Fauci’s frustration is understandable. But there is one way to hold unvaccinated Americans accountable for putting themselves and others at risk: make them pay more for health insurance through surcharges and eliminating paid time off when they are sick while offering financial incentives (including lower deductibles) for fully vaccinated Americans who enroll in wellness programs.

There is ample precedent for doing so. Smoking is exempted from federal laws restricting discrimination in premiums based on health status. Insurance companies can place a surcharge up to 50 percent (subject to limitations imposed by states) for anyone who uses a tobacco product four or more times per week. Carriers rely on the honor system, but misrepresentation constitutes fraud and in some states is a felony. Employers providing health insurance often require routine medical examinations, in which nicotine can be detected through samples of blood and urine.

And many driving infractions result in substantial increases in automobile insurance rates: Driving under the influence (DUI) can raise rate 65.5 percent; refusal to submit to a chemical test, 63.5 percent; reckless driving, 61.1 percent; at-fault accidents resulting in more than $2,000 in damages, 45.2 percent; passing a school bus, 28.4 percent; speeding, 23.8 percent; failure to stop at a red light, 22.6 percent; texting while driving, 21.6 percent; failure to use a seat belt, 5.6 percent.