Spent a long time reading about how vast bureaucratic inefficiencies are created by people worrying that "the wrong person" will benefit from government programs or that someone "undeserving" might get theirs before I do. This falls squarely in that bucket. Tragic.
I was once involved with a young woman in a homeless program which was entirely defeated by this exact "wrong person" attitude.
Get a homeless person an apartment? Great.
But it didn't end there, there was a constant stream of documentation requirements, your employer had to, monthly, sign paperwork about how much you earned (advertise to employers that you are/were homeless). The program punished you for making money and took most of your earnings away to pay for the housing. The program constantly threatened to take away your funding if the paperwork wasn't perfect. The program constantly made mistakes, paid rent late, and generally threatened a vulnerable homeless person with further homelessness.
It was infuriating to experience this through another person. In attempts to help a person, these programs were taking vulnerable people, dangling housing in front of them, and constantly threatening them with taking it away. That is of course exactly the opposite of what you need to do to someone having trouble taking care of themselves, and sadly mirrors the abusive kinds of situation which so often leads people to homelessness.
A lot of this comes from the Reagan-era idea of "welfare queens" -- that because the idea of "government handouts" are so enticing, people will cheat the system to get them.
There are two issues with this:
- "government handouts" and a reliance on welfare are typically a symptom, not a root cause, of an ailing society -- there are bigger issues at play around wealth and ownership if a large segment of the population needs government assistance
- "welfare queens" is largely a fiction -- the story comes from Linda Taylor[0], a woman who cheated the welfare system, but was caught, tried, and served prison time for her fraud. In other words, the system worked, but anyone relying on government assistance should be punished for it.
I think the same idea extends into many other areas of government. The bureaucracy is set up to give the appearance that nobody is taking advantage of the system, and optimizes only for this outcome. So ironically, only those who devote their time to learning how to take advantage of the system are rewarded.
The examples I'm thinking of are government hiring and procurement, where there are all kinds of hoops to jump through to show fairness (God forbid someone gets hired because the hiring manager wants to work with them, or a vendor gets selected because they have built a relationship with those using their services).
In my opinion it's a side-effect of having money to distribute, but having votes as the only forcing function and no economic feedback. So the pressure is to not appear to be giving anyone an advantage, even if it costs in quality of outcomes and bureaucratic overhead.
The good intention behind mandatory fairness is to fight good old quid pro quo corruption.
Of course it seems hard to separate "the hiring manager wants to work with them [because they are a great vendor]" from "the hiring manager wants to work with them because they pay for the hiring manager's kids' school and family vacation" without adequate documentation.
I'm generally for social welfare programs, however the idea of "welfare queens (and kings)" is NOT fiction. I come from Belgium which has this problem quite notoriously. It is quite common for people to be abusing the social programs to stay unemployed and make more income than blue-collar workers.
Like you allude to, I think we need to look more deeply to address this issue - why are people satisfied doing nothing and simply using handouts to survive? If they worked, shouldn't they become more prosperous? Why don't they have goals and aspirations? If someone is depressed, let's get them help. If the education system has failed them, let's fix that. It's easy to conflate the symptoms with the root causes, however the symptoms should not be ignored because they are the most visible feedback to most regular people, and that affects their perception of the system.
Who says they don't? People living on state benefits may yet have things they are passionate about. Their time is spent doing something, and sometimes that is something good for society, even though it isn't immediately profit-generating.
Living in Finland I met a man who was perpetually on the dole, but he was an extremely active Wikipedia editor, for example. I have often thought if that basic income existed, I could finally do some of the huge OpenStreetMap expeditions I had in mind (adding house numbers for the entire surrounding region, for example.)
Yes, some unemployed people might turn to drink, drugs, or petty crime, but this can be solved by building community infrastructure. The ills of the Parisian banlieues, for example, are often ascribed not just to unemployment, but to the fact that all the cultural and leisure facilities that were promised back in the 1970s were never actually built.
Your comment actually illustrates one thing I find repulsive about basic income proposals; many people seem to want basic income to finance a life of vanity, where they help no one more than themselves.
So, basically, you just don't like what you think people would do with their time, if given the chance because they're not chained to a job? Sorry if this sounds overly confrontational, but I couldn't think of a more civil way to say it.
I was specifically responding to a comment which said:
>"Living in Finland I met a man who was perpetually on the dole, but he was an extremely active Wikipedia editor, for example. I have often thought if that basic income existed, I could finally do some of the huge OpenStreetMap expeditions I had in mind (adding house numbers for the entire surrounding region, for example.)"
It is my opinion that those are examples of vanity projects which provide little benefit to others, which is why I said:
>>"Your comment actually illustrates one thing I find repulsive about basic income proposals..."
I never said that this was true for any and all people, or that:
>>>"[I] just don't like what you think people would do with their time, if given the chance because they're not chained to a job"
Wikipedia and OSM are generally seen as major human achievements because they bring a huge amount of generally reliable data to the whole world on a libre basis, and you call them vanity projects?
For them to be vanity, one's work would have to actually be deeply associated with one's identity so that one could look good in the eyes of others. In fact, 99.9% of people using that data will not know or care who originally contributed it, and editing these resources is about as thankless a task as can be.
Right, but, apparently editing Wikipedia and improving OSM aren't things you approve of someone receiving UBI doing. I'm guessing there are other things people would be enabled to do by UBI that you wouldn't approve of as well.
I'm fine with people editing Wikipedia and contributing to OSM as much as they'd like, but I think each activity is more focused on the 'contributor' than the audience, and I'd rather not subsidize it. I believe that Wikipedia, Stack Overflow, and many other crowdsourcing projects have succeeded precisely because they harness vanity, for laudable objectives. That said, most of the 'contributors' are contributing precious little.
Work-for-pay tends to be more beneficial to others than 'creative expression'-type activities such as writing, painting, or composing music. The vast majority of what people create is worthless to others, whereas much of what people do 'for work' is actually useful to others.
What makes you think that remunerative work is inherently valuable to anyone other than the person paying for that work? You, like I do, probably work largely in order to line the pockets of some already rich CEO. That doesn't mean what either of us does for a living is socially valuable. This seems more like vanity to me than editing Wikipedia or improving OSM.
I can’t speak to your work, but the reason I get paid is the same reason that my employer profits, and that is because the company provides consumer surplus to its customers.
I’ve occasionally edited Wikipedia, to correct grammatical or factual errors, but I don’t see it as having contributed much to the world.
Consumer surplus is not the only human good and infact discounts good done for humans who do not have money.
This not liking vanity thing is interesting but if you tie it to economics then anything that helps people that doesn't make money --things like free software and participating in charities-- could be considered 'vanity' too despite the good they can do.
I got similarly worked up over 'virtue signaling' and people only doing good things for personal prestige when I was an angsty teen but later realised it was better to believe that some people want to do good things sometimes because reasons.
To be clear, I’m fine with people doing whatever they want; I just don’t want to encourage it when it’s selfish behavior. I am not telling you what to do, and if you’d like to pay Wikipedia editors, I won’t stop you.
Still more ethical than a vegan having to compromise their morals by taking a butchering job because they can't find any other jobs and need to feed their kids and have a roof over their head.
I would think that given what we’ve done here in the US to the past forty years of workers, they’ve earned a decade off to live on UBI and heal from burnout and develop interests of any sort in anything at all again, before we could even begin to productively analyze their reactions to UBI. They’ve been traumatized and it will take time to heal and I certainly hope that we implement UBI and let them do so. We can afford it as a country and god knows they’ve done enough for us to have earned a break from work if they need time to heal.
The alternative to affording it seems worse. And your figured are rather assumptive, ignoring critical implementation details like “UBI could be written as a tax credit” or so on. But, let’s take your numbers and scenario briefly anyways.
$4T per year is only 15% of GDP, right? 15% is the capital gains tax, and technically GDP is the measure of a country’s capital gained, so just apply the 15% capital gains tax to the country’s capital.
“But that’s a lot!” Yup.
“Is GDP growing enough?!” Not the way we treat workers today; the last time it was above 5% was, coincidentally, right when the wage/efficiency gap started widening.
“How do we make the math work then?” Good question. What figures make your approach work, given historical rates of GDP and growth pre-Reagan, post-Reagan, and in a theoretical world where pre-Reagan rates return once we stop abusing our workers?
I was just making the point that we have a lot of healing to do before we can presume to measure under UBI the contributions and growth and courage and strength of mind and will from the workers we’ve abused for forty years.
You’re making an argument that, I think (?), we can’t afford to allow 100% of our working age citizens to subsist on UBI. So tell us what figures you think would plausibly work in your own terms, so that we can see your complete viewpoint and argument. Is that $100/person/month or $1000? Are you accounting for GDP growth over ten years or not? What percentage of workers can we afford to carry on UBI for ten years? And so on.
Do the numbers work out better if you factor in an imaginary 50T reclaimed through taxation/levy/law from those who’ve accumulated it and transfer the entire sum directly into the UBI payout fund? https://news.ycombinator.com/item?id=26102709
It’s fine to try and use math to argue your point, but being sarcastically dismissive with simple algebra hasn’t given me enough to give your point consideration, as I’m still not even sure I understand it yet. I did my best and I hope the above is some use to others, but I’m not confident at all that I understood well enough to reply to you.
Even if you can pull that much money out of... somewhere... Why is paying everyone to stop working the best use of the funds? Rather than paying for infrastructure or services or, I don't know, an awesomely large tower reaching into the sky or something?
But people mostly don’t do stuff like actively edit Wikipedia.
I’m a big fan of having a robust social welfare system, but we need to acknowledge realities that maybe we don’t prefer to acknowledge. Many people on welfare are idle don’t do anything meaningful with their time. The response to that isn’t necessarily to cut welfare. It could mean taking a bigger picture look at society to see how changes have affected peoples’ abilities to have meaningful lives and civic engagement without work.
> Many people on welfare are idle don’t do anything meaningful with their time.
Do you have a citation for this claim? My understanding is that enormous numbers of welfare recipients are elderly, frail, or have chronic medical issues.
"I'm generally for social welfare programs, however the idea of "welfare queens (and kings)" is NOT fiction. I come from Belgium which has this problem quite notoriously. It is quite common for people to be abusing the social programs to stay unemployed and make more income than blue-collar workers."
I would like to learn more about the issue. Do you have any references handy?
It's important to remember that the unemployed are just one small part of all non-workers that social-welfare programs are intended to assist. In addition to the unemployed, you have children, the elderly, the disabled, students, and unpaid caretakers. In the US at least, the burden for supporting many of these non-workers falls on their individual families. Why do you think such attention is paid to "welfare queens (and kings)" whenever the welfare state is brought up, even though they are just a fraction of one group that the welfare state is intended to support? Do you think it could be precisely because there's an easy narrative that gets people viscerally worked up about unfairness?
Yeah. It's super easy to fix, if people wanted to fix it. Even with welfare, you just make it so every after tax dollar earned reduces the welfare check by 50 cents. Tada, incentive to work, and only when you're making double what welfare pays out do you stop receiving assistance.
People may still 'take advantage' of it, by choosing not to work (if we got rid of all the systems requiring proof they're trying to find a job and etc), but honestly if the promise of making more no matter what they do, or how few hours they work, doesn't motivate them, I'm really not concerned about that loss of labor in the labor pool.
How is it a super easy fix? It seems extremely unaffordable. Forget incentive to work. The US had a tax revenue of $3.5 trillion with a population of a 330 million. You shut down the entire government and spend it on UBI. That's $883 per person per month.
But it's worse than that. Wealth doesn't appear out of thin air. Money might, but money only matters insofar as what you can spend it on. If only 300 million apples are produced then no amount of moving money around will allow everyone (330m) to get an apple. You're not poor when your dollar wealth or income is low, you're poor when you can't get the stuff you need or want.
If you want to have a UBI without sending prices of everyday goods soaring then you need cheap production of those goods in quantities that will satisfy your population. The only realistic way of doing this in the modern world is automation. The cost of production for a lot of (most?) goods comes down to how much it costs all of the human labor that's combined to produce it. Eg in the case of apples somebody has to select which apple trees to grow, acquire land, invest in it, maintain them, pick the apples, sort them, find a buyer, transport them etc. All of these require some human labor and therefore have some significant cost. The more of this you can automate the lower the costs of these apples.
Whether UBI works will ultimately come down to the efficiency of production (or alternatively, shifting the poverty to another country that does the cheap production for you, but this can't last). You need to be able to satisfy the needs of the population with the labor of the part of the population that are net tax contributors.
you're arguing a tangent to GP's point, which could be rephrased as "assuming we're already willing to spend $x on welfare, we can structure the payments in a way that effective income increases monotonically as the recipients earn higher wages for work". you can fix welfare cliffs without spending any more/less money.
I don't know if the drop off of assistance can really work that well. Say UBI is 10000 fun-bucks. A person gets a crappy job that pays 5000 fun-bucks. Their total income is now 5000+(10000-5000*.5)=12500. By getting a job and working, they've only improved their situation by 2500. Any dollar they earn above the UBI is taxed at 50%, until they've "made it" to double UBI. This amounts to taxing the poor instead of the rich, and is likely to not incentivize work as much you might like.
