Suppose an anti-abortion president gets elected and he elects someone as head and tells them that health care providers that accept medicare or medicaid cannot provide abortions. Not making it illegal per-se, but just for the providers that accept medicare or medicaid for any of their services.
You okay with this as well?
It seems to me like you just don't think medicare or medicaid should be a thing to begin with. I think it's basic sense that if we're paying for medicare and medicaid we should require the healthcare providers receiving our tax dollars to meet some standard level of care, or else we're just wasting our money. We can argue over what that level of care should be, but I don't think it's all that debatable that requiring things like vaccines could fall into that level of care if not having them is particularly risky for patients.
There's no mechanism to enforce this reasoning. It's whether the agency has the power to do it or not. For instance it could be argued that natural immunity is far superior to vaccines, so excluding healthcare workers with natural immunity from working is not about protecting patients.
> It seems to me like you just don't think medicare or medicaid should be a thing to begin with.
???
I'm not sure what you're getting at, Congress gave the agency the power to set guidelines for requirements for caring for medicaid/medicare patients, that's what they do. If a guideline would not actually impact medicaid/medicare patients, then they can't do it and it would rightfully get struck down in court when it is challenged for not falling within their powers. That's quite literally the same mechanism currently being used to challenge their power to require vaccines.
Your point about natural immunity seems reasonable, it doesn't mean requiring vaccines for those without natural immunity wouldn't still make sense though so I don't think it really fits your point. Claiming that the particular way they went about this requirement is bad is different from saying they can't require a vaccine at all. I think your point makes some sense, but it could still be paired with a vaccine requirement making it effectively the same thing.
> ???
I thought what I said was pretty self explanatory. If Medicare and Medicaid are going to be worth it then we have to have some standard level of care that we're paying for - we shouldn't be paying tons of money just for medicare/medicaid patients to receive bad care. Why should my tax dollars to go a healthcare provider who doesn't want to get the vaccine when that money can go to one who will? The medicare/medicaid patients that we're paying for will get better treatment from those healthcare providers who require vaccination, and if better care is not the goal than what is?
Please don't ascribe beliefs or intentions to me that I didn't explicitly state.
> Why should my tax dollars to go a healthcare provider who doesn't want to get the vaccine when that money can go to one who will?
Medicare and Medicaid should be fee for treatment. Why shouldn't I be allowed to choose what provider I want to visit for the same treatment? They can have different covid policies, much like schools do. I don't think it should be a federal issue.
> The medicare/medicaid patients that we're paying for will get better treatment from those healthcare providers who require vaccination, and if better care is not the goal than what is?
You're mistaking treatment for safety protocols. A health care provider can have a certain doctor to nurse ratio or a million other things and they may not all be "optimal" as defined by the powers that be. We should allow people to choose what health care provider is right for them based on their constraints and not restrict options.
Disagree. If I'm footing the bill for that care (as a taxpayer) I expect to have a say in what constitutes minimum quality of care.
And allowing unvaccinated healthcare workers to treat patients is reckless, and falls well below that minimum quality bar.
(I would also accept healthcare workers with natural immunity, assuming we can establish some sort of testable minimum antibody level that confers a similar level of protection as a vaccine.)
You can, by paying for it yourself :P
> You're mistaking treatment for safety protocols. A health care provider can have a certain doctor to nurse ratio or a million other things and they may not all be "optimal" as defined by the powers that be. We should allow people to choose what health care provider is right for them based on their constraints and not restrict options.
I see what you're saying but I think it's an odd distinction, treatment outcomes and safety protocols are clearly linked, why should tax dollars go to treatment provided with substandard safety protocols when the same can be spent for better treatment elsewhere? Functionally it would just end up costing us and the program more over time and lead to worse outcomes. The other issue here is that most patients aren't even going to know enough about the various things you listed to make an informed opinion about them.
The mechanism would be the judicial system, and in the case of restricting abortion services, the regulation would probably be subject to strict scrutiny.
