)
You have no right to be protected from getting sick... One's personal liberties should generally extend just shy of infringing on an other's rights.. That should be the default.
That said I'm not an anti-vaxxer, but I'm medically unable to take most of them now as they would dramatically increase the chance of a deadly side effect. Once in my life was enough (and the 6-figure hospital bill after insurance cap), and a 5% chance of reoccurrence is bad enough without tempting fate to make that risk much higher.
> You have no right to be protected from getting sick...
Conversely, you have no right to infect other people (this is a unconsented harm inflicted on others, the most basic thing that is a violation of rights.) To the extent that doing so is neither intentional, reckless, nor negligent, you also shouldn't be held responsible to prevent doing so -- the question with mandatory vaccination largely boils down to whether failing to use particular vaccinations without a special medical reason is such a failing of a duty of care.
I'm fine with "you can't force me to get vaccinated" if it includes an acceptance of civil liability should you be part of an outbreak of vaccine-preventable disease.
That's just petty. Even assuming liability, you cannot sue dead people back to life, or sue an epidemic away. So, no, that is silly and helps nobody. If you're going to do that just go full hog and fine people, at least it doesn't feel like petty revenge.
Ultimately it is the fact that vaccines AREN'T required that forces the government to spend the time, resources, and effort promoting vaccines. Without that they can just arbitrarily start demanding we inject things and outright reject all requests for information/data/etc.
We are actually in a good-ish place. Most of the population is vaccinated, there's plenty of data on vaccinations available to the public, and many of the concerns have been debunked using good solid science which cannot easily be refuted.
Essentially the forced-vaccination people are arguing for worse science, they just haven't figured that out yet because they aren't looking far enough into the future. If they are forced, what is the justification for the science? Or are you just going to rely on other countries where it isn't mandated for the science (in particular follow up studies)?
As the parent of twins born the day before the third trimester, I assure you my motivations here are not petty.
> Even assuming liability, you cannot sue dead people back to life, or sue an epidemic away.
Negligent homicide is punishable both civilly and criminally in most other situations. Why not in refusing to be vaccinated?
> We are actually in a good-ish place. Most of the population is vaccinated, there's plenty of data on vaccinations available to the public, and many of the concerns have been debunked using good solid science which cannot easily be refuted.
And we're finding that a certain percentage of the population is immune to scientific refutation. They're not going away, and they're causing some areas to drop below herd immunity levels. http://www.washingtonpost.com/news/wonkblog/wp/2015/01/27/ca...
Negligent homicide is punishable both civilly and criminally in most other situations. Why not in refusing to be vaccinated?
Because it doesn't actually do anything with the problem of there possibly being an outbreak of some disease with the potential for widespread death.
Okay, great, you can hold the one person accountable for not vaccinating their kids liable for the deaths of ten people. Fantastic. Ten people still died.
Our justice system is very much a "If X, then Y" system - but what if your goal is not to deal with X the consequences of X, but to prevent it in the first place?
You could argue the deterrent effect, but if someone is irrational enough to ignore the conclusive logic that vaccines prevent you from getting sick, they're probably not going to be much more convinced by a (low) possibility that they might end up in front of a court and possible face prison. (And that's even if it can be proven beyond a reasonable doubt that the one person not getting vaccinated was the direct cause of the deaths beyond a reasonable doubt)
I think it's pretty fair actually - I don't want anyone (particularly children) to be forcibly vaccinated. But people should realize that choosing not to be vaccinated may cause harm to others and in that case it seems fair to be able to obtain compensation via the courts.
That mechanism wouldn't work very well though, because it's a situation with low risk, where it's hard to prove who caused the harm, and even when you do, the damages are so high, the injury won't be restored: For instance, if an influenza outbreak, that we assumed was caused by a set of 5 people in a school contracting the disease, and that killed 10 people, would not lead to multi million dollar payouts to the families of those that died, because chances are, there are no millions of dollars to give. So the compensation will not be any good.
Therefore, all you have left is deterrent, but really, do you think an anti vaxxer would care about going bankrupt, vs their perceived chance of their kid getting autism? I'd be very surprised if it provided any deterrent at all.
> The default should not be for the state to force someone to inject a substance into their body, and if they refuse or raise concern, that it is then on them to explain/justify why NOT.
Even most "mandatory" vaccination regimes don't generally do this.
They require people to vaccinate themselves (or, most often, their children) if they are medically able to be vaccinated as a precondition of use of certain public accommodations, as a means of protecting the health of other users of the same accommodation, including especially, but not exclusively, those medically unable to be vaccinated.
It could still be a civil suit - if someone actually got sick because you weren't vaccinated, they could sue you for damages.
Also, once you give the government the authority to require people to be injected, they will probably start expanding it in various directions. That's really not a power I want to give to them.
That's the sort of tragedy-of-the-commons style fault that is prohibitively difficult to prove is due to a specific individual. Governments exist to solve such coordination problems.
If someone got sick because you weren't vaccinated, does that not imply that they were also not vaccinated? Or are there cases where e.g. you can only get vaccinated as an adult, and you're suggesting a civil suit if you infect a child?
Vaccines are not 100% effective. Some people are unable to take vaccinations. That's why we want to vaccinate as many people as possible - herd immunity protects the people who are unable to get vaccinated or people at that edge of efficacy.
And a child who is not vaccinated by their parent may want to get that vaccination when they're old enough to make that decision by themselves.
Why, categorically, should one be forcibly vaccinated in order to protect someone else? Sure, it's the civilized thing to do, but why is the justification to compel it?
(And yes, the "anti-vax" "movement" is disgusting - a fine example of the stupidity of crowds. Unfortunately, defending freedom often means defending scoundrels).
