Massachusetts is again experiencing a COVID-19 surge and our hospitals are overwhelmed, mostly with unvaccinated patients.

As a practicing physician who takes care of many high-risk diabetic patients, I ask all my patients about their COVID-19 vaccination status. I explain to my unvaccinated patients that the benefits of vaccination far exceed the risk, both at the individual and societal levels.

Unfortunately, this conversation only convinces a minority of the unvaccinated to get vaccinated. I have found that their decision is usually a political or tribal decision, not a scientific one. My experience is concordant with survey data which has found that the best predictor of vaccination status is political affiliation.

Recent social experiments have found that “incentives” have failed to convince most unvaccinated people to become vaccinated. However “disincentives,” such as employment mandates, are an effective means of convincing a majority of unvaccinated patients to become vaccinated.

The Commonwealth’s politicians need to better protect the health of our residents and minimize the expenditures of avoidable health care dollars. This can be accomplished by employing targeted disincentives.

First, Massachusetts should immediately implement a time-limited COVID-19 “fair share” health care surcharge of $500 for every Massachusetts resident, payable on one’s state taxes. The funds from this surcharge would be used to reimburse healthcare institutions struggling financially due to the COVID-19 crisis. Concurrently, fully vaccinated and boosted people would be granted a $500 credit on their taxes, as their anticipated use of health care resources will be less than our unvaccinated residents.

The Commonwealth should also mandate that all medium and large employers vaccinate a very high percentage of their employees, or the business would be financially liable to the Commonwealth for a “fair share” health care surcharge, the amount would be proportional to their total number of employees.

The decision to remain unvaccinated results in increased health care problems, increased mortality, more unemployment, and reduced economic productivity for Massachusetts’ vaccinated residents. It is time to make the unvaccinated pay their fair share.

Hayward Zwerling is an endocrinologist who blogs at I Have an Idea.