You seem to be able to make sense to Denise where I cannot.
She now has the information from you to understand that her initial reasoning about the distribution of doses was wrong and that she was being misled about the situation. The United States has not produced enough vaccine for everybody in the country and has to purchase from overseas. Even then, there will probably not be enough for the time window in which it must be distributed. 6.7 Billion People versus 400 million doses worldwide versus 300 million in the United States (I think).
I recall Denise was still firm on the women and children and elderly first thinking when last we spoke. If I misrecall, I am sorry; but that is how I remember it. That seems to assume that three out of four doses in the world will go to the United States.
The point is, to my mind at least, that no matter what is done, there has to be some rationing of health care.
I think that it is a mistake specifically to limit ourselves to this issue, but for now, let's do that. I think that any distribution plan that one settles on — and I mean distribution plan here, a way of sending vaccine to distribution points when there isn't enough to go around — is in fact a rationing plan in itself. Some places and people must get the vaccine first. Even if the distribution plan is to be completely random about sending the vaccine out, you have made a series of decisions about the importance of some lives over other lives and the importance of having a functioning country over not having a functioning country. Any decision has consequences, even the decision not to make a decision.
It is fair to say that you don't like a decision — the administration's decision, for example — but then it seems that you should be willing to say what you don't like about it. One of those things can't be that it rations health care. The fact that the government has chosen to allow doctors to live wherever they want to live has, all by itself, rationed health care. People who don't live in places with access to large hospitals and universities and a bustling cultural life have rationed their own access to health care. There are all sorts of factors, governmental by action or non-action, as well as non-governmental (are you a Christian Scientist?) that ration health care access one way or another. Some of these you will like, some you will not like. There are ways that non-governmental forces ration health care as well. Insurance companies are an enormous factor in this sector. So are Drug companies, by their pricing policies.
If you don't like the way the government rations health care, say how. Don't pretend that not rationing health care is an option for any government anywhere. How would they go about it? Simply by not telling doctors and other health care workers where to live, they are rationing access to health care. As they would if they did tell them where to live.
If doctors and nurses did not get first shot (pun intended) at flu vaccines, or other vaccines as well in an epidemic, 1) Vaccines would soon stop being distributed at all as folks who actually knew how to run the clinics would not be available to do the work; 2) larger numbers of the then non-vaccinated population at large would fall ill; 3) the morbidity and mortality rates overall would be much higher. Therefore, if you don't actively seek to kill people you don't actually need to kill, the health care workers get the first vaccines off the line.
Purely as a matter of pragmatics, how are you going to stop the medical personnel from vaccinating themselves first. In terms of enlightened self interest, why would you even expect them not to vaccinate themselves first; and would you trust a vaccine that the health care givers didn't trust enough to use first anyway? Wouldn't you be a little more nervous about using it?
Anyway, a few thoughts on rationing.
Sincerely, Bob Kaven