Lots of things could be argued; some things shouldn't be argued without evidence.
During a pandemic, statements that will be interpreted as suggesting that catching the disease beats vaccination fall squarely in that category.
Every single study done on the topic shows that natural immunity (not innate immunity) is vastly superior and more durable and more robust than vaccine immunity. Here's a study from the prestigious publication Cell: https://www.cell.com/cell-reports-medicine/fulltext/S2666-37...
What are you talking about?
CMS only controls this for patients covered by Medicaid/Medicare. It can set the tone for the entire industry, but does not solely control the industry. Typically, they create influence by setting/rejecting Medicaid/Medicare reimbursement standards. Since enough patients are covered by CMS, it tends to be easier for hospitals to broadly adopt the policies.
Not comparable. Based on current law, abortion is a Constitutionally-protected right. Based on precedent from the Spanish-flu era, the government has broad public health powers.
All that said, as someone who isn’t a fan of how much power Congress has ceded to the executive through administrative powers (which delegate legislative powers to the executive through rulemaking), I wouldn’t mind seeing those curtailed.
The decision is much more narrow that you've been led to believe.
It specifically addresses state police powers, not federal powers.
It also doesn't mandate vaccination, it allows a small fine to be paid instead.
Also, according to a well known attorney I consulted (who has argued several cases before the Supreme Court) the Jacobson decision has been overturned countless times and is considered an awful ruling, the Healthcare equivalent of Dred Scott.
[1] https://en.m.wikipedia.org/wiki/Jacobson_v._Massachusetts
Specifically avoided saying that. Stated simply, my point is there is positive precedent to the precursors to vaccine mandates, and reasonable ambiguity to the question per se. There is clear negative precedent for abortion. As such, comparing them is misleading. (Better analogy may be found in gun rights.)
Assuming it is: I think policy measures like that should be subject to medical needs. I think there's a clear medical need to require COVID vaccinations for healthcare workers, but banning abortions doesn't pass that test.
And hell, didn't the Trump administration actually do this, though maybe through different means? Withholding federal funding from providers who offer abortions?
Your example is a covered procedure, some of which is defined by the CMS, but much of it is defined by federal statute that dictates what classes of procedure are covered by medicaid/medicare. To go to your example specifically, federal statute ALREADY limits medicaid abortion coverage to abortions arising from rape, incest, or that put the health of the mother at risk. 16 states go beyond that and cover abortion in more cases, but they pay for that with their own money (which is also allowed statutorily). So in your case, what the new CMS head was declaring is unlawful on its face, as this is something that congress has specifically addressed.
The supreme court ruled that the 14th amendment[0], has somewhere hidden within it a right to privacy. This right to privacy appearently applies exclusively to abortion, as warrentless wiretapping of every US citizen has been determined not to be a constitutional violation.
I find it funny that they can find a right to privacy in the 14th, but give the thumbs up to civil asset forfeiture that directly contradicts the text and is a obvious violation. They seem to make things up as they go along depending on what is politically expedient.
[0]https://constitution.congress.gov/constitution/amendment-14/
Forcing care workers to take a medicine against their will is constitutional you say?
All medical procedures should be voluntary, or we go back to the times of lobotomy and forced sterilizations of minorities (and that's not as many decades back as you may think).
> Government can and has jailed and/or fined people for not getting a vaccine.
This means being unvaxed is a something only the rich can afford. Pay fines, and have a good lawyer.
They are not forced to take the medicine. They are given an choice to take the vaccine or find another job. If they refused to take the vaccine, that is their choice, period. They cannot claimed they are being forced because they are given an choice in the first place. They are given a free will with their decision. Thousands of Thousands people screeching for being forced when they are given a choice. Society don’t have to conform to those people who want to endanger their people and their livelihood.
The government can’t violate your right to free speech. They also can’t “ask” a private company to censor you as it effectively the same thing.
Telling someone “its your choice but if you don’t do it you’ll lose your livelihood” is not a choice at all.