Most proposals for UBI I've seen are truly universal, meaning that rich and poor alike are entitled to it.
Yep. UBI -is- meant to be universal, and I'd be for it.
I'm just saying, even without a UBI, the existing system could be made to work. 50% is just a number thrown out there; it can be reduced, it can be non-linear. The point is that as long as there is no cliff, no point where if you make $1 extra by working you net -lose- money, we avoid the existing issue.
As to whether there is enough utility at any given total income to warrant the extra work...that's a 'problem' we have now, and always will have. Presented with the opportunity, do I want to turn my time into money? That's entirely dependent on how much I value each of those things.
There's actually a reason I chose 50%, beyond it just being a nice round number. See, if the federal minimum wage was upped to $15 at the same time as changing welfare like this, we'd be able to institute the fall off while making the benefit of working those hours feel like the same amount of buying power as working now. Only difference is, essentially, that everyone making less than 2x welfare/etc benefits, would see a larger increase even than that.
It also breaks down when there are multiple overlapping programs, as there are now. Maybe each program drops $0.25 for every dollar earned... but if you are on four or more means-tested programs, that's completely removed the benefit.
Similar are the many programs that have cutoff at, say, 150% poverty level. Individually not a big deal, but when you lose a multitude of different benefits going from 25k to 35k income, it can be a perverse incentive.
> This amounts to taxing the poor instead of the rich
not really, when you consider who must be paying for the original 10000 fun bucks. the person in your example is still achieving an effectively negative tax rate.
> and is likely to not incentivize work as much you might like.
this much I agree with. the 50% falloff is probably much too steep.
If you get more money from welfare than from work iguess you would be eligible for more support. I would be interested in a ranking where gouvernemnt subsedies (welfare, agriculture, infrastracture, defense etc.) are abused most.
My guess is it's not welfare.
There's also cases where if you start working, you actually make less than you would by not working, due to eligibility requirements for certain programs.
Long term, not engaging in meaningful work has many downsides (substance abuse, relationship, career growth, etc) and its not just about money. But going to a grueling 9-5 to make less money for long term benefits is still a tough sell
> Long term, not engaging in meaningful work has many downsides (substance abuse, relationship, career growth, etc) and its not just about money.
Not working leads to... substance abuse? That sounds like some very puritanical " Idle hands are the devil's workshop" mentality.
What's more, what is so meaningful about being overworked, underappreciated, and paid less than a living wage? That soul crushing work is where you start to see people seeking escape and/or less-than-legal sources of income.
In fact, what you often seen is that, given enough breathing room to do so, people can achieve remarkably productive works. Linus Torvalds and J.K. Rowling are oft-cited examples of people who created magnum opuses while on benefits. Had their days been occupied working multiple minimum wage jobs, we might never have gotten Linux or Harry Potter.
It also comes from Parkinson's Law: give a full-time employee only one thing to do and it will become a full time job, even if it could be done more expeditiously.
It also comes from systems. They function to expand themselves, not to serve the purpose for which they were created.
This is also known as the Agent-Principal problem. [0]
Usually this is "solved" via "aligning incentives". [1] But as we all know from James Cameron's documentaries as he followed the Connors, it's not that easy to notice when things go awry.
I likewise know someone who intentionally makes as little money as possible in order to take advantage of state support program. Or to be more accurate, makes as much money as possible under the various limits for benefits while living in a comfortable (essentially inherited) situation.
This is a person with high education, without any major disability or impediment to working, they just choose not to work because the state allows it.
Fine. I see no problem with some small percentage of people gaming the system as long as the people who actually need help are not denied help (or forced through unreasonable hoops to get help).
Of course. These people exist. Wealthy people also seek to construct their retirement portfolio in order to minimize (or even eliminate) taxes. This is especially common and valuable now with ACA subsidies.
But so what?
The goal of a program should be effectively improving the functioning of society. That can still be a real outcome even if there are people who choose to be less productive so they can obtain benefits.
Well there's a motivation from some people to claim that people taking advantage of social programs don't exist, and the opposite as well to claim that social programs are overrun with fraud.
So what? Neither is right, generally. The political discussion about social programs needs to be about how to maximize their effectiveness, not to be about this existential struggle between two sides who both deny reality.
When I have the discussion about safety nets the topic of these types of people come up regularly where conservatives tend to say they're mooches and a drain on society and liberals tend to say they're an uncommon edge case. I think they're both arguing about the wrong thing.
I think this is the perfect outcome for the type of person who wants to live their life that way because the alternative, working somewhere, means they will be the worst coworker or employee you have ever had. They'll do just enough to not be fired and never enough to actually be worth their paycheck, walking the line and wasting resources that could be spent elsewhere. I've worked with this person and they destroy team morale and productivity without even trying, they're not bad people and I harbor no ill-will towards them, they just don't want to be there and have very few other options in our society.
While I think we must take care not to create too much of incentive for this lifestyle, I will happily pay money out of my paycheck to not have to work with those that prefer it.
I know some people, who parasite on the system, by leveraging systemic knowledge via the stock market. Never really contributed anything of value in their whole life - whole systems of parasites with parasites on top.
So remove the 'limit', and instead make state support programs reduce by a fraction of the earned amount. I.e. (as I mentioned elsewhere), if every after tax dollar earned equaled 50 cents loss in state support...there is no ceiling any longer where it doesn't make sense to earn more, while at the same time cutting state support off entirely at 2x what it pays if you don't do anything.
I'm fine with that. The amount of governmental waste trying to keep people from abusing the social services net is likely to cost far more than a small number of people taking advantage of the system.
Sounds like another symptom of a larger problem. Maybe a lack of reasonable opportunities? Or wages are too low to justify working due to child care or commuting costs? Maybe it's the insane cost of healthcare?
These people aren't living a comfortable life on meager government benefits. They subsisting on it because the alternative of working for a poverty wage is worse.
If you want more people to work, push for higher wages. If you want people to be capable of working for less money, ensure that childcare, public transportation, and healthcare are subsidized enough to make those wages livable.
They had ample opportunity to work, were technically skilled in a desirable field, and had a job in that field for some time.
There wasn't a mitigating circumstance outside of not wanting to work very much. If you have your housing set up for you, the state pays your healthcare and gives you food assistance, and you like cooking simple meals for yourself... well you don't actually need money for all that much.
It wasn't a matter of earning a poverty wage or not, it was a matter of earning a middle class wage or not. They chose not because they figured out how to do so and live the life they wanted.
There were social media posts boasting about this.
Did they do the early retirement thing? Like pay off their house ASAP while dumping their salary into 401k and Roth?
I ask because my family member tries something similar, but it only really works because I pay for their housing. It just doesn't seem possible to live on $350/mo otherwise.
I'm not sure what they could do to prove it, given that this is a pseudonymous forum and also that they probably aren't interested in revealing too much about their contact.
> A lot of this comes from the Reagan-era idea of "welfare queens"
Indeed. I also suspect "wrong people" is a slightly quieter dog whistle/code word for you know, "those people".
I also wonder how the welfare cheater statictic compares to the disability cheater statistic. I'd even wager disability is far more abused than welfare by ablebodied workers who make good money and have homes.
Now imagine if we used the same "wrong person" argument against disability and watch the same people who would vote against welfare vote in favor of disability because they might be affected.
I don’t know about welfare queens, but there are a massive number of older, white men blue collar workers who pretty much live off of disability for their “bad backs”
Our welfare system is entirely rife with abuse. the tricks to avoid healthcare costs are exploited by foreigners and Americans alike, people who shift assets to enroll in medicaid or come here to retire with free health care are entirely abusing the system.
prioritization in vaccination at the cost of incredible inneficiency is celebrated by the media and our political class. I'm not so upset about the cost as much as the delays it causes to herd immunity. which is presumably what this vaccination program is all about.
This is the reason I'm in favor of things like Romney's Family Security Act, which replaces application-based programs with just writing people a check, perhaps based on tax information they have to file once a year anyway.
My sister in law applied for need-based financial aid at a flagship state school. It was so complicated that my wife and I (both corporate attorneys) had to jump on a Zoom call with her and the financial aid office to help sort things out. I can't imagine having to go through all those hoops for housing, etc.
This is a critically pressing problem with Medicaid. The majority of uninsured people in the country are eligible for free insurance under Medicaid, an ACA Bronze plan, or at least subsidies under the ACA: https://www.kff.org/policy-watch/millions-of-uninsured-ameri.... Everyone who files a tax return showing income under the threshold should be automatically registered in Medicaid.
Fraud does happen. But it doesn't happen enough for it to be worth setting up an entire bureaucracy to prevent it. Especially if that bureaucracy undermines the value of the program for everyone who's faithfully making use of the services in the intended manner.
More and more, it seems that keeping social welfare programs inefficient is benefiting the people who want to remove them entirely (in favor of lowering taxes).
> But it doesn't happen enough for it to be worth setting up an entire bureaucracy to prevent it
But perhaps it would happen vastly more if that bureaucracy wasn't trying to prevent? I don't know, but I suspect there are an awful lot of people who would commit fraud if they thought they'd get away with it.
Do your verification at the application stage, don't attach income requirements, re-evaluate (gently) with yearly reviews of W-2 income. Don't punish people for successfully getting themselves further towards exiting their troubled situation.
Accept that some people getting help will need it less than others.
There's "fraud" and then there's homeless people trying to get their lives on track. People who need help and support. Saddling them with complex frequent requirements and then calling failing to meet them "fraud" is not helping people.
Be interested in helping people instead of helping only the "right" people.
I think there are alternatives. The question becomes: is the fraud detection cost higher than the potential fraud? and even if it is, is it significantly so? I don't think the current system has no fraud in it either.
It may seem pointless, but it may be administratively simpler. Similar to how people with government jobs still pay taxes, even though their paychecks come from the government in the first place.
People with fed jobs are not so simple. Are they married, does the partner work outside the fed gov., do they have a second job, etc. But I suppose in principle you could pay them net and make adjustments at tax time. It’s okay by me.
>Negative taxes are better. No need to give to the wealthy in the first place to come back and tax them later.
It's simpler just to give every citizen the same amount of money than to have to deal with all the edge cases of people having different income this year (and needing the money immediately) versus last year. If you get hit by a bus on January 1st, I'd hope that the money was available for you right away, not in another year.
Additionally, I'd like to see a "rolling average" approach to taxation. I think it's enormously unfair that someone who has a one time event (like making a million dollar commission on a sale they worked on for five years) is taxed massively more, and misses out on many more tax credits, than someone who makes $200K a year for five years.
Billions in unemployment fraud last year means billions in government services that will not b we going to help people that really desperately need help.
But I wonder about the value in the end. If we spend X to prevent Y dollars in fraud, then Y - X can go to people who need it more. As long as Y > X, that's good for the deserving beneficiaries.
However, from a society-level view, how much value do we get from the X spent in prevention? We're funneling money to a specific goal, so some verification is needed. But the more we verify, the more man-hours we spend on filling out and checking the paperwork. None of that work benefits society. Those people could've been doing other jobs that perform useful services. And it's not like the money going to fraudsters vanishes. At least it goes back into the economy. We should require only enough to make sure we achieve the program's goals within budget.
Figuring that out is the hard part. Hopefully smart minds have been tackling this.
Actually no, at least 40 billion went to a Nigerian scammer group. That’s a national security issue and overrides concerns about charity and equity. It’s an existential threat.
The fraud is entirely due to the structural problems (like hard cut offs) of these programs.
(I mean entirely, because if there are people living comfortably on the program without no motivation to do anything else in their life, then a) maybe that's okay, b) maybe that's a mental health issue [and fixing it might cost a lot more], c) at some point the fraud becomes so encompassing, that it's not the program's fault, but it's someone literally robbing taxpayers via whatever means they can. Furthermore any social program that only addresses and takes into account some narrow slice of people's life problems will be easily gameable, so let's have comprehensive integrated programs. Yes, they are hard, but it's not like putting people on the moon is that much easier.)
This is the root of a lot of problems. We spend far too much energy making sure "bad people" get what they "deserve" and don't get what they "don't deserve", and put in too little of that same energy in the case of "all people".
I'm not sure what you mean - I'm using quotes because of the dubious definition of justice in the context of shared welfare, but obviously there are plenty of scenarios where more direct consequences for being more directly "bad", for various definitions, makes sense, or is at least unavoidable in a human society.
This is a huge part of why, perhaps surprisingly, libertarian think tanks in the US have started pushing for universal basic income. The sheer weight of the bureaucracy that has accumulated due to this way of thinking means that replacing it with a straight-up program of unflinching wealth redistribution would actually make the government smaller.
And also make markets freer. The amount of rent-seeking behavior around programs like WIC is just staggering. And it serves the interests of neither WIC recipients nor the general public; it's only there because pearl-clutching is easy to co-opt for financial gain.
this is an ideological argument devoid of meaningful goals to help residents and create a strong economy.
who cares, on the face of it, what size the government is? size is not the goal, it's at best a poor proxy metric for (in-)efficiency, which itself is a proxy metric for how much we help people via public goods (and thereby the whole economy).
rent-seeking around wic is a rounding error next to property & capital rent-seeking overall. moreover, the right place to place blame (and seek redress) is with the rent-seekers themselves, not the assistance recipients (or the associated governmental programs) being exploited by them.