There's a similar argument around fire coverage. The common argument against a more libertarian approach to fire fighting is that if someone's house catches fire and is left to burn, then it will easily spread to neighbors, increasing their risk. And this the obvious physical reality, especially where things are dense.
But since those neighbors are the only concerned parties, then why (in principle) is that additional risk not theirs to bear and mitigate? It cannot cost any more than the neighbors splitting the cost of the fire protection on the unprotected building. Practically, the fire department would just pool that overhead across all customers.
Of course there is the issue of long term second-order effects - freeloading - since most likely if you didn't pay the fire department would still try to extinguish your house as quick as possible (possibly just busting it up a bit more in the process). But making coverage mandatory also ignores long term second-order effects when an organization does not have to be responsive to the people it serves (which is usually then handwaved away with the wisdom-of-crowds fallacy).
The root of the disagreement comes from different thinking about what society actually is. Is it a monolithic system we're all bound to and the only way to change it is top-down? Or is it the constructive result of the surplus that everyone is willing to bring to the table, implying that an individual should have the option to quit the game and take their ball - even if that individual then watches from the sideline or even returns to play but without their ball?
Both perspectives are needed, but every society is predisposed towards over-centralization - most people have a very hard time seeing anything besides their own perspective, so they falsely think their desires apply to everyone. Yet as demonstrated by the success of free markets, only decentralization can satisfy and incorporate minority viewpoints. When creative destruction is prevented from applying to structures within the society, then it will inevitably occur to the society as a whole.
> But making coverage mandatory also ignores long term second-order effects whereby organization becomes completely disconnected from the people it serves
I don't see how you can argue that it ignores this in the case where people advocating for mandatory fire protection coverage advocate that the agency through which the fire protection is provided be democratically accountable to the people in the covered area, which pretty much excludes anyone advocating public coverage in the modern developed world; addressing that effect is a central purpose of democratic accountability.
Democratic accountability to the served population deals directly with disconnection from the served population without appeal to either "wisdom of the crowds" (it doesn't rely on the "crowds" being correct, it relies only on them being the population served) or the "perfection" of centralized control (which seems to be a completely different issue, that might be worthy of discussing, but isn't the one you said was ignored.)
I edited right before you responded, swapping out "completely disconnected" in favor of "does not have to be responsive". The former was indeed too absolute to ever be true.
So yes democracy does create a connection between centralized government and the body politic. It's just a bit of a tenuous connection that addresses only gross problems that are understood (the inherent limitation of any centralized planning) by more than 51% of people.
> If someone got sick because you weren't vaccinated, does that not imply that they were also not vaccinated?
Vaccines are not 100% effective, and, in any case, even if they aren't, they may have a real medical reason for not vaccinating: a large part of the reason for efforts to achieve universal vaccination among those who don't have a special medical condition making vaccination unavoidable is herd immunity; the effect that reducing the rates of infection reduces the risks from vaccine failure in those who do vaccinate, and reduces the risk of exposure in those who legitimately cannot vaccinate.
Why are you debating vaccines when you don't even know the basic facts about them such as they don't end up protecting everyone, which is why herd immunity is so important?
I would guess that most of the anti and pro-vaxers are not scientifically trained, were not involved in the development or testing of these vaccines, probably have not read any of the original reports, don't know what influences could have effected those reports and are basically regurgitating info they saw on TV or the internet.
I've heard both sides of the vaccine argument and they both have points.
Non-scientific issues are understood quite well by those doing the debating. I would guess that a relatively small community truly knows what is going on in vaccinations. Besides "it prevents X", I doubt most doctors could tell you what is in this stuff.
Anti-vaccine points:
1. The people who control what vaccines the Government reccomends are "close" to the people that profit from the vaccines. For example Paul Offit, one of the louder pro-vaxies, voted to put a vaccine on the schedule and he had a patent to a similar vaccine. 3 years later he sold his patent for $182 million.
2. The Government has proven that it can be tricked (Volkswagen) and influenced by big money so its easy to not trusts the Governments medical recomendations, and reports.
3. Since 1986 vax manufactuers can not be sued for hurting your kid because of the NCVIA. Since 1986 the amount of vaccines that have been added to the schedule has increased. Anybody over 30 did not have as many or the same vaccines that are recommend for children now.
Pro-vax
1. Vaccines have eradicated issues that were deadly in the past
2. Vax works best if we all do it.
3. Yeah vax may hurt you but a seat belt could hurt you too. Still the majority of the time it is safer to where the seat belt.
4. I had vax and I'm fine so my kids can have vax.
5. Yeah the vax can cause problems but so can the diseases they prevent.
(Pro-vaxxer here:) Another anti-vax point is a variation of the "Gell-Mann Amnesia Effect"[0]. You know that the government policy with respect to some drugs/medicine is completely unscientific - why would you assume they're right about other drugs?
The government mandating or coercing what is required to be put in people's bodies, is a dangerous precedent. That's kinda important (the only one I care about).
Vaxx yourself, force your wife and child to vaxx, create a policy of only befriending vaxxed people, but the next time you think about telling me what to do, you can fuck off.
I myself am an anti-anti-vaxxer (a pro-vaxxer?) who actually supports state-mandated vaccinations, but this puts me in the very uncomfortable position of having to defend one corner of an industry that does the kinds of things described here and a government that has failed at the most basic oversight.
So the next time you read about a measles outbreak at a theme park or you see a scientifically illiterate ghoul like Jenny McCarthy peddling her child-killing nonsense on TV, spare a thought for Johnson & Johnson, because they're feeding the anti-vaxxer paranoia and kneecapping legitimate public health efforts.