The ability of the government to establish vaccination requirements is long established. It's only becoming a hot topic now because anti-science folks have been programmed to fear a safe and effective vaccine.
The difference is you flipped the switch and decided to turn up to work without clothes. You decided to radically change your behavior and actions in the workplace. This will obviously have consequences due to your unsightly naked body offending co-workers.
When someone doesn't flip any switch, but continues to work exactly as they did before, they have not done anything you can label a "choice with harsh consequences".
Unvaccinated people are not suddenly shedding and dangerous, in the way a naked person is shedding pubic hairs everywhere.
>Unvaccinated people are not suddenly shedding and dangerous, in the way a naked person is shedding pubic hairs everywhere.
Unvaccinated people are inherently dangerous. The change is that we now have the ability for them to become vaccinated people who aren't nearly as dangerous to their clients.
In June 2020, we had no choice but to have unvaccinated health care workers. Today, we do.
They are not dangerous. A person who has access to sharp knives but is currently not holding a knife, is no more dangerous than someone who does not have access to knives.
But even that analogy doesn't fit, since vaccinated people can certainly still get sick and transmit the virus.
Besides, I am not restricting my position in this debate to health care workers. I am talking about anyone with a job, who is now required to get vaccinated. That's what happened where I live (Australia). Everyone in my state from barristers, to builders, office workers, truck drivers... literally every professional who isn't working from home, is required to get the vaccine or lose their job.
Many are pissed off with the expanding scope of mandates.
I can understand the requirement for health workers to be vaccinated. But even then, they should have the option to be tested regularly instead.
This is what happens... incremental laws expand and eliminate choice. Suddenly you live in a world where you must get jabbed every 6 months, and repeatedly prove your vaccine status to everyone every day. Tagged, tracked and validated for walking around doing normal things is not a world we should be encouraging, even in pandemic times. If we must disagree on that point, then fine, we disagree.
Vaccinated people can get sick and transmit the virus, true, but it's much less likely that they will. People with STIs can also transmit the virus, so we wear condoms to make the risk of transmission substantially less. If your sexual partner is unwilling to wear a condom or unwilling to have sex with you if you wear one, you can just choose to not have sex with them and the risk of transmission goes to nothing. That choice doesn't exist with work. If my co-worker chooses to remain a massive public health risk, my chances of catching COVID-19 go up quite a bit. I can't choose to just not be around you and the rest of anti-vaxxers. Not to mention there are people who have legitimate medical reasons who are unable to get vaccinated who are put at substantially higher risk by being forced to be around conspiracy theory anti-vaxxers.
I'm talking about 'well-established' in that it's been happening for 200+ years. The conservative right-wing theocratic extremists that trump appointed will destroy our judicial norms for the next 50 years but that doesn't make them right.
Don't pollute comparisons with situations that have other considerations
You are not an island. You live in a society, a community of people that requires individuals to give up some personal liberties for the good of the whole. Those who don't like that should go move to an isolated island where their harm to others can be limited.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
Vaccines are safe and effective so I wont get into what conspiracy theories you believe about the COVID-19 vaccine. Most importantly, vaccines have been mandated by the government in different settings for years. I'm sure if you went to college at a public school, you had to certain vaccines. I know I did.
Despite what the media and elected/appointed officials are telling you the SARS-CoV2 vaccine is not 100% safe[1] or effective[2]. The authority to mandate vaccines resides with states not the federal government. The SCOTUS has upheld this authority in Jacobson v. Massachusetts. The federal government has absolutely zero authority to mandate vaccination in any capacity.
Yes, I did get vaccinations that were mandated by my state to attend public school. All of them were for diseases that are much more destructive and deadly than SARS-CoV2. In my case the vaccines required by my state were diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella.
[1] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/ad...