I'm not sure I see why killing the engine that fuels the rent-seeking gravy train, and, in the process of doing so, taking a huge monkey off the backs of people who are receiving assistance, would somehow misplace blame on those same people. It's simply suggesting that perhaps we should address a cause of the problem rather than only focusing on its symptoms. And the way in which the market gets freer, in this case, is by taking away unnecessary and paternalistic restrictions that WIC imposes on where recipients shop and what they're allowed to buy.
Perhaps framing things in classical liberal terms feels like de-centering assistance recipients. I get that, but I'm not sure that's actually a bad thing, in this case. I can't imagine your average WIC participant actually wants to live under a microscope, regardless of the political leanings of the person who's looking through it.
you're mistakenly associating assistance programs with rent-seeking, and moreover focusing on an entirely irrelevant corner of it. rent-seeking will occur anywhere there is wealth to be extracted, which is basically everywhere else in the economy, so that association is unwarranted. you should be looking at where capital is concentrated and deployed if you're truly concerned about rent-seeking over "big government".
It's not that assistance programs are rent seeking. It's that the assistance programs, as they're structured, are a honey pot for rent seeking. A program that micro-manages what people can put on their table at home invites lobbying to influence those rules for one's own financial gain.
It's an example of how pearl-clutching attitudes - in this case, fears, based on deeply entrenched moralistic notions about less-wealthy people's ability to make decisions for themselves, that people might buy the wrong food - are easy to co-opt for mercenary purposes, to basically nobody's benefit.
And it's also looking at the finger rather than where it's pointing. I could just as easily have picked on health care, for example, or housing assistance programs. But I'm not trying to write a book, here.
I think the more interesting phenomenon here is that seeing the negative consequences of a largely fiscally conservative cause is bringing fiscal conservative thought leaders to the point of putting their support behind a traditionally socialist cause.
If so, then I guess we're arguing over a straw man? Because that argument would be a great response to a suggestion that we just end welfare, but it doesn't really make much sense as a response to a comment about the idea of massively expanding it by replacing it with universal basic income.
ubi would not change the dynamics. the same trivial rent-seeking would happen, but it’s still irrelevant if what you really care about is rent-seeking as economic drag/inefficiency, not ideological concerns.
UBI gives people control over their own money. Food stamps for example gives poor people a disproportionally large food budget which studies has shown makes them fat. People who are equally poor but aren't on food stamps are healthier than those who get it, even though their purchasing power increased.
So only reason to give them food stamps instead of just giving them money is to feed money into grocery stores and to create government bureaucracy jobs. If you scrapped the entire program and just gave people money poor people would be healthier, the government would be leaner and the poorer would have more money to spend on stuff they need.
but again, your concern then is efficiency, so let's look at efficiency metrics directly rather than the poor proxy that size is. that also neatly sidesteps the manipulative use of "big government" as a tool by politicians to deploy power against the common interest.
You make a valid point when considering the total size of governments at all levels. However, I think what people most want to avoid is specifically an excessively large government at the federal and (to a much lesser degree) state levels. This is a worthy goal. This is not unrelated to efficiency: the legendary inefficiency of the federal government is correlated with its bloat and unaccountability, problems which are much easier to address at the state and local levels (and you can move away from the failures).
power will always try to overflow its limits, no matter the size. the fed has a fairly limited mandate via the constitution, but federal politicians of all stripes are constantly grubbing for power, which is where the inefficiencies largely come from. the answer is not to focus on size, but how and why it's overflowing via power grabs. focusing on size leads to the wrong conclusions and the wrong responses. that's the point.
Our education in the US is in the same position. We spend far more time, energy and money on problematic students who don't give a rip than we do on dedicated/motivated students.
The goal posts aren't there. If a certain number of students fail it creates red flags for the district and if those students are a certain minority that can viewed as evidence of institutional racism and open up legal liabilities as such the districts are highly motivated to pass everyone along but to not to make the good and willing better.
Chance are, the dedicated/motivated students likely have a far more supportive environment than the kids on the bottom. Increasing resources and support to the top kids will surely increase inequality, while also improving the top's capabilities.
Meanwhile, the kids at the bottom get left behind.
In US "gifted" education, we take top performers and throw them into more rigorous study without any real decent support, at least in public schools. I was in the gifted program and I assure you we have no more support, at home, or at school -- you were just expected to do more. Both of my parents worked and relied on the school's aftercare program to support me. It did not do wonders for a 10-12 year old.
I turned out relatively fine but I would rank my time in the "gifted" program as an active harm to that from what I remember.
its important to say that the vast majority of kids at the bottom get left behind because of the parents. Parents that aren't involved, don't review homework, don't instill good study habits, set their kids up for failure. There are plenty of reasons why parents don't get involved. Those reasons range from working too much, to they don't give a shit.
And parents that work odd hours, multiple jobs, have insecure income streams, and whose parents also suffered the same so they also don’t have the necessary knowledge and network for success.
This exactly, as I stated elsewhere I was in the gifted program but because my parents were unable to be involved more thoroughly from both working whether I was in that program or not doesn't really compare to the lack of parental support in terms of how it all worked out for me.
All I am pointing out that gifted kids likely have supportive environment that nurtured their growth, even if it's just parents that can throw money at problems. What happens if you throw societal support at them? They will likely do even better.
They will be better educated, have more economic opportunities, more financial support from society, and be more well connected.
Meritocratic programs exacerbate inequality and grow the divide between the kids at the top and those at the bottom.
Maybe we shouldn't stop doing them, but we need to think about supporting the bottom, such as free lunch, without exception.
Based on my experiences, many "bottom parents" don't want support, or they've delegated the job of "education" to teachers. Getting parents to care matters.
Free lunch doesn't do that. full bellies learn better, but if mom/dad have a "who cares" attitude, that is very likely to flow down to kids.
I also acknowledge the challenge of getting people to care. Its no easy feat.
Isn't the parent stating too many people are doing exactly what you're proposing, which is protesting that services are being provided to people who don't deserve it?
(Separating children into deserving and undeserving categories of educational attention seems that way to me...)
Not separating into inherently deserving and undeserving, but those who desire a good education and those who do not. There are students in poor schools who push to become learned in spite of obstacles. Think Ben Carson for an example. And there are those who have tons of resources and opportunities but fail to use them, those who don't care about learning something. I knew quite a few of the former, people who would go to the library for extra study or to learn things after school. And I knew quite a few of the latter, who would go home and play video games or go out and drink, who didn't care about learning anything.
In today's school system, the resources go to those who do not desire an education. This is because of programs like "no child left behind", and because a higher graduation rate looks better. But I think we should make a normative judgement that those who do not make an effort to better themselves should receive no support from society. Put less money into summer schools for kids who fail, and put more money into before- and after-school tutoring. This will benefit those who put in the effort to the detriment of those who don't care, which is a good trade-off.
And this is how we get a permanent underclass. I don't disagree with the overall thought that we should spend effort on people who appreciate and care for that effort to be spent. I just think that in practice, the effects would be disastrous.
Yea, pay now (education) or pay later (prison / public assistance). You can't just say, well this person doesn't care or is hopeless so not my problem!
My argument is that all children inherently want to learn. All children desire a good education, defined as being in a supportive environment where their curiosities can be wholly quenched and allowed to thrive. There's no child that's born not giving a flying fuck about anything, only children who don't have that curiosity beaten out of them by the world. Labeling literally children as irredeemable only adds to their beating.
Why can't we have summer schools and before/after-school tutoring?
This is why I generally support universal basic income if it could replace the US safety net. Currently we spend more than it would take to eliminate poverty if we just gave it away. But the beauracratic machine just destroys so much wealth.
Do you have numbers? How much do we spend eliminating poverty? And how much would we spend on universal income? Assuming 200 million adults get universal income, that would cost $1 trillion per $5,000 of income. But $5000 hardly gets you out of poverty.
Normally Universal basic income plans are combined with abolition of most other welfare, and changes to taxes so that people on all but the lowest incomes end up paying the money back as tax. So maybe flatten all tax rates below 24%, everyone earning more than $80000 is now paying an extra $6000, but you give that back to them as the UBI. Everyone earning less than $80000 pays more tax than before but still gets $6000 UBI, so is better off.
I suppose the question is does it mean people don't flock them to em super expensive overcrowded cities if they get UBI. I don't have an answer to it personally.
the beauracratic machine just destroys so much wealth
In theory I sympathize with the sentiment, but 1) the dole is not wealth 2) the administration costs of the dole don't make money disappear, its just routed into income for the admin workers, 3) the administration costs of the dole do not necessarily decrease with UBI and might increase given a larger population to administer.
I generally do not support UBI since the key problem isn't cash in people's pockets, it is lack of engagement with society in ways that add value. UBI papers over the core problem.
A lot of people treat the government as authority to rank people, beliefs, etc. in importance. A lot of people, in fact, want the government to do this.
It's not just selfishness, I think we've run into something fundamentally unintuitive for people's lower brain. For much of human history, shutting out cheats & freeloaders was an important part of making good use of a resource. These days, we have hit a point where the bureaucratic overhead of shutting them out can become more expensive than just letting them in. That's not intuitive for people.
The problem with this take is that it’s more useful than just to preserve a resource. By allowing people to get away with fraud you are encouraging people to do it again, including ways that transcend whatever system that fraud was originally within. I don’t actually know that chasing pranksters has ever been an efficient use of time, but someone should chase them if we expect the boundaries of normal operation to be known as a society.
Right, the $36B lost to unemployment fraud (10% of payments) in the past 12 months definitely illustrates that some amount of guardrails are still appropriate. There is an optimum level somewhere in between where the sum total of losses & overhead together are minimized.
That $36B is a drop in the bucket on the scale of a country. It's 25% of Jeff Bezos's net worth. How many $B spent on enforcement is it worth to reduce that to, say, $30B?
If you read the news about it, the scams were depressingly basic & the screening failures were rudimentary. It will not cost billions of dollars to rein that number in dramatically.
I agree that it's career criminals, many of whom are even overseas. The problem is that these agencies have to be able to distinguish legitimate vs. fraudulent claims, and sometimes the processes they come up for doing this could be described as "jumping through hoops."
How does that compare to other years, both in total amount of fraud and in what percent of total paid out was for fraudulent claims?
If the system is fine except in situations like a once a century global pandemic that throws way more people out of work than normally happens even in most recessions and throws them out of work for longer than is normal where it jumps to a fraud rate of 30% or so (and presumably returns to normal when the pandemic is over), I'm OK with that.
I see it more as a power play by the regulating agencies to maintain control. NY Governor Cuomo for instance threatened severe penalties for anyone stepping out of line.
If the "undeserving" argument were true, there wouldn't be talk about increasing eligibility to the prison population, especially given their low mortality rates compared to 65+
I think in Israel if there is any vaccines left over from that day because people didn’t attend their appointment anyone can show up and get it. Our obsession with fairness is ridiculous.
There is a comment exactly about this in the article:
> Last week a local vaccine site had extra doses nearing the end of the day and word spread. Ultimately, they put them in the arms of whoever could get there in time.
> I personally know two unrelated people who raced there and got vaccinated, despite not meeting the criteria mentioned in the article. The only criteria that mattered in this instance were being present and being willing.
> This was also in Houston and at an “official” site. I attempted to get similarly lucky at the same site the next day by visiting at closing time. The worker that turned me away told me that because of complaints from those who missed out the day before, they were told to no longer accept walk-ins. I’m content to wait my turn, but that experience combined with this persecution story...I have to wonder how many doses are going to waste in my community.
the real problem is that two core issues exist in opposition: 1) what is the most cost efficient way to solve the problem 2) how people feel about the chosen solution
solving 1 does not automatically solve 2. the slider between anarchocapitalism and state-owned and -operated socialism belongs somewhere in the middle and everyone wants to tug it into a different spot.
if theres anything the internet + social media is teaching us, its that the public has a very, very bad habit of watching one 15 second video of anecdata and vigorously extrapolating, thinking they have arrived at actual data.
all it would take is a couple tweets about some homeless asshole partying in his free government house with his foodstamp money to upset 2 and overthrow 1, even if it was the best solution on the spreadsheet.
There is no slider between state socialism and anarchocapitalism. Economically, there are quite a few more axes. It's possible to have full socialism without anymore state ownership than today, and it's possible to have capitalism with a lot of state ownership, and it's also possible to have cybernetics-market chimera to organize the economy.
This is just Kafkaesque. People in a position of authority with blind adherence to rules intended for optimal scenarios. They're literally saying he should have just thrown them away instead of distributing them as best he was able. This whole thing is a logistical clusterfuck and they're trying to throw this dude under the bus. It's obscene.
