On Holding Still
Vaccines, transaction costs, and the sexual politics of hierarchy
The author looks back on a day spent preparing for, transiting to, waiting at, getting through, getting home from, and recovering from another child vaccination appointment, and wonders: What if society valued women’s time, instead of routinely lining us up in waiting rooms for routine care?
Right now, we privatize the costs of waiting and travel. And, disproportionately, moms pay them. It doesn’t have to be that way. Society could decide to socialize transaction costs to promote vaccine uptake and gender equality. This might involve delegating power more from physicians to other healthcare workers as part of a public health infrastructure making home visits to deliver and administer vaccines, information — and chocolate.
The doorbell rang. The baby was sleeping, so I let the vaccine delivery-woman in quietly and offered her a cup of tea. She shook her head no. Water would do.
In the rhythms of the infant and the world, we had been doing our usual dance: diaper-milk-nap, clean-tidy-provision, think-read-write. Nice as it was to have the slight change — the company, the service — it was still the most dreaded sort of visit: the kind where I had to hold my baby out to be hurt, watch her wince, and talk her down from crying, as much from hurt feelings and fear as from pain.
But this was a painful one, too. When she was moaning from fever and pain that evening, I opened the bag the visitor had left: infant paracetamol, a review of the latest relevant medical literature (as we had just discussed), and chocolate. Luckily, after the medicine kicked in, she could drink her backlogged bottles and get some sleep.
I hoped I would be able to, too. I still had not had time to read the literature properly before getting her latest shot. How did anyone do this before the Internet? I wondered. And before vaccine delivery made getting the shot itself a momentary inconvenience — instead of a day-long undertaking?
And why did anyone pay taxes before vaccine delivery people brought them chocolate?
I always look for regulations or unintended consequences of taxes or programs when I see things not working as they should. There's an old but interesting Forbes article that points out that house calls in the US by doctors didn't start dwindling until the 1960s, and it seems to coincide with the change from patients paying doctors directly, to payments being made by private health insurance, Medicare, Medicaid, and the Children's Health Insurance Program. The cost of waiting and travel time (and chocolate) shifted from doctors to patients because the customer was no longer able to signal how much they valued their time.