[2] https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
Who the fuck's been saying either of those things? None of the mainstream sources I've seen, certainly. Usually, for the efficacy angle, they're emphasizing that it's not 100% effective, and that's part of why it's important that more people get vaccinated and that vaccinated people continue to take precautions.
a) Many frontline workers have superior natural immunity anyway.
b) We're in a pandemic and this nuclear option ensures we have fewer healthcare workers, not more ("fewer workers to make the curve more impactful!")
c) Not a year ago these were our heros and saviours, and now they're villains for failing to comply. LOL
This is the top Google result for “fire in a crowded theater”: https://www.theatlantic.com/national/archive/2012/11/its-tim...
With firecodes what they are today, a bomb is a more comparable danger to what a fire was 100 yrs ago, anyway.
Be careful about so willingly giving up your right to self-ownership.
You may not ever get it back.
Apply that to other rights like the right to bear arms. If government couldn’t set standards and people could procure any weapon, how does society function? How does air travel even exist with people owning anti aircraft missiles.
That’s why our founders made our constitution a living document with courts interpreting the constitution and balancing individual rights with our collective rights.
The founders were purposefully vague in several areas of the constitution because they absolutely did want circumstances to determine interpretation, however they were not vague at all about delegated and reserved powers. These things are not "living" in a sense of judicial review.
By "living" document, it was intended that the constitution could be modified by an amendment process. There was never a provision for judicial review.
In fact, then entire concept of judicial review arose from Marbury vs Madison [1] where the court claimed this power.
The purpose of the U.S. Constitution, and one of the things that makes it unique in history, is to limit the powers of the government. The founders believed that individual rights were innate (granted by God), not granted by government and certainly not granted by the federal government.
All powers other than those specifically Delegated to the federal government are reserved for the States - the 10th Amendment makes this clear.
It is not the role of the federal government to decide on "greater good" mandates, those powers are very specifically reserved for the states, who are constrained on what they may do by the Constitution and its amendments.
We, as a country, have allowed the federal government to overstep this in many areas. The DEA, for example, only exists because of a very bad interpretation of the Interstate Commerce Clause, which arose from a bad Supreme Court decision (Wikard vs Filburn)[2] about whether or not you were allowed to grow your own wheat.
> Women have a constitutional right to get an abortion.
Do they? Where is that written?
EDIT: the vague "life, liberty, or property" clause as interpreted by Roe vs Wade. This is such a blank-cheque it may as well not be in the constitution as in hands all power to the interpretation of the courts.
If you read federalist papers or any of the writings of founders on the constitution. The constitution is a living document that is decided by the courts. It is really hard to have a fruitful debate without people having even basic knowledge on this subject.
That’s how you end up with Russia taking over Odessa due to “national security” reasons.
If it’s a living document it’s not worth the paper it’s written on.
> having even basic knowledge on this subject
That's your opinion. People debate in echo chambers all the time, if that's what you'd prefer.
Yes, but at some point there must be a limit to how much power they can delegate. If Congress created a new Super-Congress that it granted all the powers of Congress, I would contend that would be unconstitutional. It clearly goes against the founding principles of having three branches of government. That would be akin to the government creating a fourth branch without amending the constitution.
Amending the constitution is a process that is clearly defined by the constitution. If that process isn't needed to create a fourth branch of government, a change that changes the core of the constitution, what would it ever be needed for and why would they have included it?
If we are going to talk about what's the right answer from a position of "if the court says it that's how it goes" then I can assume you're happy with this court decision?
Still, I'm happy that we're not breaking the rules for the convenience of getting an outcome I'd like better.
People very broadly give power to the CDC that I don't think they have.
Do you know that the two federal mandates were issued by CMS and by OSHA, two completely different organizations from the CDC?
BTW, the law as written gives very broad powers to OSHA and other agencies. This is controversial mainly because one political side in the country is anti vaccine right now.
My point still stands. Vaccine enforcement and mandates was not even considered as under their purview. It's quite hair-splitting to say "there's nothing that says they _can't start enforcing vaccine mandates_."