The really telling part to me is that (seemingly) no one from any of the organizations involved (the hospital and the prosecutors office) will come forward and outright say that what was done was immoral. They are all hiding behind a veneer of "what he did broke the rules and my job is to enforce them", which is about the weakest argument one can make in defense this sort of thing.
The DA who brought the case, Kim Ogg, is an elected official. Top Google result for her name is this campaign page: https://www.kim-ogg.com/. Further down the list is a news article about threatening employees with performance reviews to appear at a food drive for her political benefit.
Had the judge not thrown out this case, she'd have another feather in her cap, another headline for the website: "Kim Ogg puts nepotistic, racist, embezzling doctor behind bars!" Doesn't need to be honest, just needs to sound good.
I am a Houstonian and absolutely hate Ogg. She bills herself as the "most progressive DA" and therefore prosecutes/does not prosecute certain things based on their political appearance. That is not what a DA should be doing, and she is the embodiment of all that is wrong with the "progressive" left these days.
Why is this anti-progressive? It sounds like he's being prosecuted because he gave vaccines to lighter-skinned people. Kim Ogg wouldn't be prosecuting him if he'd given them all to dark-skinned Black people.
The official statements of the medical associations in the article state: “It is difficult to understand any justification for charging any well-intentioned physician in this situation with a criminal offense.” As there is clearly no legal justification, the only justification in sight is progressive identity politics attacking a "white-adjacent" physician.
Could you explain a bit for those not familiar with US "progressive" stuff? What does she not prosecute and why, and why is that a problem? How left are we talking about?
Probably in this case OP is referring to identity politics and intersectionalism.
Basically, the more categories of historically marginalized people groups an individual belongs to, the more acceptable that person is, the more of a voice they’re allowed to have, and the more laudable it is to favor that person (and the more unacceptable it is to fail to favor that person regardless of the circumstances).
This doctor apparently “failed” to favor the right people. The progressive calculus around the case is all about “who”, and it intentionally excludes what, when, where, why, or how.
this is a straw man. where in the article / materials related to the case is race brought in to question? are we treating Indian-Americans as a majority group now? that's nonsense. You paint a picture of the "progressive calculus" that's quite obviously not informed by any actual exposure to it. I can only imagine the image you've adopted was gathered from outsider perspectives on what the word progressive means.
I never mentioned “race”, and neither did the DA in her court filings, as far as I know.
The problem she had with his decision was that he was “favoring” certain people in an unfair and illegal way — a conclusion that could only be reached by disregarding every question about the incident except “who”. That approach finds its origin in modern progressivism, where the only truth that matters is “who”.
Covering your ass isn’t a weak defense for the underlings. There exists a leader(s) somewhere that made the rules and that can change the rules. They are the only ones responsible, and I don’t see why anyone else should stick their neck out and risk their income for it.
It’s actually a strategy for leaders to want the underlings to stick their neck out, so that they can be sacrificed as a scapegoat when convenient.
(in these bureaurocratic situations, obviously I’m not talking about a leader asking people to murder others and them not being responsible for that).
I don't know that that's a useful question in this context. Bureaucracies function in intensely amoral ways. Even ones with a moral mission. You can embarrass the leadership with moral judgments, and that will steer things for at least as long as public scrutiny maintains its attention span. Internally, though, the rules look more like game theory, and the bureaucracy will naturally tend to reject anyone who doesn't want to play the game.
With the prosecutor. In a government, it starts with the politician. I don’t know why the article doesn’t state who is responsible for the rule making, but I’m always an advocate for more transparency.
> what's difference that makes 'just following orders' suddenly not apply?
I don’t know, but this situation isn’t it in my opinion. It can be fixed with a flick of a pen (or email) by a higher up.
>People in a position of authority with blind adherence to rules intended for optimal scenarios.
Most of them aren't blind. They know full well they're missing the forest for the trees but they follow through anyway in order to cover their butts and they justify it with "policy is policy" and "I've only got three years until my pension kicks up to the X% bracket".
In Germany a tax office once got the great idea to collect taxes on food donations based on the cost of ingredients. As far as the law was concerned this was the correct way to handle a food donation, most tax offices just didn't consider it. The issue got resolved, but for some time any business that wanted to be on the safe side had to "sell" its donation for the symbolic price of one Mark. Early on this also resulted in businesses throwing away food instead of donating it.
Only as a side effect of existing taxes. When you buy food and then donate it you pay consumer centered taxes at the point of sale. When a company gives away food for free there was apparently a regulation that applied the taxes on the ingredients instead and in this case the tax office decided that this also applied to donations.
I think the problem is that there are incentives to just keep finding 10 vaccines about to expire.
I think the issue here is that the organization was stupid and unable to use them. And while the doctor’s motives seem virtuous, his wife got a vaccine ahead of schedule.
I think we have to improve efficiency, but not also set up a system where friends and family of doctors get preferential treatment because of proximity.
This whole issue is solved by better inventory management where about to expire doses are used first, not poorly managed so that a healthcare worker has to try to handle logistics directly.
I think the whole case would have been different if he didn’t personally benefit through his decisions by giving a dose to his wife.
I agree with you that that's the part that made it "look bad," but it sounds as if he truly did everything he could to give it to other people first, gave it to her only as a very last resort with minutes to go, and she was eligible anyway.
If he wanted to cover-his-ass, he shouldn't have given it to her. If he wanted to actually do the right thing, he was doing the right thing.
It seems like the guy was unlucky. But corruption is a really bad thing and I lean on the side of anti-corruption any day of the week.
It’s very convenient that there was only one dose left for his sick wife. The wife was right to question whether it was right, but more importantly was that they should have considered the perception of the situation.
If something will have the look of corruption, but will result in waste, go for the waste, every time.
It would be easy to imagine a cooked up scheme whereby two vials were opened, instead of using an entire one resulting in a surplus of 10 doses with 6 hours expiry overnight which would mean “I had to give them to my family”.
So imagine if this is left to slide, there is the potential for huge numbers of vaccines to be given to family and friends. The desirability of the vaccine and the deadliness of the virus could also encourage bribes to propagate such schemes.
The whole thing has a very bad look and to trust the people in charge of the program would require a full investigation in order to clear the situation of corruption. Of the officials don’t act, they are at risk of being complicit.
The potential reputations damage from his action is much greater than he realized.
Copy paste this to other scenarios and I think you will find the excuse of “otherwise it would go to waste” a massive vector for all sorts of corruption at every level. How hard does someone try to find someone in need of something will go to waste? How will we ever know? It’s the slippery slope of corruption that poison societies.
Corruption is the deadliest thing in human existence.
Corruption is everywhere and unavoidable. Not that you shouldn't try to fight it but you should not be overzealous. For example this guy, he immigrated to the us. Impossible without money right? Except Pakistan has none so likely a family member helped him at some point. Corruption. He should have been denied a visum if we are being strict. Corruption can be prosecuted in specific cases when there is ample proof. In this case all there is is idle speculation. I don't know what a world without corruption would look like. As an extreme example I would not be able to buy flowers for my girlfriend anymore because doing so is a personal favour.
It makes sense when you think about it. Without the rules, there's excuse to -not- find the people the vaccine is meant for and use it yourself.
Anyone who thinks that this would not happen doesn't know human nature very well. They are welcome to post situations where such excuses haven't been taken advantage of. I'll take lack of replies as acceptance of my point.
He did attempt to find the 'people the vaccine is meant for'. He just wasn't able to find enough on a tight timeline.
In my opinion that makes this, at least in part, a fault of those above him. There should be a standby list with a clear expectancy of urgency. If you get a call at 2am, you either show up or get passed by. Fill it with all the front-line workers in the county or something like that first, then start pulling in the public.
There should be _no_ shortage of people willing to take this, we're just spending so much time worrying about who gets it and not enough time worrying about ensuring that every last dose is effectively used and not wasted.
Edit: Also, I only replied so you would realize that you don't have implicit agreement.
If there were a list of "people the vaccine is meant for", I'd tend to agree with your point. As it happened there was no such list, and his attempts to find front-line workers to give the vaccine to failed. He was unable to find "people the vaccine is meant for", so I'm willing to give him some leeway there.
People who don't give a hoot about the rules are more prone to be spreaders anyway. After medical staff, we have the prioritization of who should get vaccinated completely inverted.
I think the logic is reasonable but the response is too strong.
A doctor driving around vaccinating whoever he can find at their house is clearly not how you want to distribute the vaccine in early December, it's not going to get to the most at risk people as soon as it can and any issues that arise are a huge liability problem unless he can fix it with what's in his car.
At the same time not having any plan or procedure of how to use the remaining vaccines or how to decide if the last batch should be opened is only going to create bad scenarios so you can't blame the person following the instructions for having a bad outcome if that's all you gave.
What's really messed up about this (and probably why the response had to be overly strong) is it was made into a news story about how he maliciously took the vaccines for his own use when really it's a story about how the vaccine rollout procedure wasn't good enough and left him in a shitty situation.
> A doctor driving around vaccinating whoever he can find at their house is clearly not how you want to distribute the vaccine in early December, it's not going to get to the most at risk people as soon as it can and any issues that arise are a huge liability problem unless he can fix it with what's in his car.
No, but it is absolutely what I would want any doctor to do if the alternative was throwing away COVID vaccine doses.
Like, I literally think this should be the standard policy. Do absolutely everything within your power to never waste a dose, ever. If that means getting in your car and driving around town, you need to go do that, no question.
Not wasting a dose doesn't necessarily imply driving around and sticking the first person that says yes at the spot they happen to be though. e.g. standard policy could be to not open the next batch of 10 until certain conditions are met, call people on tomorrows list until you get 9 that can show up in the next 6 hours, or any other planned action. These are superior options because:
1) everything still happens in a controlled setting
2) fair distribution is still ensured
3) you're not making unrealistic demands of a person who has to give out doses every night to then drive around town without a plan
Obviously none of these are the fault of the guy taking the fall though, it's process work that needed to be done by the people that fired him and charged him. That's why the response is a bit strong, he wasn't the one that created the problem and he seemed to try to talk to anyone he could reach about a better solution. At the same time that doesn't mean this was a good outcome or what should happen.
I.e. if 9 doses have to go to waste to safely improve the distribution process as a whole it's probably better than telling doctors to independently try to take it on the road unplanned.
I don't necessarily disagree with any of that, but I think it's a delicate balance.
If two people cancel one morning because, I don't know, a storm knocked down a bunch of trees in their area, and you've tried your future appointments list, do you now have to phone the other six patients and ask them to reschedule too? Or do you have a nurse go out and find two people off the street who want a COVID vaccine, and bring them to the office asap? Remember that the vaccines have a limited shelf-life even in the freezer, and that the ultimate goal is to get shots into arms as quickly as possible.
You can optimize for speed, or you can optimize for equity. I don't think we should throw out equity, but we should lean towards speed.
Vaccine appointments are booked weeks out (I waited about 3 weeks after scheduling mine and I scheduled to get it the first available day at a 7 am appointment that was left open), someone further down on the list will answer and be available that afternoon. If for some reason this realization happens after the last person walks in the door for the night and you just opened a fresh case at least do it at a proper location not throw it in your car and go to random houses (I assume he waited the 15 minutes after and had an epipen and such with him, if not that's another story in itself)
> it's a story about how the vaccine rollout procedure wasn't good enough and left him in a shitty situation.
Nothing done at this scale and speed is going to be perfect. There's always going to be problems.
I wish that people like the administrator who fired him and the prosecutor who charged him would have used better judgement. This logic is not "reasonable" given how extreme the outcome is.
It takes a lot of steadfast effort to go after someone like that knowing that it's going to be a PR nightmare (except perhaps on HN, where people will argue that it was "logical"). This story seems completely insane to me.
> A doctor driving around vaccinating whoever he can find at their house is clearly not how you want to distribute the vaccine in early December, it's not going to get to the most at risk people as soon as it can and any issues that arise are a huge liability problem unless he can fix it with what's in his car.
This is entirely reasonable, but it comes down to - what to do when faced with this situation? True, it's not going to get to the most at risk people, but what's the alternative?
Presumably the fact that you're not allowed to drive around an give away the remaining doses like this is calculated to make doctors be more careful about when the open batches.
After all, vaccination is not an emergency treatment, so it should be easy to avoid the situation in the article.
If the rules were changed to allow for this, you can easily imagine that some less ethical doctors would decide to break seals just before closing the clinic, and then vaccinating their family and friends because "it would be a shame to waste it".
> They're literally saying he should have just thrown them away instead of distributing them as best he was able.
I wouldn't necessarily object to that particular policy. It's a shame to waste perfectly good medicine in a pandemic, but would we feel the same if he had not found anybody vulnerable who was available, and instead ended up vaccinating his own children, who are fit and healthy? What if, instead, he taken the vaccine vial to Beverly Hills and called up the rich and famous to try and find someone who wanted to be vaccinated?
I think the prosecution in this case is wrong; and the authorities should have prepared well in advance to make use of spare vaccines in a fair way. But the motivation for the prosecution is understandable - a distribution policy exists to protect the equity of society, and bureaucracy is meant to be a guarantee of that equity.
So your problem is that it’s not fair how he distributed it? You’d rather see life saving medicine trashed rather than go into a human being’s arm? How can you defend that position? It’s so unethical.
