> The restrictions on their rights are of an employer-employee variety

An arrangement defined and described by laws Congress wrote. Laws which restrict the free speech of Americans.

I agree that the negative rights of the American Constitution are far superior to the positive-rights philosophy of e.g. the UN Declaration on Human Rights, which is unenforceable ambiguous. But these rights are balanced against each other in a complex way.

It is entirely within the scope of a government to enact restrictions on the people acting on behalf of the government with government power. This is less of a contradiction than you seem to think it is. In fact, it is the point of the Constitution to restrict the government!

Even so, Congress still doesn’t have the power to prevent government employees from speaking out politically, or choosing their own church or choosing not to participate in church, or from operating a printing press that criticizes Congress, or from publishing a blog criticizing the Senators from their home State. The restrictions upon government employees are entirely within the scope of their service to the government, and no further.

Or to put it another way, since Congress shall pass no law restricting the establishment of a religion, they can’t mandate civil servants in the Department of Agriculture attend a Catholic Church while those in the Department of Justice must be of a Protestant persuasion.

> It is entirely within the scope of a government to enact restrictions on the people acting on behalf of the government with government power

HIPAA restricts what non-government people can say.

You’ve made a solid observation, and I don’t have a solid response off hand.

It’s entirely possible the penalties applied by HIPAA could fall within the boundaries of what is and what isn’t Constitutional, but it’s also possible it is unconstitutional, and unconstitutional laws get struck down all the time when they’re thoroughly challenged, but in our legal system, they have to be challenged first, meaning someone has to make the case.

Most of the HIPAA restrictions can be waived by the patient, i.e. you can contract around it, so it's really more about contractual defaults and consent than censorship.

But that's obviously still a slippery slope. You get the same sort of scenario with classified documents which are at the same time evidence of government misconduct. Everyone with access to the documents agreed not to disclose them, which means there is no one who can reveal the misconduct to the public without violating that agreement.

That's one right (speech) weighed vs another (privacy)

They can't choose tobe exempt from laws criminalizing the disclosure of classified documents. It is substantially more than just an employer relationship.