Even if the law as written allowed it? Since the OSHA act and Social security acts that give OSHA and CMS regulatory authority passed, the USA has never faced a deadly virus pandemic that could be combated with a vaccine.
If Congress specifically wrote the law to allow flexibility for new situations it doesn’t make sense to me to argue that because the situation didn’t arise in the 20th century that the authority and law has lost its power.
What I'm not seeing is engagement with the actual text of the statutes that Congress already wrote and put on the books. For instance, the OSHA Act specifically gave OSHA power to regulate "new hazards".
https://www.govinfo.gov/content/pkg/USCODE-2019-title29/html... "1) The Secretary shall provide, without regard to the requirements of chapter 5 of title 5, for an emergency temporary standard to take immediate effect upon publication in the Federal Register if he determines (A) that employees are exposed to grave danger from exposure to substances or agents determined to be toxic or physically harmful or from new hazards, and (B) that such emergency standard is necessary to protect employees from such danger."
Similarly the Social Security act already gave broad power to issue regulations. https://www.law.cornell.edu/uscode/text/42/1395hh# "such regulations as may be necessary to carry out the administration of the insurance programs under this subchapter" "No rule, requirement, or other statement of policy (other than a national coverage determination) that establishes or changes a substantive legal standard governing the scope of benefits, the payment for services, or the eligibility of individuals, entities, or organizations to furnish or receive services or benefits under this subchapter shall take effect unless it is promulgated by the Secretary by regulation under paragraph (1)."
the Act clearly envisions the secretary having authority to change standards for benefits, payment for services, and eligibility. There's no limitation saying that eligibility criteria can be based on other safety measures, but not vaccines.
EDIT: and SCOTUS precedent interpreting this language in the past was clear about the scope of authority it gave. See page 34 of the PDF here https://drive.google.com/file/d/1dGiMcVAxfziaoecQtd40-nERZr_...
A mandate for vaccinating healthcare seems a lot closer to existing regulations that the law was designed to allow. It’s clearly a health and safety regulation just like the dozens of previous health regulations regulating quarantine, mask wearing, sanitation, safe handling of items, etc.
The reason congress doesn’t reserve this power is because in our system congress can’t react quickly or sometimes at all. It has to pass laws giving up this type of authority to the executive branch because it knows its own processes don’t work quickly or efficiently enough.
Congress did give itself instead the authority to veto regulations it doesn’t like, using the Congressional Review Act. It used to give itself even stronger authority using the one-house legislative veto, but the Supreme Court struck that down. < https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article...>
This is from someone who chose freely to get the vaccine. Even at my own peril I support other’s freedom to choose.
Most of the argument is whether this requirement is in the "employee must wash hands before surgery" category, which is about the patients' right to be safe not the employee's (in theory the patients didn't "choose" to be there).
The people complaining are reacting as if the ruling sounds like "male high school teachers get vasectomies, to keep teenage pregnancies down", because the effects are "permanent, * upto six months" and directly to your body without it being an on-the-job requirement.
The part that makes me leery is that these sort of "are your vaccines upto-date" checklists have always existed, but this time it is controversial (or maybe it was for MMR - but it wasn't news).
this is also the first time where the vaccine industry and the broader public health space have been put under this kind of scrutiny and the combination of politicization, outright lies and deception over masks and policy in both directions and the overall visibility of the sausage making process happens to be occurring alongside a decline of trust in institutional expertise. when most people got their tetanus shots, the faces of the medical profession were not acting as explicitly political agents.
Nearly every common-sense measure implemented during this pandemic has been derided by the right as some sort of unacceptable infringement on individual rights.
Not saying those in power have gotten it all right 100% of the time; I'm especially disappointed with the mask fiasco you mention, but... c'mon. Doctors are not acting as "political agents" in the vast majority of situations that have caused the US's pandemic response to be as lacking as it's been.
It's not common sense if a plurality of people don't agree with it. Denying children in-person schooling for a year wasn't "common sense", cancelling elective procedures like cancer screenings wasn't "common sense", forcing people to wear masks outdoors wasn't "common sense", and so on. Lots of people were denied rights in these cases and would consider those measures unacceptable.
something, something, consequences.