>So your problem is that it’s not fair how he distributed it?
No, the point I'm making is that his actions were outside of the system we use as a society to ensure fairness. He could still have distributed the vaccine fairly - but he also could have done it unfairly. The concern comes from the lack of due process.
>You’d rather see life saving medicine trashed rather than go into a human being’s arm? How can you defend that position?
This is a strawman, so thankfully I don't have to defend it.
Ultimately, the point is more this one: if you view this with a utilitarian mindset, then you may feel that the ends justified the doctor's means. But the rule of law is deontological, not utilitarian - both because it simplifies decision-making in the justice system, and because it protects people from utilitarian injustice. And from that perspective, the doctor acted unjustly in bypassing policy, even if the outcome was good - and that's what the prosecutor is concerned with.
The article says that he reports following the policy as he understood it. He also reports that he was later told he should have disposed of the vaccine or returned it, rather than caring about wastage.
The county prosecutor maintains that policy directed him to act differently, since that is the basis of her case against him. So, from the prosecutor's perspective, he bypassed policy. Since I'm making a point about the prosecutor's motivations, it's charitable to see this from the view of the prosecutor.
A policy that was not written down anywhere. There's no reason to fire someone over such an informal policy that contradicts an explicit guideline. At best, this should have warranted a warning and the introduction of a clearer policy.
But in this case, the policy would still be wrong if it encouraged wasting vaccine that could have been used to save lives.
It's frankly bizarre to see people value bureaucracy over lives.
The case has been thrown out, which gives you a sense of how ridiculous the prosecutors position was. Quoting the Harris County judge who threw it out,
> In the number of words usually taken to describe an allegation of retail shoplifting, the State attempts, for the first time, to criminalize a doctor’s documented administration of vaccine doses during a public health emergency,” Bynum wrote in his order, adding the prosecutor’s affidavit was “riddled with sloppiness and errors.”
He did attempt to find the people who should have received it. He just wasn't able to find enough on a tight timeline.
Honestly? As long as he made a good faith effort to distribute the doses he had available, then hell yeah I endorse him vaccinating any warm body available to him, whether it's his family or not.
Now if he took money in exchange? That should be a criminal offense and he should loose his medical license. But if he walked into a grocery store with an hour left and a rich person just happened to get the shot, so be it, as long as no favor was exchanged.
In my opinion this whole mess is, at least in part, a fault of those above him. There should be a standby list with a clear expectancy of urgency. If you get a call at 2am, you either show up or get passed by. Fill it with all the front-line workers in the county or something like that first, then start pulling in the public.
There should be _no_ shortage of people willing to take this, we're just spending so much time worrying about who gets it and not enough time worrying about ensuring that every last dose is effectively used and not wasted.
The current distribution policy does not exist for the equity of society, it puts the most at-risk first. That makes sense, but it shouldn't be the point at which we draw the line. For herd immunity to take effect, 70%+ of the population must be resistant, so a few people getting the vaccine out of order shouldn't cause this much of an outrage when done without malice.
> As long as he made a good faith effort to distribute the doses he had available, then hell yeah I endorse him vaccinating any warm body available to him, whether it's his family or not
I agree, but I think if I were in the position of having an extra dose that needed a warm body I'd try to find someone outside my family to avoid even the appearance of a conflict of interest.
Oh, I agree. But if it comes down to dropping it in the trash or giving it to his family? In that case, I vote administering the vaccine.
At no point should this vaccine be wasted, people have literally given their lives to save others during this pandemic. Throwing away doses because it looks improper is an insult and a disservice to those who have paid the ultimate sacrifice in the service of others.
It's not a popular opinion, but I think anyone who's administering the vaccine should have their immediate family added to the standby list anyways, if not placed in the current phase.
Eliminate the temptation for these people to want to go outside the normal channels to protect your family, and you eliminate the risk of impropriety.
That's not to say it shouldn't be rationed and planned so the high-risk populous suffers though. It's ultimately a contentious line we have to walk, since supply is limited and demand is high, though not as geospatially dense as we'd like in all cases. It makes efficient delivery to those in rural or less well served areas much harder, which brings about intended and unintended inequalities to the front.
> It's a shame to waste perfectly good medicine in a pandemic, but would we feel the same if he had not found anybody vulnerable who was available, and instead ended up vaccinating his own children, who are fit and healthy?
If he'd made an honest attempt at offering it to vulnerable people first and couldn't find any takers, then I'd be fine with him giving it to his healthy children.
> What if, instead, he taken the vaccine vial to Beverly Hills and called up the rich and famous to try and find someone who wanted to be vaccinated?
That's worse, but I think it's unfair to offer these as the comparisons to what he actually did - offered it to first responders, healthcare workers, and finally the most vulnerable people he could find, all on his own time, money, and effort.
> * But the motivation for the prosecution is understandable - a distribution policy exists to protect the equity of society, and bureaucracy is meant to be a guarantee of that equity. *
Unfortunately, "equity" is a nebulous term here. The bureaucracy took one look at the list of names, saw a bunch of brown South Asian names and assumed this was unfair - why? Was their net worth written next to them? Could they have taken this step with a latino doctor and all the names were latino names - or with a black doctor?
> a distribution policy exists to protect the equity of society
Not really - the policy was exists in most places heavily favors the most vulnerable, not equitable racial distribution. There is some overlap between those two groups, for sure.
>I think it's unfair to offer these as the comparisons to what he actually did
They're not comparisons. They are hypotheticals, intended to explore the range of possibilities that people would allow or oppose.
If people want to argue that the doctor was right to go out and distribute the vaccine ad-hoc, I think they should consider not just the actual result, but also counterfactuals, and whether in those counterfactual cases the actions would still be "justified". By returning to the real events, you're avoiding that consideration.
>Not really - the policy was exists in most places heavily favors the most vulnerable, not equitable racial distribution.
I did not mean "equity" in terms of "equitable racial distribution". I meant "equity" in the nebulous way of "fairness".
> If people want to argue that the doctor was right to go out and distribute the vaccine ad-hoc, I think they should consider not just the actual result, but also counterfactuals, and whether in those counterfactual cases the actions would still be "justified". By returning to the real events, you're avoiding that consideration.
I agree that we must consider counterfactuals, but we can still only judge him by his actions, not hypothetical scenarios. Considering counterfactuals should help guide policy, not punishment.
> I did not mean "equity" in terms of "equitable racial distribution". I meant "equity" in the nebulous way of "fairness".
So how do we determine a particular list of recipients was "equitable" or not? While I agree with the idea that equity should mean fairness, I would offer that unfortunately in America that notion begins and ends with "equitable racial distribution".
If he could not find any suitable recipients in time, yes, he should have vaccinated his own children. Still better than throwing it away. Selling it for profit would be something totally different and should absolutely be treated as theft. But vaccinating anyone, even his own family, is better than throwing it away. Of course to prove he's not abusing his position to benefit his family, it's probably wise to document his efforts to find other suitable people. But if he can't, just use it on anyone. That's what the guideline says, after all.
The thing is, a vaccine isn't exactly a good that people want, try to get, then they have it and someone else doesn't. It's not a Furby. Every single person in the population who gets it is benefitting the others who haven't gotten it. Why would you waste it when you know giving it to literally anyone will benefit everyone?
> It's a shame to waste perfectly good medicine in a pandemic, but would we feel the same if he had not found anybody vulnerable who was available, and instead ended up vaccinating his own children, who are fit and healthy? What if, instead, he taken the vaccine vial to Beverly Hills and called up the rich and famous to try and find someone who wanted to be vaccinated?
If he can get from Texas to Beverly Hills in six hours, I'm fine with it. Every shot in an arm is a step closer to ending this thing. I'd rather it get couriered to Bill Gates than dropped in a trash can.
>They're literally saying he should have just thrown them away instead of distributing them as best he was able
I don't understand why people make arguments like this. Throwing them away and giving them to friends and family aren't the only two options. There's a whole swath of acceptable and achievable options.
Giving doses to friends and family is a pretty bright ethical line. I don't think arresting him is the right call. But there shouldn't be much dispute that he acted wrongly here.
> Throwing them away and giving them to friends and family aren't the only two options.
With a six hour window, it's unlikely he's gonna be able to invent a fair queuing system on his own, and get applicants to it. The article indicates he tried first with EMS, police, etc. at the vaccination location.
There should be state-wide efforts at this; a "we might call you at 2am to ask you if you can be to the hospital by 3am for a shot" list.
I've said this in other responses but it's worth repeating. He was the medical director of the Covid vaccination program for the county. If there was no plan for left over vaccines that's his fault.
Nobody expects him to come up with a perfectly fair queueing system on the spot. He should have done that sometime in the 6 months he had to prepare for the rollout. Even if we overlook that, using your position of public trust for personal benefit or for the benefit of your friends is a bright line you are not supposed to cross. And it is a bright line that is there for good reason and should be enforced.
> Around 6:45 at night, as the event wound down, an eligible person arrived for a shot. A nurse punctured a new vial to administer the vaccine, which activated the six-hour time limit for the 10 remaining doses.
Why would the nurse open a new vial when they know they are about to close? That is very reckless, considering that vaccination is not time critical. That person could just come back tomorrow.
I'm not sure what's the situation in Tx. especially in December, but here in NY getting an appointment is the limiting factor. Even as of today, there are no appointments available for eligible recipients till mid April. An appointment only gets you through the door, and if you can't make it you have to get a fresh appointment through the state website. The vaccination site itself cannot reschedule your appointment for the next day - it can only book a follow up for the second dose weeks later.
Source: I work at a medical school, and was told this by the doctor managing the vaccination line. He walks up and down the line, counting the number of people who showed up and opens the vials accordingly, but he's not in a position to ask anybody to come the next day. At least with Moderna, it's 10 doses per vial. Even though my employer had sufficient vaccine supply for us, our hospital was overrun with COVID cases in early January and medical staff to actually perform the vaccination was in short supply. The senior medical students were recruited to help out, and even then it would take many weeks to cover our staff. I actually got vaccinated at a different site 30 miles away, but I doubt this is an option available to most people. If you miss your appointment you're screwed.
There are plenty of folks for which getting to a vaccination site is already a hardship - having to get time off work, arranging transportation and childcare, etc. Doubling that effort unnecessarily leads to poor outcomes, too.
Giving doses to friends and family is a pretty bright ethical line. I don't think arresting him is the right call. But there shouldn't be much dispute that he acted wrongly here.
Give me a break.
The guy started work before dawn. The countdown started after 6 PM. He had 6 hours to find 10 eligible recipients that met the guidelines. Most that he found were strangers.
He gave the last dose to his wife after he had only found 9, and it was after midnight. It is easy to sit in an armchair and say that he should have found someone else. But how?
His job was to use up all the vaccine. He tried to give it to the professionals around him first (eg law enforcement and hospital workers). Then he searched out people who met the criteria for vaccination. Yes, he ended up giving the last dose to his wife, but the last dose that was about to expire, he wasn’t going to find another person in the time left, and his wife me the medical criteria.
The guy is a hero who is going above and beyond what his job requires, and not a criminal.
Is there a specific alternative option you have in mind? The article mentions that he tried vaccinating everyone in the clinic and called the county to ask; I'm legitimately unsure what else he could have done to find people.
Not sure about in TX, but in my state the list of people he actually vaccinated comes before front line workers. I'm impressed that he was able to find so many head-of-the-line people so quickly.
(Further, he made house calls to sick elderly people, which is something sorely missing from our existing vaccination strategy.)
If I saw someone in the grocery store claiming to have a covid vaccine and asking people if they want to be vaccinated I would probably call the police.
>That sounds superficially reasonable, but would you get what appears to be a vaccination from some random stranger that shows up with a syringe?
With ID, sure. Besides, he's been the medical director of the Covid response for the county since April. His job was to put procedures to handle situations like this in place.
Do you know what the ID of "the medical director of Covid response since April" looks like? I don't and neither do you or the firemen/police he would approach.
It took me 20 seconds of googling to find a picture of the medical director for my county.
But that's not really the point. The point is that part of his job was to come up with a plan for these situations. And he settled on give them to my friends and family. That's obviously a poor choice fraught with ethical issues. Like I said, arresting him is not the answer but he is not innocent.
Obviously the best alternative is to make sure to vaccinate an even multiple of 10 people before you close. So if you're about to close, just finished a vial and a single person shows up, then don't open a new vial and put yourself in the position where you have to run around and find patients.
That's how the appointments are given out, but not everybody shows up.
For my second shot, I drove out 30 miles in a snowstorm, and waited two hours in line. Other people probably waited longer. Should the last couple of people be turned away after waiting 2 hours because there aren't neat multiples of 10 at closing time? Your solution, while reasonable, optimizes vaccinate utilization but at incredible cost to an unfortunate few.
For me the main point is really to avoid moral hazard, not saving those 9 doses. It would be worth wasting a few doses here and there if it greatly decreases the level of corruption in the system.
