Here’s an easy lesson for health reformers and policymakers: you get what you pay for.

O’Leary and colleagues demonstrate how costs are the rate limiting step to enhancing US immunization rates, noting that “private practices are the backbone of the childhood immunization program.” Yet from their study we might glean how to change this step from rate limiting to rate accelerating.

Immunization delivery policy in the United States has historically had 2 arms: (1) immunizations provided by the private sector to individuals who would accept or who requested this protection for themselves or their families; and (2) immunizations provided in public health clinics to the indigent or the general public in times of public health emergency. The public health sector, which includes the US Centers for Disease Control and Prevention and state health departments, researches and gives guidance on proper vaccine administration to all children, but the delivery of...

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