If you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it.
If expect there are certain Catholic organizations who would fire you if you admitted to having had an abortion.
... Which goes to the court ruling that's the topic of the article: Congress has the power to decide these issues.
what about all the WFH people mandated into vaccines? how does it impact that employer?
It significantly reduces the likelihood that you spread it to your coworkers (and, perhaps more importantly, to the old and sick people that healthcare workers tend to serve). https://www.medrxiv.org/content/10.1101/2021.09.28.21264260v...
> what about all the WFH people mandated into vaccines? how does it impact that employer?
Obviously vaccine requirements for remote workers don't make a ton of sense in principle, but in practice I worry that an exemption for remote employees would result in a lot of people getting mis-coded (intentionally or otherwise) as remote and ultimately showing up at work unvaccinated and putting vulnerable people at risk.
To a significant degree.
> what about all the WFH people mandated into vaccines?
This case wasn't about them.
This is, as far as I can see, the most directly analogous situation. Those who support vaccine mandates, how do you feel about this situation? (And note that this was just an "unofficial" employee mandate - there was no government entity involved.)
Also, this is a minor point but illegal abortions are many orders of magnitude more risky than COVID vaccines.
I strongly oppose broad-reaching government-imposed vaccine mandates, but I strongly support a vaccine mandate for healthcare workers specifically. The US government has already taken on the responsibility for setting employment eligibility standards for healthcare workers, and it makes sense for being vaccinated to be one of those criteria.
I think the two situations are comparable in some ways, and not in others. The "have to do something medical in order to keep your job" part is one of the ways it's comparable. The "bodily autonomy" is another. It's different in that it's not a government mandate. It's different in how it affects others.
So: Did you actually want to engage, or did you just want to give a plausible dismissal?
And would you be comfortable having a pediatrician who wasn't inoculated for diphtheria knowing that an infection could be fatal for your baby?
Why not? if the cost & benefit ratio is worth it, maybe we should. The same for any other diseases you can think of. If the answer is yes, then there are no reason for any of us to refuse unless we have good excuses.
Intentionally coughing on someone is a prosecutable crime in many parts of the world --- What do you think makes it a crime?
It is? By Easter right? With what other coronavirus have we ever reached herd immunity?
Does that not include the unborn?
Congress does not delegate lawmaking, Congress delegates the execution of its powers to the Executive branch. This is how the country has functioned since the beginning, for it would be impractical for it to work otherwise.
Say more: delegation will happen at some level, by definition. In military matters, every step or shot a soldier takes is a decision that has been delegated through a chain of command from Congress. Since Congress is not ever going to be in a position to execute every decision for every individual over which Congress has power, Congress inevitably will delegate the execution of its powers. It has always been this way, and will be this way as long as we have a republic.
That's the Constitution, not Congress. Regulation, as well, is not execution. Thomas's concurrence on Whitman v. American Trucking Ass’ns signals where things might go.
This is an opinion that was not widely held for most of the last 100 years or so.
> Thomas's concurrence on Whitman v. American Trucking Ass’ns signals where things might go.
Definitely agree that our legal regime looks headed for major changes. I consider it likely that SCOTUS will reverse itself on a set of major principles, creating uncertainty for citizens and businesses until a new equilibrium is reached.
Most of our other problems are a consequence of that.
They set rules for everything from how many hospitals can be owned by a single entity, to what sorts of qualifications are required for hospital administrators, to what types of medical orders are allowed to be given to patients. Their explicit charter is to ensure Medicare and medicaid patients are cared for and their health is looked after. From that lens, requiring a vaccination that reduces the likelihood that one of those patients is infected with a potentially deadly disease (particularly deadly for those on Medicare, given the demo), is eminently reasonable.
And the administrator is confirmed by congress. If this regulation was about almost anything else, this would be a nothingburger