But if people waiting for 2 hours is common, then turning away the last ones doesn’t seem like a good solution. If they really wanted to they could of course come up with an efficient, low corruption system but they don’t seem terribly organized in the first place.
> It would be worth wasting a few doses here and there if it greatly decreases the level of corruption in the system.
While reasonable in isolation, I would suggest that this view doesn't account for the extreme scarcity of the vaccine, and the stretched healthcare resources. I mean, while I work 300 feet from our hospital and our vaccine stockpiles, it was quicker to travel to the neighboring county with a lower caseload. As someone who still experienced close to 4 hours standing in line in total & driving over a 100 miles, the situation is pretty dire. Ironically, NY state has been extremely boneheaded in vaccine delivery policy. They didn't allow hospital networks any leniency is how vaccines are administered, but punished them for slow rollout. In the initial two weeks or so, NY state mandated that only COVID ward staff, emergency & delivery staff should be vaccinated. We were done with them in a couple of days, but the state wouldn't allow the rest of medical staff to be vaccinated. It was a ridiculous situation - we had thousands of medical staff waiting & ready to get vaccinated, we had the resources, and we had the vaccine - but the state would not update their policy. By the time they did in mid January, we were already facing the post Christmas & New Year related travel surge in cases and didn't have staff to spare for vaccination. According to me, hospitals/counties should have been allowed to move further down the priority list as and when they had the capacity to do so, rather than requiring the governor to allow it. Instead, we had ridiculous situations like 30% utilization of stocks.
> If they really wanted to they could of course come up with an efficient, low corruption system but they don’t seem terribly organized in the first place.
Agreed, but what's the options available to the last mile staff, like the nurse who opened the vial, or the doctor in question?
Perhaps the simplest solution would be that after they select who is to be vaccinated that day, they also select 30 or so as backup, and tell them to be ready because it _might_ be their turn so they might get a phone call that evening.
Those 30 could simply be the first 30 from the next day.
True - a lot of people think a waitlist of people might be the way to go.
Unfortunately, the way the system is setup right now, at least from my own experience in NY, is not like this. The appointment itself is treated as sacrosanct, and the time on it is meaningless - it only gets you through the door on that day. You can show up at any time. I think the vaccination starts at 7 AM. Considering how far in advance the appointments are given (months at this point) and how inconveniently many centers are located, it's a tough call for most people.
It probably would be better to have a separate wait list of opportunistic recipients, who say they can show up at an hour's notice at the end of any day. To prevent abuse, the people vaccinated through this waitlist can't exceed 10-20/day. Honestly, let these people be the family members of the healthcare workers at these sites. I have absolutely no qualms with the household of hospital workers get preferential treatment with the vaccine - they're at elevated risk as it is.
The article addresses your concerns. He was willing to give the vaccine to anyone he could get his hands on. After that, he chose people who were teetering on the edge healthwise, while only having a few hours to do so.
If he were turning away people from the vaccine site and squirreling away vaccines for friends and family that would be a bright line, but that's not what happened here at all.
Please don’t make statements like this, it is against the rules.
“Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that.”
The article says “acquaintances and strangers,” and his wife. If he was trying to prioritize family and friends you’d think he’d give it to his elderly dad right off the bat.
In Spain we had many cases of politicians and public people using this excuse to get vaccinated before the rest (even bishops used it, and not only one!).
I think it would be an easy to fix thing: Have a list of extra people available if you end up with an extra dose.
It shouldn't be that hard, we had a year for preparing for this...
Its called leading from the rear, and that is basically what I thought when Greg Abbott (Texas gov) got his, since AFAIK he isn't in any of the identified groups.
that works if you show it publicly(and then there is the debate that its bad because you jumped the queue, or its bad because not getting a vaccine shows they aren't trustworthy)
But in spain the cases that have surfaced are of mainly politicians who got the shot and tried to keep quiet about it, which think we can all agree its bad.
So, thats a loophole, just get it done with the camera's rolling?
In the US much of the vaccine resistance is a result of the news/propaganda channels a particular party (which Greg Abbot belongs to) uses to generate fear and doubt in order to win elections. So they generate the problem, then they get to help show its safe? I mean they aren't going to convince any of the hardcore conspiracy theory people they weren't just injected with saline.
Plus, many of the politicians assume they are more valuable than the political system which is designed to replace them every couple years says they are. Particularly in TX where the governorship is unusually weak.
The last few elections in the US haven't been won by convincing people. They have been won by getting people who are already convinced to actually vote. That is why the undecided voters portions of most poles were basically 0%.
We don’t need health officials to figure out how to ship things that are really cold really quickly. This could have been managed much better by the federal government overall. It shouldn’t fall to health departments to do this.
It’s such an easy thing to lie about. “I had only one dose left and had to use it on my wife.” How do we know there was not 10 more people but he did what he could to get exactly 9. There is huge incentive too. It would be less suspicious if his wife wasn’t sick.
I suspect the nytimes is interested in pushing the racism angle more than anything.
The response to COVID-19 is very different between Spain and the US. Harris County got the vaccine faster than anticipated and no protocols from late December even existed.
This just goes to show how people are. They don’t want others to benefit if they don’t also benefit. They would rather more people get sick and die than someone get a shot before their turn. So much about politics can he explained by looking at people this way.
There is a Russian story about a farmer without a cow who lived next to a farmer with a cow. He fumed about the unfairness of it, but no matter what he did he couldn't scrape up the resources to get a cow of his own.
So he prayed about it, and God offered him a wish. Did he want a cow of his own? "No," he said, "I want you to kill my neighbor's cow!"
That is short-term thinking. What happens if this is left to slide. Someone hears about it and then you have more open vials that needed to be used late at night - “my family was the only ones awake so I gave it to them”. Bribes could be paid too.
It only seems like one dose here but that’s how corruption always begins and then one day you become Russia.
It underlines a large ideological difference in politics that exists...let’s help people in front of us here and now...vs let’s do things that will maximize benefits on the long run and reduce risk of negative consequences.
A wasted vial here and there is nothing compares to thousands wasted via corruption.
Then we'd have fewer vaccines expire before they can be used.
This wasn't a problem because a doctor vaccinated people out of order. This was a problem because the hospital failed to find recipients for the vaccines they had. If you're going to make an example of someone, make an example of the hospital.
To open a batch you should have an equal amount of people already queued up for the shot. If at the end there are still unused shots for whatever reason I would give the doctor in charge full authority to use those however they see fit as long as they are not selling them for money or other benefits.
Sadly the US has now a system where everyone with any responsibilities has zero authority and everyone with authority has zero accountability.
You can hardly expect people to wait around until you have enough people for a single vial. Wasting less than a single vial per day doesn't outweigh the downsides of making it harder to get vaccinated.
You missed the point of this story. This was in the very, very early days of vaccinations in Harris County. There was hardly any system. Harris County Public Health had to toss their first vaccination registration system, when it turned out signup invitation links could be shared and hundreds of invalid people showed up for appointments.[0] You can be sure this didn't happen after January 1, and protocols for handling extra doses are now very well known.
The charges levied against him are from the DA’s office. Bit of a stretch to imagine his employer personally reaching out to the DA to try to get cause for dismissal.
Over and over again we re-learn that the single proven way to distribute scarce resources is the free market. Anything else we tried led to abuses, aberrations, waste and in the end fewer people gaining access to that resource.
I have seen this in the planned economy I grew up in, which was unable to provide even toilet paper to its people - but it was ok, because we didn’t have any food either.
Our blindness to the simplicity, obviousness and logic of the market laws and our obsession with the forced, unnatural "fairness" and "equality" make us relearn this lesson the hard way, by paying the price. Unfortunately this time the price is in lives.
> you’re suggesting that we should determine access to the vaccine based on how much money you have?
No, I'm suggesting people should get the vaccine based on how much money they are willing to spend on it. Just like everything else. This would in effect reduce demand (most people would decide a mask is enough protection or to simply wait) and make sure that only people needing the vaccine (or their sponsors) would spend the money for it.
The free market works for even more essentials like food, clothes and shelter, but suddenly is not for vaccines?!
Only Moderna is a US company. BioNTech and AstraZeneca are European. The vaccine's very existence is owed to the free market and private enterprise. The failure to distribute and use the vaccine is solely due to governmental intervention.
My first reaction was "this can't possible work", but it's interesting to think about.
I wonder how the market would price it.
If there was a "vaccination passport" in operation to let those vaccinated travel freely, I would be happy to pay up to 1/2K to jump-the-queue. It's a minor premium on the expense of an overseas summer vacation.
Would also be happy if part of the fee included a subsidy for low-income.
However, morally, I would prefer to wait for first-line responders and elderly at-risk to be prioritized with first doses. Which kind of leads us back to where we started with government prioritization.
Would be interesting to see how an SV startup revenue team would price it with their huge data points on pricing models. Worth an A/B test perhaps.
the flu vaccine is delivered annually by experts. now they are creating a whole new vaccine distribution system run by people who have never done it before. the politicians are celebrating their megasites as if that is suppose to impress us. I have no doubt if the money was ever counted that we're spending ten times more per shot for covid then we do for influenza, just on the distribution.
Actually freezing prices is the best way to create long term shortages. We saw that last springs when countries with free markets kept having N95 masks available, at slightly elevated prices while countries that imposed priced controls did not have any until fall.
In a free market the vaccine would’ve cost 10k for a month while producers would’ve been scrambling to increase availability and production to take advantage of this amazing opportunity. Pretty soon after the price would’ve dropped at a greatly increased availability.
Right now the vaccine is free and very few lucky ones can get it. And it’s been months.
I think you’re looking at this too much from a pure demand theory point of view.
Ignoring the moral issues with distributing a live saving vaccine based on who has enough money, I don’t think that free market pricing would have made things much faster.
It’s not like any random person can get into the business of complex vaccine manufacturing. The companies and the government have already been scrambling to get it out faster but even if you believe that there is/was more room to incentivize the 2(?) main companies making the vaccine then again the government(s) could just say pay the companies more/less based on the timing of doses.
However I really don’t think that additional profit motive was a factor here. If there was more room to say build another factory at some high cost, I find it hard to believe that these companies would decide not to and not offer governments an offer to expand capacity (eg. we can give you X doses and bump you up but we need more money to build the factory).
I agree that price controls create shortages in the long term. The issue is that emergencies are about the short term.
I would be very surprised if more money would have helped produce more vaccines. Canada is burning a billion a day to keep everything in lockdown - money does not seem relevant to the current situation. Adding it in just makes everyone pay more for the same limited amount of vaccines.
This emergency does not seem short term. Pandemics generally aren't. There are already talks of new strains and corresponding vaccines in winter.
Canada is burning billions because it has decided to prioritize COVID protection above everything else in life. It was clear from the beginning that lockdowns were a bad idea because they weren’t feasible in the long term. Alas, this is the path most of the world's government chose. We'll be paying the price for years to come...
The supply constraints for the vaccine are short term.
> Canada is burning billions because it has decided to prioritize COVID protection above everything else in life. It was clear from the beginning that lockdowns were a bad idea because they weren’t feasible in the long term. Alas, this is the path most of the world's government chose. We'll be paying the price for years to come...
How does this relate to money being a limiting factor for vaccine production?
Do not underestimate the power of human creativity and antreprenorial spirit when correctly motivated. The ability to sell this vaccine at obscene profits would've been extremely motivating.
Now I am not in pharma I don't know how exactly the extra money would've helped, but I know that in pretty much any business more money help with new hires and better people, new machines for production lines, more wild ideas being tested and discarded if not working. Also this is a supply chain issue and they would've been strongly incentivised by more profits. Even those damn syringes missing in Japan and little container bottles to store vaccines in. Finally at macro level better profits would've attracted and incentivised more entrepreneurs with more ideas and imagination. Remember, the very existence of the Moderna and BioNTech companies is due to the free market and private enterprise.
Now on the more very short term an expensive vaccine would've reduce demand by making people consider alternatives and by making sure only people that really need it would get it. It would've avoided aberrations like vaccinating terminal patients or people who are not active and can very well wait for the price to come down wearing masks in the meantime.
But I am afraid that the supply constraint for the vaccine is long term. Because the virus is changing. And our incentives are more aligned with prolonged lockdowns than vaccine production.
I think this is where we disagree. If wealth was equally distributed I would agree but wealth follows a power law distribution. People with a 1000x less money than me but with 100x more risk should get the vaccine before me.
Do you know of the mythical man month problem? It seems to apply here.
> People with a 1000x less money than me but with 100x more risk should get the vaccine before me.
And this is how you get shortages. Because there are a lot of people considering themselves at 100x risk (high demand) and very few people interested in serving them for no profit (low supply). The market laws are simple and implacable.
This is our current strategy and I consider it disastrous. But you should be pretty happy with it then. The current vaccination is run exactly according to your priorities, so kudos!
Again, I know too little about producing vaccines to know if this is a MMM situation, but based on my expertise in other fields, I highly doubt it.
In this case many of the manufacturers are American.
