“Mandate-Schmandate,” Rick Perry and the HPV vaccine – by Richard Thaler

Nudge blog note: Last night’s Republican debate prompted Richard Thaler to weigh in on Rick Perry’s handling of an HPV vaccine executive order, but not the policy itself. Also, Thaler recently started tweeting. Follow him.

By Richard Thaler

In the Republican Presidential debate last night at the Reagan library a question emerged about Rick Perry’s now famous 2007 executive order requiring all Texas girls to receive a vaccine against the human papillomavirus (HPV) before entering the sixth grade. Perry said during the debate that his order was not a “mandate,” which is grounds for treason in Republican circles, since there was an opt-out provision. (The issue became moot since the Legislature over-ruled him and the shmandate was never imposed.)

These kinds of issues are well known to nudgers. There is not a bright line distinguishing a mandate from a nudge; the question becomes one of costs. In the case of a default option, the question is how costly is it to opt out. As we have often said, the ideal nudge has “one click” as the cost of opting out. And the button to press for that click should be easy to find. Mandates are also not all equally offensive. In Romneycare, for example, there was a fine for not having health insurance, but the fine was pretty small — around a couple hundred dollars — at least initially.

If it is sufficiently onerous to opt out of a default rule then it effectively becomes a mandate. Conversely, if the fine for violating a mandate is small and/or unlikely to be imposed, the mandate is rather mild. (Consider the mandate to clean up dog poop. Have you ever heard of anyone being busted for this?)

The actual facts of the Perry inoculation mandate are summarized well by Politifact Texas. They assigned a “mostly false” verdict to Perry’s claim that his policy was not a mandate. This verdict was based on the fact that parents would have to request and file a conscientious objection affidavit form, the same form that is used if parents want to opt out of other health mandates such vaccines for measles or polio. Apparently few parents elect to fill out this form, though the reasons are unclear.

We don’t know whether the form is hard to get, hard to fill out, or whether most folks want their kids to get their shots. I conjecture that one reason might be the name given to the form. I am guessing that the term “conscientious objector” is not highly regarded in Texas. A “hell no, I ain’t goin’ along with this” form might have gotten more take-up. Politifact also notes that Catholic schools do not accept these forms, presumably because the Church is in favor of strict mandates.

Politifact’s verdict might be a bit harsh. On the Nudge-Mandate continuum, Perry’s policy was somewhere in the middle. There is an opt-out, but it is clearly more costly than one click. Still, I am guessing that Mr. Perry will not be endorsing libertarian paternalism any time soon.

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