Secondly, the government can purchase the vaccine at “market price” and then distribute it at a fixed price. There’s no need to have price gouging (at least given a certain supply in the US)
It would be so simple to have a system where everyone can sign up with the local health department to receive extra doses at the end of the day. If there are extra doses, you receive a text message and have 10 minutes to confirm that you'll be there within the hour, otherwise it moves on to the next person. There should be no reason a single dose of this stuff should ever go to waste.
This might be a rare edge case case involving unforseen circumstances. For rare cases like this (presuming that that's true), we probably don't want to set up a whole communication apparatus, since doing so is quite expensive. Instead rely on common-sense ad hoc decision making, just like the doctor in question did.
We just need a small caveat in the rules that only people the doctor doesn't know (either directly or through a mutual acquaintance) are allowed to receive an unplanned shot in this manner, to eliminate the incentive to do it on purpose. As well as some accountability after the fact, depending on the details of the case.
The outcome of this is fairly tragic, I consider this doctor somewhat of a hero and here he is being punished by unthinking bureaucrats. What a shame.
I don't know that this situation is that rare. I just got Moderna dose 1 last night and heard the nurses talking about no-shows and how many bottles they were going to have left over (I didn't catch the number). Anecdata of course, but I don't think leftover doses is some crazy rarity.
Edit: To be clear, I don't know whether these left over bottles were going to go to waste or if they had contingency plans to use them.
In Israel, before vaccines were made available to the entire public, people created Facebook groups reporting clinics which had spare vaccines, nurses would even go outside and offer random passerbys an option to get vaccinated.
It may seem simple but your scheme a fraught with equity issues. The ability to respond in a timely manner or arrive within a limited timeframe such as you propose is likely to reflect the luxury of privilege. And yes, equity concerns are more important than concerns over whatever minimal delays or waste they create.
Please consider that such views complicate efforts to deliver justice. Recognizing inequities and the potential for inequities before they emerge is crucial to achieving equity and justice.
This is like the trolley problem, but even dumber. You have a trolley headed for a bunch of people. You can throw a switch to take some people out of the path of the trolley, or do nothing. You are suggesting that doing nothing is better, because that way there won't be "equity" disparities in trolley victims.
Correcting historical equity disparities such as unfair distribution of medicines is one example of the steps necessary to achieve a just world. Note that placing the term equity in quotes as you have done can be seen as implying some qualification of the concept, as though it is in doubt or not legitimate. I'd ask that you please avoid this in the future.
It is not I that insists on unused vaccine being allowed to expire for the sake of adherence to policy. I merely defend the prevailing policies that work to deliver equity. The values we have collectively adopted weigh equity as more important than lives. Not only in theory in some forum on the internet, but in actual practice.
As is only just. No?
Perhaps the good doctor will think harder about exactly to whom he is bestowing the benefits of his efforts in the future. There is an awful lot of injustice that has to be made good and we must all do our part, especially professionals such as doctors, who should be well equipped to make the correct distinctions and prioritize these factors in every facet of their profession.
In the general case actions such as these are quite rightly prohibited--it's so easy to engage in self-dealing behavior. The best solution would be a waiting list of people to be notified. However, this was the initial rollout, glitches are to be *expected*. He found one and scrambled to do the best he could with the situation. There was no right answer, he picked the least wrong one.
We have seen other places where the rules were followed and doses thrown away. As far as I'm concerned any bureaucrat who ordered that should be thrown in the same dumpster.
This is a complex issue. Ideally we would have a much better organized rollout avoiding these scenarios. I don't think we ever want individual physicians using their own contacts list to find candidates regardless of good intention, it just opens the door up too much abuse. I don't think the penalty matches the crime, certainly not a criminal prosecution.
Dude. "This overall situation isn't ideal from my perspective" is really, REALLY not equivalent to "this particular person committed a crime".
If it's night time and you have six hours to administer the doses, you have to administer them in six hours. To someone you can contact in six hours. At night.
Your position just boils down to "I'd rather let people die than be open to a bureaucratic exception in a desperate emergency situation in the middle of a pandemic."
It's monstrous, quite frankly. You should reconsider.
If we can confidently confirm that 1) there are leftover vaccines, 2) good-faith efforts were made to administer them to the target audience, and 3) there were leftover vaccines that were definitely otherwise going to go to waste then I'm 100% fine with people administering to their contact list. I'd rather that 1000x over than unused vaccines be tossed into the garbage. We all lose with unused vaccines.
It's just poor design to allow for good-faith. It's too easy for a bad actor to artificially create "leftover" doses to give to friends and family. Just don't allow doctor discretion and organize better for the next day, problem solved.
You don't need to blindly trust that someone is acting in good faith, you need merely examine the evidence. If what counts as "evidence" is documented in advance this becomes all the easier.
For instance, one simply needs documented evidence that 1) the right populations were clearly made aware of vaccine location and time, 2) communications went out to "in-scope" target audiences at least X hours before the doses expired, and 3) if vaccines are at threat of expiring once they are - let's say - two hours from expiring then those that control that particular supply should do everything they can to use them.
And while this solution is a bit reductive, it's honestly not that reductive; this is a solvable problem. People on Hacker News solve much, much, much harder problems than this.
And I'd rather 20% of vaccines go to the wrong people than 5% of vaccines go in the trashbin, personally.
> It's too easy for a bad actor to artificially create "leftover" doses to give to friends and family
How? If X people made appointments in a day, then exactly X vaccines should be distributed for that day. Leftover vaccines will only be distributed after all those appointments are over, so it is impossible for any of the X people(assuming they arrived on time) to lose their vaccine.
It would be better for 100 people to get the vaccine out of order than for 1 dose to be wasted. The leverage from removing people from the pool of potential spreaders is MASSIVE.
The same thing has been happening across the country. This is basically states failing to create a proper portal that can provide a vaccine-provider a list of the next n prioritized people in the city, and then blaming the doctors when they don't have arms to inject.
This is a failure of management from the very top, and people lower down getting the blame.
It is simply insane to me that most (all?) states haven't used the past six months to build proper portals that can do this. This doesn't even need to be some complex medical-records-transfer monstrosity -- allow people to put in their own information (or the information on non-tech-savvy relatives or neighbors), and verify them at the point of injection.
Here in Massachusetts, an extremely tech-savvy state, run by a health insurance exec, there is absolutely no centralized way to register yourself, and no way to put yourself on any kind of list at all, besides calling up individual vaccination sites once you become eligible. And there is no centralized list of what vaccination sites have openings (though a private citizen was able to make one via web scraping).
Is hippa partly at fault? I wonder how much of our healthcare cost is related to hippa. The only time I have had to use a fax in the last decade is to get my medical records to a new doctor.
I don't see why it ought to be. That's why I was specifying a non-medical-records-transferring site.
Already when you book an appointment, I believe, you simply state why you're eligible for the current group and when you get to the injection site they double-check that (to the best of their ability). I don't believe that any states are requiring verification that you are, e.g., a smoker.
So you should be able to just input your data, your age, if you are a frontline worker, whatever, and check the box that you have 2+ of the listed medical conditions. When you get to the site, the triage person can check that.
This is no more or less security than currently exists, it just centralizes it.
I can submit my data anywhere I want. I can permit it to be shared with anyone I want.
Having a registry that I submit info to, get it verified, and shared to doctors is probably easier because of HIPAA. Because at least there’s a common standard that system operators can plan around and there’s at least some protection.
You would think that state's had no advanced knowledge of a vaccine. In Maryland (my state) the state health director published a "white paper" on what steps they were planning on taking to vaccinate. Then a few weeks later he retired.
This is dumb. Are we really willing to slow down the vaccine distribution because we're afraid some trivial amount might not be distributed in the correct order?
The question should not be "why did he give the doses to people he knows?", it should be "why were there even doses available for him to do this with?". Someone failed to make sure every available dose of a highly demanded vaccine had a patient. That is the real problem and it likely has nothing to do with this doctor.
It's a shame the article doesn't name the hospital he worked for because it looks like they're using him as a scapegoat for their own failings.
But honestly I'm not surprised. Lockdowns and isolation have turned some of my more reasonable acquaintances into rabid social media junkies who do nothing but judge anyone for the smallest social infraction.
Sometimes he's not involved at all, but people still try to blame him because they've got an ax to grind. There's no indication social media had anything to do with his actions or the ensuing punishment.
I’m pro universal, single payer healthcare, but these types of stories highlight my main concern with it.
The people attracted to these bureaucratic positions select for rule following. It’s a reinforcing thing. Those that follow the policy are rewarded and move up. Pragmatic people sometimes bend the rules and sooner or later are pushed out.
These bureaucrats would rather see people die than for there to be a break in sacred government policy. We need to do whatever we can to keep such people from being in positions of power.
Overzealous prosecution, and being told no is the one thing the government will not stand for. This feels like similar power struggles across the country between the government and citizens, where the government is determined that you will abide by its rules and do as it says, or else.
There is no down side to the prosecutor for pressing on with this. The state pays for the prosecution. She's already got her name in the NYT. A loss would go unnoticed and a win would be a feather in her cap.
The real issue here is that federal and state governments didn't think through the logistics of distributing vaccines even though it has been many months since we've known a vaccine would be coming.
Where I live, there are about 10 different places that vaccinate, between county governments, pharmacies and hospitals. All of them have separate registration systems. Meanwhile, appointments go quickly and appointment availability is often announced on Twitter, which is probably isn't the best place for the 65+ crowd.
What they needed to do starting in December is create a state-wide (or at least county-wide) registration system. Essentially model it as a priority queue with different buckets:
1) covid ward healthcare workers
2) other front line healthcare workers
3) 65+
4) preexisting conditions
5) etc.
You can disagree about which buckets go first, but that's not my point here. This should have been setup and publicized well before the vaccine rollout started. Now, you get a sense of exactly who wants to be vaccinated, so you don't get wasted doses when 45% of a nursing home's staff doesn't want the shot.
You also ask people how far they would be willing to drive for a shot. I know people who drove a few hours. I know others who didn't want to drive more than 20 minutes. So it's relevant. You also ask times of day that people are willing to be vaccinated and if they want to be notified if earlier slots open up.
Once vaccines are actually available, you have a central queue and you pick randomly within each priority group. So let's say you are up to 65+ adults in the general population (which is a large group). 1000 appointments open up at a hospital in zip code 12345. You send out a text message and email to 1400 (since not all 1400 are going to respond to the text message) randomly selected people in zip code 12345 or who are willing to drive there. For some elderly people, you might need to make phone calls. You give people some time to respond and if they don't, then add them back to the pool and send messages to more people until you get all slots filled.
There are thousands of people in any major city who would drop what they are doing and run out to get the vaccine on a moment's notice. With a better system in place, this should never have fallen on the doctor in the first place.
The system you describe is exactly what is happening in the UK.
There is a country-wide registry of everyone (already existing, because the NHS covers everyone's healthcare) and everyone is assigned a place in line to get vaccinated based on their estimated clinical risk, from highest to lowest.
Everyone gets a letter in the mail when their turn comes up allowing them to register for any of the currently open vaccine appointments at one central website. There's little to no fight to book slots because the appointment system is paced by the letters.
When a whole risk group is nearly completely vaccinated (so far, that includes age 80+, 75+, 70+, and social care workers), then that group switches over to open registration to encourage any stragglers to get vaccinated.
The priority queue of people left to vaccinate (and the logic behind it) is widely publicized and progress through the steps widely tracked in the media:
1. residents in a care home for older adults and their carers
2. all those 80 years of age and over and frontline health and social care workers
3. all those 75 years of age and over
4. all those 70 years of age and over and clinically extremely vulnerable individuals
5. all those 65 years of age and over
6. all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
7. all those 60 years of age and over
8. all those 55 years of age and over
9. all those 50 years of age and over
It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19.
The UK is currently working on group #5 and catching any remaining people left in #1 - #4.
My point is not that the UK is doing everything perfectly (obviously not). It's just that a mass vaccination system like this is doable and easily could have been done in the US if the government was more together over the last year. And organization works - the UK is not only significantly ahead of the US in number of shots administered per capita, but it also has a much higher percentage of age 70+ citizens reached (well over 90%) while the US vaccinations so far are more spread across age ranges.
The alternative would be to allow doctors to dispose of the remaining doses as they please, and the moral hazard of that should be pretty obvious to everyone.
Can someone indict that district attorney and the supervisor for endangering the vaccination effort by persecuting medical professionals who vaccinate people and encouraging the waste of vaccine?
When you consider the stacked selection biases that apply to the people who come to find themselves managing the government vaccination programs this sort of thing falls squarely within the expected failure modes.
The chain of people who fired this guy got where they were by following rules and covering their butts. People don't wind up managing important things for government by bending rules where appropriate, assuming responsibility and using discretion. The system either marginalizes, removes or crushes the spirit of those kinds of people.
For reference for non-Houston readers, he took the vaccine from a vaccine event in Humble to his home in Sugar Land. That's over 40 miles through the fourth largest city in America. His route home would have had him drive by the Texas Medical Center, which contains 21 hospitals that employs over 100k people. Further, the city/county run vaccine effort has been very strict about verifying addresses. He took the vaccine across county lines.
As much as I strongly believe that rigid rules hurt good people, I believe it's a false dichotomy to assert that either he takes the vaccine home or it goes to waste. Further, it is important to maintain some semblance of public trust during this process and the optics of driving across one of the largest cities in America, by one of the largest medical centers in the country, and taking the vaccine home to find eligible people is not good. Now, yes, it's not quite as easy as calling up a hospital as asking if they could use it, but it doesn't sound like he tried.
Now, even if we believe he did the right thing, I'll still stress that there will always be a contention between optics, trust, and corruption. Say I work as the mayor of a city and my brother really is the best contractor for the job, do I hire him? I'll contend that's not exactly an easy question and neither is the case with this physician and the vaccine.
> I believe it's a false dichotomy to assert that either he takes the vaccine home or it goes to waste
I don't see a specific, viable, knowable-at-the-time alternative course of action Dr. Gokal could have taken, from you or anyone else. And the events in question happened over a month ago. Dr. Gokal's boss has had over a month to BS about what Dr. Gokal should have done, and failed to come up with anything. Dr. Gokal had six hours.
> Say I work as the mayor of a city and my brother really is the best contractor for the job, do I hire him? I'll contend that's not exactly an easy question and neither is the case with this physician and the vaccine.
I am disgusted with the laid-back, bureaucratic attitude so many people seem to have about this vaccination campaign. It is truly no surprise anymore that we have managed this pandemic so disastrously, and let so many people die needlessly.
Dr. Gokal had six hours to get ten doses into vulnerable people's arms. It was night time and he had no guidance from management on how to avoid wasting those doses. Wasted doses mean dead bodies.
Do you understand that? And after understanding that, can you explain to me how armchair quarterbacking Dr. Gokal is anything but unconscionable?
This is not a time to gab with the angels on our shoulders about optics, about whether we look like perfect little boys and girls. It is time to actually be good. It is time to save as many lives as we can. Dr. Gokal did that, he made no attempt to hide it, and he paid a terrible price. If you're going to sit in judgment of people, it should be the horrible bureaucrats who dare to judge him, when it was THEIR failures that put him in this position.
Well, here's one option. Between Humble and Kingwood there are about half a dozen freestanding ERs in addition to a hospital ER at one of the Hermann branches. They would have been within 5-10 minutes of the vaccine's original location.
While freestanding ERs have a number of issues, there is a single attending on staff that is extremely easy to get hold of by another physician. He could have called at least one of them to see if there were eligible patients in the facility that would accept the vaccine. Yes, this takes time, but note that depending on traffic it takes about an hour to drive back to Sugar Land. I believe that if he would have dispersed the vaccines at one of those facilities, the story and perception of this physician would have been dramatically different.
My point in bringing this up is that there were other realistic options that he could have taken. It is not quite as simple as take the vaccine home or it goes to waste.
Interesting post, better than most making this side of the argument.
Do we know if those ERs would administer vaccines from another hospital's punctured vial in their facilities? Do we know how long it would take to get the answer to that question, trimming off the 42 minutes per person Dr. Gokal had to find, administer, and properly document the vaccine injection? And at the end of all that, would there be enough high-priority individuals on hand, ready and willing to be vaccinated? Was that clearly better than calling up people the doctor knew, and knew to be vulnerable?
Yeah, I don't think you know any of that. It's fine to speculate about the hypothetical optimal course of action in this situation, but it's deeply wrong to judge Dr. Gokal without certain knowledge of all those things.
I very much agree that we don't have all of the information here and that it's very easy to Monday morning quarterback a decision that was made under pressure without good guidance. Sadly, it's possible that this whole situation will turn into a trap where there all available options have some kind of negative outcome. That said, I don't think that it's entirely inappropriate to discuss or postulate other courses of action because it's something that can help other people in the same situation.
With respect to the freestanding ERs, I would contend that they would probably take it. A friend of mine owns a couple in Houston. My wife used to work off and on with a different company at them as the attending physician. That does not make me an expert in this area, but I can say with absolute confidence that getting hold of the physician on duty quickly with this kind of matter is guaranteed. Whether they would want the liability to give the vaccines is unknown to me. The next time I see my friend, I'll ask him because I'm genuinely curious.
I'll also mention that there are certain cultural biases that come into play here as well. I spent years doing federal contract work and it was well ingrained into me that avoiding the appearance of impropriety is important for a well functioning organization. As much as the organizations that I worked with don't want waste, the bias is to side with clean, unreproachable conduct even if this is more wasteful. Not all of the government works this way and the reality of life is that this isn't always so easy. I mention this because that kind of bias suggests a different way of looking at the problem and provides a different set of solutions. That's not a value judgement to say that these solutions are better or worse, but an implicit assumption that there has to be a different way.
> As much as the organizations that I worked with don't want waste, the bias is to side with clean, unreproachable conduct even if this is more wasteful.
The problem with this, which few in the government seem to understand, is that knowingly and wilfully letting people die needlessly in a pandemic is deeply reproachable conduct. Personally, I'd actually call such conduct despicable. But my personal standards of conduct could perhaps be much higher than average, so we can leave it at reproachable as a basline.
It turns out that Dr. Gokal was punished for "taking doses away from a vaccination site" [1]. So your proposal probably would not have kept him safe from firing or prosecution.
Other articles say that he was punished for violating a protocol which required that expiring vaccines be returned to a hub site (i.e. throw them away and let people die or be punished.)
I agree that the NYT article presents a false dichotomy, and offers a rosy picture of the doctor's actions. That said, I genuinely wonder what's the alternative action available to him? I agree that the article creates a false ticking time bomb narrative and he's Jack Bauer. Still, he made good faith (presumably) attempts to eligible people at the vaccination site, who refused. Would the Texas Medical Center have accepted an opened half used vial from some guy who drove up? If the only people who might accept it were people he personally knew and his patients, I'm not sure what he could do besides try Sugar Land. I agree he could have tried harder, but honestly - when his supervisors didn't care when he called them, why should he?
> Late last month, a judge dismissed the charge as groundless, after which the local district attorney vowed to present the matter to a grand jury
Considering that grand juries would indict a ham sandwhich, this seems like the prosecutor is reaching just to prolong the process and pain this doctor is going through. Even assuming the best case argument for the prosecutor that he did “steal it”, he vaccinated 10 people with expiring vials. More realistically, given that it was only 10 expiring vials that went to eligible patients, the doctor should be commended for driving around and finding people who needed it. Who the fuck cares if it was primarily his own community or one of the vials went to his sick wife?
This just looks like the DA was caught being overly aggressive (perhaps even racist given the comments in the article) and is just trying to save face. Dollars to donuts the case is thrown away and I hope the doctor countersues for malicious prosecution, although more realistically he’ll take a plea to avoid going to trial and end this nightmare.
> Considering that grand juries would indict a ham sandwhich
I am not American. When I hear about grand juries in American media, it is usually when they refuse to indict in a case of brutality or killing by police officers, even though there is clear evidence about the incident. It seems that grand juries never indict anyone, not the other way around. Where do grand juries' biases lie in reality?
Grand juries give you the result the prosecutor wants. The ham sandwich tounge-in-cheek joke is that usually the prosecutor wants to indict, otherwise why would they bother going to a grand jury. For police officer involved brutality/killings, it's usually the opposite. The prosecutor doesn't want to bring the case (since their office needs to work with cops to prosecute civilians) but there's political pressure from the community, so the prosecutor brings the case to the grand jury & scuttles the indictment.
A huge improvement is probably actually to just remove the grand jury. That way prosecutors can't hide behind the "well I wanted to indict but the grand jury didn't let me" while removing the guilty by association act of "well a jury clearly thought the indictment had merit".
The grand jury's bias is the bias of the prosecutor trying to convince them on a one sided case. The prosecutor is the one explaining the law to them and trying to get them to agree with their view. When there's no defense to provide a rebuttal it's a lot easier to convince a jury.
That the extra doses were administered in a different county (Fort Bend) probably exacerbated the response, plus the very plausible bias of the local officials in Humble. The Harris DA Kim Ogg is a Democrat (tellingly not mentioned in this article) who is painted by opponents as a “Soros DA” who is soft on crime.
While this case is quite bizarre, giving doses to random people rather than having the vaccine go bad is pretty common, and makes sense.
Except for one thing: If I am the lucky recipient of this vaccine, ahead of schedule (since I am under 75 and have no comorbidities), then what about the second dose? Do I have to get lucky a second time, the right amount of time after my first dose? (My understanding is that there have been no studies of delayed second doses.) Or am I given priority because I've had the first dose?
I don't think anyone really has any formal policies or if there are they probably vary drastically based on your municipality (the US healthcare system is a mess). The data does indicate that even 1 dose gives you some immunity, just not the 95%. That's why there's been a big push from some scientific corners to just get needles in arms to inoculate as many people as people with some immunity & worry about making sure optimal 2nd shot later (broad herd immunity with less efficacy vs smaller more effective herd immunity).
Aside from the main thread of the article, what blows my mind is how many people he asked who declined the vaccine. Were they just being good samaritans, hoping the vaccine would go to someone who needs it more? Maybe I am a lesser person, but I'd trample people to get a jab right now.
We have a caste system here in the U.S. and he violated its boundries! We've all seen the reports of the California committees composed of dozens of non-medical people who spend their time ranking the population while vaccine sits in the freezer. For example:
After being required to get the vaccination in order to receive hospital treatment. I'm still told that I have to quarantine wear a mask and try to be as safe as possible which tells me that the vaccine didn't do jack and nobody has confidence in it.
This event will just get doctors to end up wasting vaccines if there are any left for the day. I am surprised that the bureaucracy in place did not account for there being remaining doses in a vial as part of the roll out plan.
As stupid as this sounds, this is extremely standard policy in many, many jobs. Just because something is expiring doesn't mean you can use it against the standing rules and procedures.
On the other hand, most standard jobs have documented procedures and managers that respond to questions about policy accurately. The NYT reporting turned up no such things.
And seriously on the other hand, most jobs are not potentially life and death situations. There are few, if any parallel situations to this. Maybe it would be akin to parking a company vehicle incorrectly so you could stop and help an injured person.
It could introduce corruption otherwise too, selling doses that are about to expire to the highest bidder. Which then could introduce incentive to let more doses "expire". I agree that in this case it seems stupid, but the rule is there for a reason.
You are focusing on a very unlikely scenario instead of focusing on the bigger picture, the more people get it, the better it is for everyone, regardless of anyone's status. The rule is there for a reason is a terrible reason to do something that harms our society.
In most jobs (outside of the hyper-unionized, hyper-bigCo places that are policy, checkbox and butt-covering driven and internally function a lot like government) management will cover for these kind of actions even if they're not officially sanctioned by policy. Basically what you do outside of the rules is on you but if the outcome is good you don't get fired like this guy did.
> Dr. Gokal said the advice was to vaccinate people eligible under the 1(a) category then those under the 1(b) category.
> After that, he said, the message was: “Just put it in people’s arms. We don’t want any doses to go to waste. Period.”
It sounds like not wasting the limited vaccine was actual policy (possibly unofficial policy, but the message he was receiving).
And this would be the right policy. It's absolutely correct to get vaccines into people before the expire, so long as you hav correctly exhausted all means available to you of finding the right people.
The issue is that the states haven't made it easy for providers to find the right people when you have six hours remaining to use a vaccine.
Not only was he within policy, he was given permission, explicitly.
> Dr. Gokal said he called a Harris County public health official in charge of operations to report his plans to find 10 people to receive the remaining doses. He said he was told, simply: OK.
According to the doctor that was explicitly not the policy. His version is that the health department made it clear that they should do whatever they had to do to keep from wasting doses.
This lines up with what I know from family members doing vaccinations in other areas.
Well, there were no rules and procedures, per the article.
> a prosecutor told him by email that there were no written protocols from late December; nor had a written wait list yet been found.
And giving short life vaccines to people with co-morbidities during a pandemic is a world of difference than grocery store food. I'm not sure why we're even comparing the two.
You are being downvoted - but this is realistic. Restaurants trash or donate expiring food. Corporations shred perfectly good hardware instead of giving it away.
Not saying it's good - but there are reasons these policies are in place.
It can also result in the situations we see here which sounds like this doctor had the best of intentions and is being punished for it.
Not only was there no such policy in place according to the article, but physicians are given wide latitude in making medical decisions (using drugs off label, using expired drugs etc...).
If they act unethically, there is a built in method to address this through the licensing boards that regulate them.
Criminal behavior is different, but the Judge that heard the case completely rejected the argument that the behavior was criminal.
>On Dec. 22, Dr. Gokal joined a conference call in which state health officials explained the protocols for administering the recently approved Moderna vaccine. The 10 or 11 doses in a vial are viable for six hours after the seal is punctured.
>Dr. Gokal said the advice was to vaccinate people eligible under the 1(a) category (health care workers and residents in long-term-care facilities), then those under the 1(b) category (people over 65 or with a health condition that increases risk of severe Covid-related illness).
>After that, he said, the message was: “Just put it in people’s arms. We don’t want any doses to go to waste. Period.”
What he did was explicitly ordered by the government. It is what the health department told everybody to do, in no uncertain terms.
